Renal denervation: a potential new treatment modality for polycystic ovary syndrome?

TLDR

Polycystic ovary syndrome is characterized by sympathetic nervous system activation, insulin resistance, and hypertension, and renal denervation has been shown to reduce sympathetic outflow and lower blood pressure. This study aimed to assess the impact of renal denervation on hemodynamic, metabolic, and renal parameters in two obese PCOS patients with hypertension. Baseline sympathetic activity was measured by microneurography and norepinephrine spillover, insulin sensitivity by euglycemic hyperinsulinemic clamp, and renal function by cystatin‑C, creatinine clearance, and albumin‑creatinine ratio, with all assessments repeated three months after percutaneous endovascular radiofrequency renal denervation. Renal denervation markedly reduced sympathetic nerve activity, modestly lowered blood pressure, improved insulin sensitivity by ~17.5%, and decreased glomerular hyperfiltration and albuminuria, supporting its therapeutic potential in PCOS.

Abstract

Polycystic ovary syndrome (PCOS) is associated with sympathetic nervous system activation, insulin resistance, and blood pressure elevation. Renal nerve ablation has been demonstrated to reduce sympathetic outflow and improve blood pressure control. Here we report on the effects of renal denervation on hemodynamic, metabolic, and renal parameters in two obese PCOS patients with hypertension.Sympathetic nerve activity was assessed at baseline using microneurography and norepinephrine spillover measurements. Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp. Measurements of cystatin-C, creatinine clearance, and urinary albumin-creatinine ratio were also obtained. All measurements were repeated 3 months after bilateral renal denervation achieved via percutaneous endovascular radiofrequency ablation.Muscle sympathetic nerve activity and whole body norepinephrine spillover were substantially elevated at baseline in both patients by approximately 2.5-3-fold. Bilateral renal nerve ablation reduced both indices of sympathetic nerve activity. This was associated with moderate reductions in blood pressure and a substantial improvement in insulin sensitivity by approximately 17.5% in the absence of weight changes at 3-month follow-up. Glomerular hyperfiltration and urinary albumin excretion were also reduced.These findings corroborate the relevance of sympathetic activation in PCOS and suggest that renal denervation exerts beneficial effects not only on blood pressure control but also on insulin sensitivity, renal, and endocrine abnormalities characteristic of PCOS.