Treatment of Congenital Adrenal Hyperplasia by ReducingInsulin Resistance and Cysticercosis Induced Polycystic Ovarian Syndrome

Abstract

Among the most common causes of female infertility, anovulation, menstrual irregularity, hirsutism, acne, and alopecia are congenital adrenal hyperplasia (CAH) and polycystic ovarian syndrome (PCOS). These two conditions resemble one another quite a bit, especially the nonclassic forms of CAH (NCAH). Another common cause of such problems is hyperprolactinemia, which results in increased androgen synthesis by both the ovaries and the adrenal cortex, while suppressing gonadotrophin-releasing hormone, gonadotrophin, and estrogen synthesis. Hyperprolactinemia, in turn, may be caused by primary hypothyroidism, prolactinomas, stalk effects of other pituitary and hypothalamic neoplasia, as well as a host of prescription and recreational drugs; it may also be idiopathic. Other, less frequently encountered causes of these problems include Cushing's syndrome and virilizing tumors (ovarian, adrenal, or ectopic). A growing worldwide problem in this sphere is androgen doping to improve athletic performance. Additional causes of menstrual irregularity include uterine leiomyomata, puberty, perimenopause, chronic illnesses eg. poorly controlled diabetes mellitus and sickle cell disease, elite athletics and dancing, eating disorders, endometriosis, and Asherman's syndrome. Infertility may also be caused by stress, tubal factors, Asherman's syndrome, immune response to spermatozoa, luteal phase inadequacy, and male factors. In this chapter we shall focus on 3 novel concepts: • The treatment of the congenital adrenal hyperplasias and the acquired/unmasked adrenal hyperplasias by interventions which reduce insulin resistance.

Association of Vitamin D Repletion with Normalization of Elevated Serum 17-OH-Progesterone

“…Vitamin D repletion in patients who are vitamin D-deficient/insufficient mitigates insulin-resistanceassociated disorders such as T2DM, PCOS, and NCAH [1,2,4]; however, the present report is the first report of the amelioration of elevated serum 17-OHP during vitamin D repletion in a patient with likely NCAH.…”

“…As mentioned earlier, in our patient population, which may not be representative of the general world population, T2DM is reason enough to screen for NCAH [3][4][5].…”

“…Serum 25-OH-vitamin D levels have been reported to be lower than in the general population in many conditions associated with insulin resistance, including: obesity, T2DM, PCOS, and both classic and non-classic congenital adrenal hyperplasia [1][2][3][4]. Vitamin D receptors are abundant in the adrenal cortex [6], suggesting a possible direct regulatory role for vitamin D in the biosynthesis of adrenal steroids.…”

“…The Endocrine service was asked to see him to improve glycaemic control. Serum vitamin D level was performed per routine, as most of our in-patients are found to have hypovitaminosis D, and screening for non-classic adrenal hyperplasia (NCAH) was performed because he had T2DM, which we have previously reported to frequently be associated with NCAH [3][4][5].…”

“…We have previously reported that diverse interventions that reduce insulin resistance and hyperinsulinemia ameliorate non-classic adrenal hyperplasia (NCAH), biochemically and phenotypically, much as such interventions ameliorate polycystic ovarian syndrome (PCOS) [3,4].…”