Low Dose Growth Hormone in Obese PCOS Women

The study will be a double-blinded cross-over study. Thirty subjects will be screened for eligibility initially, and the first 12 eligible subjects will be enrolled. Six subjects will be randomized to receive the low GH dose (0.1 mg/day) treatment and 6 subjects to receive Placebo treatment for 12 weeks, exchanging their treatment for a further 12 weeks after a 4-week washout period. The study drugs will be stored at the Oregon Health and Science University (OHSU) Research Pharmacy and following randomization, the subjects will be taught by our Endocrine Nurses to self-administer the subcutaneous GH and Placebo injections using Nutropin/Placebo vials and insulin syringes into the abdomen at 2200h. Randomization for treatment assignment will be performed by an investigator not directly involved in the patients' recruitment, treatment and follow-up care. The randomization process will be performed by computerized pre-assigned random codes by blocks, stratified by age and examined for possible differences in body mass index. During their in-patient stay at the Oregon Clinical and Translational Research Institute (OCTRI) at OHSU, subjects will only be allowed to eat the food provided to them by the OCTRI.

Initial Screening Assessment (outpatient)

The following assessments will be performed:

• Written informed consent
• Demographics (demographic information including the subject's birth date, and race)
• Physical exam and medical history
• Previous/significant medical history
• Concomitant medication review
• Vital signs, e.g., pulse and blood pressure measurements
• Height and weight
• Laboratory findings, e.g. CBC, electrolytes, and fasting glucose levels
• Visit 1, Baseline Assessment for the First Treatment Phase (in-patient)

The following is a description of the assessments that will be performed after consent is obtained:

• Physical exam and medical history
• Vital signs, e.g., pulse and blood pressure measurements
• Height and weight
• Waist circumference measurement
• Concomitant medication review
• Urine pregnancy test
• Fasting blood assessments, e.g., hemoglobin, glucose, insulin, C-peptide, serum total and free IGF-I, IGFBP-3, C-reactive protein, non-esterified fatty acids (NEFAs), testosterone, albumin, sex hormone binding globulin and androstenedione
• A 3-hour one-step hyperinsulinemic euglycemic clamp
• MRS and DEXA scans
• Cortisol clearance rate assessments
• Fat biopsy
• Randomization to GH or Placebo
• Teach GH or Placebo self-administration
• Visit 2, Final Assessment for the First Treatment Phase (Week 12 +/- 1 week) (outpatient)

The following is a description of the assessments that will be performed at the end of the first treatment phase with either GH or Placebo. Subjects will also be monitored for safety with the collection of the following:

• Physical exam and medical history
• Vital signs, e.g. pulse and blood pressure measurements
• Height and weight
• Waist circumference measurement
• Concomitant medication review
• Adverse event recording
• Urine pregnancy test
• Fasting blood assessments, e.g. hemoglobin, glucose, insulin, C-peptide, serum total and free IGF-I, IGFBP-3, C-reactive protein, adiponectin, ghrelin, non-esterified fatty acids (NEFAs), testosterone, albumin, sex hormone binding globulin and androstenedione
• A 3-hour one-step hyperinsulinemic euglycemic clamp
• MRS and DEXA scans
• Cortisol clearance rate assessments
• Fat biopsy

Washout Period and Crossover After the first treatment phase with GH or Placebo, the subjects will have a 4-week washout period and the treatment will be crossed over for another 12-week treatment phase with either GH or Placebo. During this time, the subjects will be advised to maintain a stable diet and weight.

Visit 3, Baseline Assessment for the Second Treatment Phase (Week 16 +/- 1 week) (as outpatient)

The following is a description of the assessments that will be performed:

• Physical exam and medical history
• Vital signs, e.g., pulse and blood pressure measurements
• Height and weight
• Waist circumference measurement
• Concomitant medication review
• Adverse event recording
• Urine pregnancy test
• Fasting blood assessments, e.g. hemoglobin, glucose, insulin, C-peptide, serum total and free IGF-I, IGFBP-3, C-reactive protein, adiponectin, ghrelin, non-esterified fatty acids (NEFAs), testosterone, albumin, sex hormone binding globulin and androstenedione
• Treatment exchanged to Placebo or GH
• Visit 4, Final Assessment for the Second Treatment Phase (Week 28 +/- 1 week) (as inpatient)

The following is a description of the assessments that will be performed at the end of the second treatment phase with either GH or Placebo. Subjects will also be monitored for safety with the collection of the following:

• Physical exam and medical history
• Vital signs, e.g. pulse and blood pressure measurements
• Height and weight
• Waist circumference measurement
• Concomitant medication review
• Adverse event recording
• Urine pregnancy test
• Fasting blood assessments, e.g., hemoglobin, glucose, insulin, C-peptide, serum total and free IGF-I, IGFBP-3, C-reactive protein, adiponectin, ghrelin, non-esterified fatty acids (NEFAs), testosterone, albumin, sex hormone binding globulin and androstenedione
• A 3-hour one-step hyperinsulinemic euglycemic clamp
• MRS and DEXA scans
• Cortisol clearance rate assessments
• Fat biopsy
• Because of the potentially long duration of Visits 1, 2 and 4, the studies can either be divided into two separate admissions upon prior arrangement or can be done all at once with one admission, depending on the subject's wishes and schedule.