Effect of Spironolactone on Adrenal or Ovarian Androgen Production in Overweight Pubertal Girls With Androgen Excess
This study is not yet open for participant recruitment.
Verified June 2012 by University of Virginia
Information provided by (Responsible Party):
Christine Burt Solorzano, University of Virginia
First received: August 22, 2011
Last updated: June 12, 2012
Last verified: June 2012
This study will test whether spironolactone administration can ameliorate androgen (male hormone) overproduction in overweight pubertal girls with androgen excess. The investigators hypothesize that reduction in P450c17alpha overactivity and androgen receptor blockade by 12 weeks of spironolactone administration will improve androgen levels after adrenal stimulation testing with ACTH and ovarian stimulation testing with recombinant human chorionic gonadotropin (r-hCG).
Polycystic Ovary Syndrome
Drug: r-hCG (Ovidrel)
||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Basic Science
||Effect of Spironolactone on Adrenal or Ovarian Androgen Production in Overweight Pubertal Girls With Androgen Excess (CBS006)
Primary Outcome Measures:
- Changes in free testosterone and 17 OH progesterone levels after ACTH and r-hCG administration respectively, before and after spironolactone administration for 12 weeks [ Time Frame: 12 weeks after spironolactone treatment ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- Changes in adrenal and ovarian steroid precursors after ACTH and r-hCG; body composition via air displacement plethysmography, BMI, and glucose tolerance testing results; baseline and after 12 weeks of spironolactone administration [ Time Frame: 12 weeks after spironolactone administration ] [ Designated as safety issue: No ]
Experimental: spironolactone, dexamethasone, Cosyntropin (ACTH), and r-hCG
12 weeks spironolactone, Dexamethasone and ACTH to perform standardized adrenal stimulation testing, dexamethasone and r-hCG to perform standardized ovarian stimulation testing
50-100 mg PO BID (X 12 weeks)
1 mg PO twice
250 micrograms IV twice
Drug: r-hCG (Ovidrel)
25 mcg IV twice
|Ages Eligible for Study:
||7 Years to 18 Years
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
- overweight(>85th BMI%) females
- Early to late puberty (expected age range 7-18)
- Hyperandrogenemic (free testosterone greater than 2.5 standard deviations above the mean for normal control subjects of the same Tanner Stage)
- Screening labs within age-appropriate normal range, with the exception of a mildly low hematocrit (see below) and the hormonal abnormalities inherent in obesity which could include mildly elevated LH, lipids, testosterone, prolactin, DHEAS, E2, glucose, and insulin and decreased FSH and/or SHBG
- Age < 7 or > 18 years
- Inability to comprehend what will be done during the study or why it will be done
- BMI-for-age < 5th percentile
- Positive pregnancy test or lactation.
- Abnormal laboratory studies will be confirmed by repeat testing to exclude laboratory error.
- Morning cortisol < 3 µg/dL or history of Cushing syndrome or adrenal insufficiency
- History of congenital adrenal hyperplasia or 17-hydroxyprogesterone > 300 ng/dL, which suggests the possibility of congenital adrenal hyperplasia (if postmenarcheal, the 17-hydroxyprogesterone will be collected during the follicular phase, or ≥ 40 days since last menses if oligomenorrheic). NOTE: If a 17-hydroxyprogesterone >300 mg/dL is confirmed on repeat testing, an ACTH-stimulated 17-hydroxyprogesterone <1000 ng/dL will be required for study participation.
- Total testosterone > 150 ng/dL, which suggests the possibility of a virilizing neoplasm
- DHEAS greater than the upper limit of age-appropriate normal range (mild elevations may be seen in PCOS and adolescent HA, and elevations < 1.5 times the age-appropriate upper limit of normal will be accepted in these groups)
- Previous diagnosis of diabetes, fasting glucose ≥126 mg/dL, or a hemoglobin A1c ≥6.5%
- Abnormal thyroid stimulating hormone (TSH) for age. Subjects with stable and adequately treated hypothyroidism, reflected by normal TSH values, will not be excluded.
- Abnormal prolactin. Mild elevations may be seen in overweight girls, and elevations <1.5 times the upper limit of normal will be accepted in this group.
- Persistent hematocrit <36% and hemoglobin <12 g/dL. Subjects with a mildly low hematocrit (33-36%) will be asked to take iron in the form of ferrous gluconate for up to 60 days. Subjects weighing ≤ 36 kg will take one 300-325 mg tablet oral ferrous gluconate daily (containing 36 mg elemental iron);subjects weighing >36 kg will take two 300-325 mg tablets oral ferrous gluconate daily (containing 36 mg elemental iron each). They will return to the CRC after 30-60 days of iron therapy to have their hemoglobin or hematocrit rechecked and will proceed with the remainder of the study if it is ≥12 g/dL or ≥36%, respectively.
- Persistent liver test abnormalities, with the exception that mild bilirubin elevations will be accepted in the setting of known Gilbert's syndrome. Mild elevations may be seen in overweight girls, so elevations <1.5 times the upper limit of normal will be accepted in this group.
- Significant history of cardiac or pulmonary dysfunction (e.g., known or suspected congestive heart failure; asthma requiring intermittent systemic corticosteroids; etc.)
- Abnormal sodium, potassium, or bicarbonate concentrations, or elevated creatinine concentration (confirmed on repeat)
- No medications known to affect the reproductive system or glucose metabolism can be taken in the 3 months prior to the study. Such medications include oral contraceptive pills, progestins, metformin, glucocorticoids, and psychotropics.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01422759
|University of Virginia Center for Research in Reproduction
|Charlottesville, Virginia, United States, 22908 |
|Contact: Michelle Y. Abshire, PhD 434-243-6911 firstname.lastname@example.org |
|Principal Investigator: Christine Burt Solorzano, MD |
|Sub-Investigator: John C. Marshall, MD, PhD |
University of Virginia
||Christine Burt Solorzano, MD
||University of Virginia
No publications provided
||Christine Burt Solorzano, Assistant Professor of Pediatrics, University of Virginia
History of Changes
|Other Study ID Numbers:
|Study First Received:
||August 22, 2011
||June 12, 2012
||United States: Institutional Review Board
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on May 23, 2013
Polycystic Ovary Syndrome
Signs and Symptoms
Genital Diseases, Female
Endocrine System Diseases
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs