Insulin, androgens, and obesity in women with and without polycystic ovary syndrome: a heterogeneous group of disorders

Department of Obstetrics and Gynecology, School of Medicine, Miguel Hernández University, Alicante, Spain.
Fertility and Sterility (Impact Factor: 4.3). 08/1999; 72(1):32-40. DOI: 10.1016/S0015-0282(99)00184-3
Source: PubMed

ABSTRACT To analyze the correlations among insulin, androgens, body mass index (BMI), and other related metabolic anomalies in women with and without polycystic ovary syndrome (PCOS).
Retrospective study of normal and obese women with and without PCOS.
Gynecologic endocrinology units of Elche, San Juan, and Alicante Hospitals and Hormone Laboratory at Alicante University Hospital ("Miguel Hernández" University).
A total of 212 women were studied: 137 with PCOS and 75 without PCOS.
BMI, gonadotropins, insulin, androgens (T, androstenedione, DHEAS), 17alpha-hydroxyprogesterone, sex hormone-binding globulin, and triglycerides were studied. Glycemia and insulin response to the tolerance test (GTT) with a 100-g oral glucose load were also assessed in 103 women.
A good correlation between insulin and BMI was found in normal and obese women without hormonal dysfunction and in patients with or without PCOS. Good correlations, although lower, between insulin and T, and BMI, insulin, and T with triglycerides were also found in patients with PCOS. These patients fell into clearly distinct categories: with or without insulin resistance and with or without obesity, but slim women with PCOS had insulin and metabolic variables similar to those without PCOS, and most obese women with PCOS were insulin-resistant and more hyperandrogenic and hypertriglyceridemic.
Insulin, androgens, and BMI are related in women both with PCOS and without PCOS, especially in obese ones. Insulin and metabolic indices are similar in lean women with PCOS and those without PCOS, but obese women with PCOS are more insulin-resistant, hyperandrogenic, and hypertriglyceridemic. Three types of disorders can be distinguished: simple nonhyperandrogenic obesity, typical nonhyperinsulinemic PCOS, and insulin-resistant PCOS.

  • Journal of Clinical Endocrinology &amp Metabolism 06/2001; 86(6):2428-2436. DOI:10.1210/jc.86.6.2428 · 6.31 Impact Factor
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    ABSTRACT: Objective To evaluate serum concentration of anti-Müllerian hormone (AMH) in adolescent patients with polycystic ovary syndrome (PCOS) with respect to body mass index (BMI), and to investigate the relationship with clinical, metabolic and hormonal parameters. Study design Fifty-eight adolescent girls (29 normal weight and 29 overweight–obese) diagnosed with PCOS and 28 apparently healthy girls (controls) were enrolled in the study. BMI was calculated in all cases. Serum AMH, hormonal and metabolic parameters were compared between patients with PCOS (normal weight and overweight–obese) and controls. Results Serum AMH did not differ between patients with PCOS and controls (p = 0.283), and no correlation was found between BMI and AMH. A significant positive correlation was found between 2-h plasma glucose on 75-g oral glucose tolerance test and AMH (R = 0.364, p = 0.005). HOMA-IR index and insulin were significantly higher in overweight–obese patients with PCOS than in controls, but no significant difference was found between controls and normal-weight patients with PCOS. Conclusions AMH was not found to be a reliable predictor for the presence of PCOS, and serum AMH did not differ between obese and non-obese adolescent patients with PCOS.
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    ABSTRACT: Context: Adrenal hyperandrogenism affects around 25% of polycystic ovary syndrome (PCOS) patients but its relation to obesity is not totally understood. Objective: To assess dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) levels in relation to body mass index (BMI) in PCOS. Design: Prospective observational study. Setting: Institutional practice at an Obstetrics/Gynecology hospital. Patients or Other Participants: This study included 136 PCOS patients, 20-35 years old, and 42 matched-age control women. The participants were classified with the BMI cutoff value of 27 kg/m(2) as follows: 1) high-BMI PCOS patients; 2) low-BMI PCOS patients; 3) high-BMI control women; and 4) low-BMI control women. The data were reanalyzed with the BMI cutoff value of 30 kg/m(2) to corroborate the findings in obese and non-obese patients. Intervention(s): Blood samples were taken. Main Outcome Measure(s): LH, FSH, insulin, T, androstenedione (A4), DHEA, DHEAS, and glucose levels were determined. Homeostatic model assessment was calculated. Pelvic and abdominal ultrasound for ovarian morphology and adipose tissue, respectively, were performed. Results: Obese PCOS patients presented significantly more insulin resistance than non-obese PCOS patients. The LH levels and LH/FSH ratio were significantly higher in low-BMI than in high-BMI PCOS patients. The A4 and DHEAS levels were significantly higher in non-obese than in obese PCOS patients. A significant correlation between LH and A4 in non-obese PCOS patients was observed. The frequency of hyperandrogenism by increased A4, and DHEA along with DHEAS was significantly higher in low-BMI PCOS patients compared to high-BMI PCOS patients. Some findings observed with the BMI cutoff value of 27 kg/m(2) changed with the cutoff value of 30 kg/m(2). Conclusions: Low BMI more than high BMI is associated with increased LH, high A4, DHEA and DHEAS levels in PCOS patients. The BMI cutoff value of 27 kg/m(2) classified better than 30 kg/m(2) for hormonal and metabolic characteristics.
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