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Pioglitazone improves insulin resistance and decreases blood pressure in adult patients with congenital adrenal hyperplasia.

Author(s): Kroese JM, Mooij C, van der Graaf M, Hermus A, Tack C

Affiliation(s): J Kroese, endo, radboud, nijmegen, Netherlands.

Publication date & source: 2009-09-15, Eur J Endocrinol., [Epub ahead of print]

Context: Patients with congenital adrenal hyperplasia (CAH) are chronically treated with supraphysiological doses of glucocorticoids, which are known to induce insulin resistance. Thiazolidinediones might reverse this effect and improve insulin sensitivity. Objectives: To assess insulin sensitivity in CAH patients and the effect of pioglitazone treatment on insulin sensitivity in CAH patients. Secondary objectives were effects of treatment with pioglitazone on blood pressure, body fat distribution, lipid and steroid profiles. Design: Randomized placebo controlled cross-over trial Participants: 12 CAH-patients and 12 body mass and age matched control subjects. Intervention: 16 week treatment with pioglitazone (45 mg every day) or placebo. Main outcome measure: Insulin sensitivity measured by euglycemic clamp and oral glucose tolerance test (OGTT). Furthermore, 24-hour blood pressure profiles, body fat distribution measured by MRI, DEXA and Bio Impedence procedures, liver fat by MRS, lipid and steroid profiles. Results: CAH patients were insulin resistant compared to healthy controls. Treatment with pioglitazone significantly improved insulin sensitivity in CAH patients (GIR from 28.5 +/- 11.6 to 38.9 +/- 11.0 micromol/kg/min, P=0.000, GIR in controls 46.2 +/- 23.4 micromol/kg/min, P<0.05 vs CAH). Treatment with pioglitazone decreased blood pressure (systolic: 124.0 +/- 13.6 mmHg vs. 127.0 +/- 14.9 mmHg, P<0.001, diastolic: 72.8 +/- 11.5 mmHg vs. 77.4 +/- 12.6 mmHg, P<0.001). No changes in body fat distribution, lipid and steroid profiles were observed. Conclusions: CAH patients are insulin resistant compared to matched control subjects. Treatment with pioglitazone improves insulin sensitivity and decreases blood pressure in CAH patients.

Page last updated: 2009-10-20

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