MON-369 Treatment of Nonclassic 11-Hydroxylase Deficiency with "Hair, Skin, and Nails," an Over-the-Counter, Insulin Sensitizing Vitamin/Mineral Supplement

Background: Insulin Resistance (IR) is seen in classic (CAH) and non-classic congenital adrenal hyperplasia (NCAH). We previously reported amelioration of biochemical/clinical features in patients with NCAH and Type 2 Diabetes Mellitus (T2DM) or prediabetes using insulin sensitizers (IS) metformin and/or thiazolidinediones. Regrettably, these medications can have undesirable side effects e.g. GI intolerance and peripheral edema, respectively. It would be useful to explore alternative treatments that might function as IS, perhaps with fewer side effects. A few studies suggest that biotin might be an IS. Pre-clinical studies showed improvement of IR with biotin use in biotin deficient rats, and human trials revealed improved fasting glucose and insulin levels after biotin use in diabetics. These outcomes suggest that biotin might be an IS and a possible treatment for T2DM, CAH, NCAH, and PCOS where IR prevails. Clinical Case: Our patient is a 62 year old Afro-Caribbean female with a past history of autoimmune thyroid disease, vitamin D deficiency, prediabetes, and central adiposity (BMI=31.96kg/m²) who complained of recent onset hair loss in a male-pattern. Investigation revealed that she had non-classic 11-hydroxylase deficiency. To treat her alopecia and reduce her risk of developing T2DM, we prescribed lifestyle changes and metformin 500mg daily, which she discontinued after two doses due to GI intolerance. She took a hair, skin & nails supplement once daily for 114 days containing beta carotene 2500 IU, vitamin C 100mg, biotin 2500 mcg, zinc oxide 11mg, and copper oxide 0.9mg. Following this, her serum 11-deoxycortisol levels (11-DOC) fell from 80ng/dl (<37) [2.16xULN] to < 20 ng/dl, with reduction of scalp hair loss. Hemoglobin A1c during this period fell from 5.7% to 5.3%. Conclusion: Improvement of this patient’s 11-DOC and HbA1c levels with use of this product, has led us to explore the role of its components as IS. Biotin, beta-carotene, vitamin C, zinc, and copper, all contained in this preparation, are reported to have IS properties. Biotin regulates insulin receptor transcription and improves beta cell function. Zinc improves alopecia, hirsutism, and plasma malondialdehyde levels; however it did not affect other key parameters in women with PCOS, although a trend toward reduction in CRP level was seen. We conclude that this preparation may be an effective treatment for non-classic 11-hydroxylase deficiency, and suggest that it may ultimately be used in treating other IR conditions e.g. NCAH, CAH, PCOS, non-alcoholic fatty liver disease, T2DM and prediabetes, if our results are corroborated in larger studies.