Effect of Metformin on Sensitivity of the GnRH Pulse Generator to Suppression by Estradiol and Progesterone
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Ovarian Cancer, Women's Studies, Endocrine |
| Therapuetic Areas: | Endocrinology, Oncology, Reproductive |
| Healthy: | No |
| Age Range: | 10 - 17 |
| Updated: | 11/30/2018 |
| Start Date: | July 22, 2008 |
| End Date: | December 2019 |
Effect of Metformin on Sensitivity of the GnRH Pulse Generator to Suppression by Estradiol and Progesterone in Hyperandrogenemic Adolescent Girls (JCM025)
Many, but not all, girls with high levels of the male hormone testosterone go on to develop
polycystic ovary syndrome (PCOS) as adults. Women with PCOS often have irregular menstrual
periods, excess facial and body hair, and weight gain. PCOS is also a leading cause of
difficulty becoming pregnant. The investigators do not understand why some girls with high
hormones develop PCOS and others do not. In a previous study by our group, some girls with
high levels of male hormones had abnormalities in the secretion of another hormone, called
luteinizing hormone (LH), that are often seen in women with PCOS. However, another group had
normal LH secretion. The girls with the abnormal LH secretion had higher levels of another
hormone, called insulin, than the girls with normal LH secretion. The investigators will test
whether metformin, an insulin-sensitizing agent, changes the effects of high male hormone
levels in adolescent girls, specifically by looking at their LH secretion response following
metformin treatment.
polycystic ovary syndrome (PCOS) as adults. Women with PCOS often have irregular menstrual
periods, excess facial and body hair, and weight gain. PCOS is also a leading cause of
difficulty becoming pregnant. The investigators do not understand why some girls with high
hormones develop PCOS and others do not. In a previous study by our group, some girls with
high levels of male hormones had abnormalities in the secretion of another hormone, called
luteinizing hormone (LH), that are often seen in women with PCOS. However, another group had
normal LH secretion. The girls with the abnormal LH secretion had higher levels of another
hormone, called insulin, than the girls with normal LH secretion. The investigators will test
whether metformin, an insulin-sensitizing agent, changes the effects of high male hormone
levels in adolescent girls, specifically by looking at their LH secretion response following
metformin treatment.
A better understanding of the factors that make adolescent girls more or less susceptible to
the adverse neuroendocrine effects of elevated androgens will hopefully lead to improved
prevention and treatment strategies for PCOS. In this study, we propose to explore the role
of hyperinsulinemia on neuroendocrine function in hyperandrogenic adolescent girls by
assessing the effect of the insulin sensitizer Metformin on hypothalamic progesterone
sensitivity. Other differences between the progesterone sensitive and progesterone
insensitive subgroups, including racial and ethnic differences between the two populations
and a trend towards older gynecologic age in the progesterone insensitive population, are
being pursued through other ongoing studies (IRB-HSR# 8588 and 12160).
the adverse neuroendocrine effects of elevated androgens will hopefully lead to improved
prevention and treatment strategies for PCOS. In this study, we propose to explore the role
of hyperinsulinemia on neuroendocrine function in hyperandrogenic adolescent girls by
assessing the effect of the insulin sensitizer Metformin on hypothalamic progesterone
sensitivity. Other differences between the progesterone sensitive and progesterone
insensitive subgroups, including racial and ethnic differences between the two populations
and a trend towards older gynecologic age in the progesterone insensitive population, are
being pursued through other ongoing studies (IRB-HSR# 8588 and 12160).
Inclusion Criteria:
- Girls ages 10 to 17
- Hyperandrogenemic (free testosterone greater than 2.5 standard deviations above the
mean for normal control subjects of the same Tanner Stage)
- Creatinine clearance > 90 ml/min as calculated by the Cockcroft-Gault equation
- Hemoglobin > 12 mg/dL or Hematocrit > 36%
- Normal screening labs (with exception of the expected hormonal abnormalities inherent
in hyperandrogenemia)
- Sexually active subjects must agree to abstain or use double barrier contraception
during the study
- Subjects must agree not to take any other medications during the course of the study
without approval by the study investigators.
Exclusion Criteria:
- Abnormal screening labs (with the exception of the expected hormonal abnormalities
inherent in hyperandrogenemia)
- Creatinine clearance less than 90 ml/min as calculated by Cockcroft-Gault equation
- Hemoglobin <12 mg/dL or hematocrit < 36%
- Abnormal liver function tests, including Aspartate Aminotransferase (AST), Alanine
Aminotransferase (ALT), Bilirubin, Albumin, and Alkaline Phosphatase
- Weight < 34 kg
- History of renal dysfunction, liver dysfunction, congestive heart failure, deep venous
thrombosis, breast cancer, endometrial cancer, or cervical cancer
- Pregnant or breast feeding
- On medications known to affect the reproductive axis within 3 months of the study
(including oral contraceptive pills, metformin, and spironolactone)
- Are currently participating in another study or have been in one in the last 30 days.
- Subjects using restricted medication (see restrictions below) are excluded unless the
subject's primary care provider approves stopping the medication.
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