Spironolactone in the treatment of polycystic ovary syndrome: Effects on clinical features, insulin sensitivity and lipid profile

Zulian, E.; Sartorato, Paola; Benedini, Stefano; Baro, Geeta; Armanini, Decio; Mantero, Franco; Scaroni, Carla

doi:10.1007/bf03345529

Cited by 78 publications

(57 citation statements)

References 21 publications

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“…The therapy was associated with a significant decline of mean high-density lipoprotein (HDL), 39. CI 4.4, 5.6) vs. 6.4 (95% CI 5.7,7.1) (P < 0.05). No significant change was noted in total cholesterol, triglyceride or fasting blood glucose levels.…”

Section: Resultsmentioning

confidence: 89%

Short term effects of spironolactone on blood lipid profile: a 3‐month study on a cohort of young women with hirsutism

Nakhjavani

Hamidi

Esteghamati

et al. 2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Spironolactone is known to have antiandrogenic features and agonist activity at progesterone receptors, which are responsible for several of its hormonal side-effects.• The potential unfavourable influences of this medication on serum lipoproteins have long been a concern but literature lacks sufficient data on this issue. WHAT THIS STUDY ADDS• Spironolactone can adversely affect serum lipids by decreasing high-density lipoprotein and increasing low-density lipoprotein in women treated for hirsutism on a short-term basis. AIMSTo investigate the effects of spironolactone on serum lipids in women with hirsutism over a 3-month period. METHODSIn a prospective setting, 27 hirsute women (20 with polycystic ovary syndrome and seven with idiopathic hirsutism) with a mean age of 23.0 Ϯ 5.1 years were studied at baseline and 3 months after receiving a daily dose of 100 mg of spironolactone. Patients did not receive any other medications and did not go through a specific diet during the study. Lipid profile, fasting blood glucose, testosterone, dehydroepiandrosterone sulphate (DHEAS) and prolactin (PRL) were measured at baseline and 3 months after therapy. RESULTSMean body mass index of patients was 26.1 Ϯ 5.1 kg m -2 before treatment and 25.9 Ϯ 5.7 kg m -2 after treatment (NS). The therapy was associated with a significant decline of mean high-density lipoprotein (HDL), 39. CI 4.4, 5.6) vs. 6.4 (95% CI 5.7,7.1) (P < 0.05). No significant change was noted in total cholesterol, triglyceride or fasting blood glucose levels. Serum values of testosterone, DHEAS and PRL decreased significantly after 3 months of therapy (P < 0.05). CONCLUSIONSSpironolactone might have adverse effects on serum lipoprotein levels by increasing LDL and decreasing HDL over a short course of treatment. While treating hirsutism with spironolactone, special care should be given to women with metabolic disorders such as dyslipidaemia.

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Section: Resultsmentioning

confidence: 89%

Short term effects of spironolactone on blood lipid profile: a 3‐month study on a cohort of young women with hirsutism

Nakhjavani

Hamidi

Esteghamati

et al. 2009

Brit J Clinical Pharma

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“…29 Similarly, a 12-month spironolactone (100 mg/day) administration significantly decreased insulin and HOMA-IR in overweight women with PCOS. 30 The effect of spironolactone on serum glucose and lipids in women with PCOS is controversial. In one of the above-mentioned studies, 29 spironolactone plus ethinyl estradiol/cyproterone significantly decreased serum LDL and total cholesterol, but had no effect on HDL and triglycerides.…”

Section: Discussionmentioning

confidence: 99%

Effect of spironolactone and vitamin E on serum metabolic parameters and insulin resistance in patients with nonalcoholic fatty liver disease

Polyzos

Zafeiriadou

Patsiaoura

et al. 2011

J Renin Angiotensin Aldosterone Syst

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Aim:The renin-angiotensin-aldosterone system has been implicated in the pathogenesis of insulin resistance and nonalcoholic fatty liver disease (NAFLD). The beneficial effect of spironolactone in a mouse model with diabetes and NAFLD has recently been reported. The main aim was assessment of the effect of spironolactone on serum metabolic parameters and insulin resistance in patients with NAFLD. Methods: This study includes preliminary results of a single-centre randomised controlled trial of treatment with vitamin E (group 1, 10 patients) versus spironolactone plus vitamin E (group 2, 10 patients) in biopsy-proven NAFLD. Serum transaminases, lipids, potassium, sodium, glucose and insulin were measured, and homeostatic model assessment-insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) were calculated before and 8 weeks after baseline assessment. Results: Insulin was decreased within group 2 (15.3 ± 2.7 at baseline vs. 10.3 ± 5.0 at week 8, p = 0.013). Although no difference in glucose was observed, HOMA-IR significantly decreased (4.4 ± 0.9 vs. 2.8 ± 0.5, respectively, p = 0.047). QUICKI was increased, but not statistically significantly. Conclusions: Spironolactone and vitamin E combined therapy seems to exhibit a favourable effect on serum insulin and HOMA-IR in patients with NAFLD. If validated in a large-scale clinical trial, it may prove an inexpensive therapeutic approach for the management of NAFLD patients.

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“…Spironolactone is a potent anti-androgen that can be used in conjunction with COC or metformin. Spironolactone can improve menstrual irregularities and cutaneous manifestations of hyperandrogenism, but it does not improve metabolic abnormalities (48,49). Ganie and colleagues found that combination metformin and spironolactone was superior to either drug alone in improving menstrual irregularity, hirsutism, serum androgen levels, and insulin resistance (50).…”

Section: Management Considerationsmentioning

confidence: 99%

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

Kamboj

Bonny

2017

Transl. Pediatr

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Controversy continues about the underlying etiopathogenesis, diagnostic criteria, and recommendations for polycystic ovary syndrome (PCOS) in adolescents. Recent literature has recognized these deficiencies and evidence based expert recommendations have become more available. The purpose of this chapter is to offer primary care providers a practical understanding and approach to the diagnosis and treatment of PCOS in adolescents. Although the presence of polycystic ovary morphology (PCOM) is included as a key diagnostic criterion of PCOS in adults, it is currently not recommended for the diagnosis in adolescents. As such, the diagnosis of PCOS in adolescents currently hinges on evidence of ovulatory dysfunction and androgen excess. Recommended evidence of ovulatory dysfunction includes: consecutive menstrual intervals >90 days even in the first year after menstrual onset; menstrual intervals persistently <21 or >45 days 2 or more years after menarche; and lack of menses by 15 years or 2-3 years after breast budding. Recommended evidence of androgen excess include: moderate to severe hirsutism; persistent acne unresponsive to topical therapy; and persistent elevation of serum total and/or free testosterone level. Importantly, a definitive diagnosis of PCOS is not needed to initiate treatment. Treatment may decrease risk of future comorbidity even in the absence of a definitive diagnosis. Deferring diagnosis, while providing symptom treatment and regular/ frequent follow-up of symptomology, is a recommended option.The treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. Goals of treatment are to improve quality of life and long-term health outcomes. Lifestyle modifications remain first-line management of overweight and obese adolescents with PCOS. Combined oral contraceptives (COC) are first line pharmacotherapy for management of menstrual irregularity and acne, and metformin is superior to COCs for weight reduction and improved dysglycemia. COCs and metformin have similar effects on hirsutism, but often need to be paired with other treatment modalities to achieve further improvement of cutaneous symptoms. Clinicians should be cognizant that PCOS is associated with significant metabolic and psychological comorbidity and screen for these issues appropriately.

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Spironolactone in the treatment of polycystic ovary syndrome: Effects on clinical features, insulin sensitivity and lipid profile

Cited by 78 publications

References 21 publications

Short term effects of spironolactone on blood lipid profile: a 3‐month study on a cohort of young women with hirsutism

Short term effects of spironolactone on blood lipid profile: a 3‐month study on a cohort of young women with hirsutism

Effect of spironolactone and vitamin E on serum metabolic parameters and insulin resistance in patients with nonalcoholic fatty liver disease

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

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