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Ketoconazole Reverses Hyperandrogenism in a Patient with Insulin Resistance and Acanthosis Nigricans^*

Department of Medicine, Long Island Jewish Medical Center New Hyde Park, New York 11042
Department of Medicine, the Brookdale Hospital Medical Center Brooklyn, New York 11212
Department of Medicine, Beth Israel Medical Center New York, New York 10003
Department of Medicine, Mt. Sinai Medical Center New York, New York 10024

Address all correspondence and requests for reprints to: Gary M. Pepper, M.D., Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11042.

We administered ketoconazole to a young woman with ovarian hyperandrogenism, insulin resistance, and acanthosis nigricans. While taking ketoconazole, her serum testosterone, androstenedione, dehydroepiandrosterone, and cortisol levels declined, while serum progesterone, 17-hydroxyprogesterone, and 11-deoxycortisol rose. Serum LH, FSH, and estradiol levels were intermittently higher during ketoconazole treatment, although LH and FSH responsiveness to GnRH did not change. Basal and stimulated serum insulin concentrations were high before and during ketoconazole therapy, while fasting glucose levels and glucose disappearance rate constants were normal throughout the study. A dramatic improvement in hirsutism occurred, and menses resumed after a 6-yr hiatus. Adverse drug effects or clinical evidence of adrenal insufficiency were not encountered. These results support a role for ketoconazole in the therapy of ovarian hyperandrogenism.

^* This work was supported in part by NIH Grant HD-227381 (to L.P.).

Received February 9, 1987.

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