Pregnancy after treatment with the insulin-sensitizing agent troglitazone in an obese woman with the hyperandrogenic, insulin-resistant acanthosis nigricans syndrome

Objective: To report a case of unassisted pregnancy after 5 months of trogl itazone treatment in a severely hyperandrogenic, insulin-resistant woman wi th acanthosis nigricans (HAIR-AN) previously managed with depot leuprolide acetate (LA) plus oral contraceptive and dexamethasone therapy. Design: Case report. Setting: Private infertility clinic. Patient(s): A 28-year-old African-American woman with excessive obesity (bo dy mass index = 42 kg/m(2)) and HAIR-AN syndrome. Intervention(s): Androgen suppression with depot LA plus oral contraceptive and dexamethasone therapy, troglitazone treatment resulting in normalizati on of fasting insulin and testosterone, spontaneous menses, and an unassist ed pregnancy. Main Outcome Measure(s): Luteinizing hormone and testosterone concentration s, fasting insulin and glucose levels, insulin-glucose ratios, hCG levels, and ultrasound examinations. Result(s): Spontaneous menses followed by an intrauterine pregnancy after 5 months of treatment with troglitazone, an insulin-sensitizing agent, in a woman with severe HAIR-AN syndrome whose hyperandrogenism previously could be normalized only with depot LA plus oral contraceptive therapy and dexame thasone. Conclusion(s): Troglitazone treatment resulted in attenuation of both hyper insulinemia and hyperandrogenism in an obese woman with HAIR-AN and resulte d in resumption of menses and a spontaneous pregnancy. (C) 1999 by American Society for Reproductive Medicine.