Effect of Spironolactone on Adrenal or Ovarian Androgen Production in Overweight Pubertal Girls With Androgen Excess
Effect of Spironolactone on Adrenal or Ovarian Androgen Production in Overweight Pubertal Girls With Androgen Excess
Whether 12 weeks of spironolactone can reduce androgen production from ovaries and adrenal
 glands of girls with obesity and androgen excess
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 adrenocorticotropic hormone (ACTH) and ovarian stimulation testing with
 recombinant human chorionic gonadotropin (rhCG).
Inclusion Criteria:

 -  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 luteinizing hormone (LH), lipids, testosterone, prolactin,
 DHEAS, E2, glucose, and insulin; and decreased follicle-stimulating hormone (FSH)
 and/or sex hormone-binding globulin (SHBG)

 Exclusion Criteria:

 -  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 Polycystic Ovary Syndrome (PCOS) and adolescent Hyperandrogenemia (HA),
 and elevations < 1.5 times the age-appropriate upper limit of normal will be accepted
 in these groups)

 -  Virilization

 -  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 Clinical Research Unit (CRU) 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.