Normalization of hyperinsulinemia by chronic opioid receptor blockade in hyperandrogenemic women

ObjectiveEvaluation of the effects of naltrexone on hyperinsulinemia and hyperandrogenemia in hyperandrogenemic, hyperinsulinemic women.DesignControlled clinical study.SettingDepartment of Gynecologic Endocrinology and Reproductive Medicine, Center of Obstetrics and Gynecology, Medical University of Innsbruck, Austria.Patient(s)Thirty-nine hyperandrogenemic, hyperinsulinemic women were studied.Intervention(s)Women were treated with naltrexone (50 mg/d) for ≥3 weeks.Main Outcome Measure(s)Body mass index (BMI), gonadotropin (LH, FSH) and androgen (T, free T, DHEAS) levels, and plasma levels of glucose, insulin, and C-peptide, during a standard 75-g oral glucose tolerance test (OGTT), were determined before and during chronic opiate receptor blockade.Result(s)The BMI did not change during therapy. When OGTT was repeated after treatment with naltrexone, glucose levels were not different from those before treatment. Insulin response, however, had dramatically declined. We also observed a significant decrease in the levels of serum androgens.Conclusion(s)Hyperinsulinemia associated with hyperandrogenemia can be improved or completely abolished by chronic opiate receptor blockade. This observation suggests that endogenous opiates play a critical role in the process leading to hyperinsulinemia in hyperandrogenemia.