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: 4.59). 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.

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    • "Furthermore associations have been made between obesity and androgen regulation with androgens being shown to decrease plasma adiponectin, which may subsequently decrease in insulin sensitivity [32]. It is well recognised that androgens are produced in sex organs [5] and the adrenal glands [37] [39] [42]. "
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    ABSTRACT: The metabolic syndrome is a cluster of metabolic disorders characterized by insulin resistance and hyperinsulinaemia, and its presence can increase the risk of cardiovascular disease significantly. The metabolic syndrome is associated with increased circulating androgen levels in women, which may originate from the ovaries and adrenal glands. Adipocytes are also able to synthesise steroid hormones, and this output has been hypothesised to increase with elevated insulin plasma concentrations. However, the contribution of the adipocytes to the circulating androgen levels in women with metabolic syndrome is limited and the effects of insulin are not fully understood. The aim of this study was to investigate the presence of steroid precursors and synthetic enzymes in human adipocyte biopsies as markers of possible adipocyte androgen synthesis. We examined pre and mature adipocytes taken from tissue biopsies of abdominal subcutaneous adipose tissue of participating women from the Department of Obstetrics and Gynaecology, of the Royal Derby Hospital. The results showed the potential for localised adipocyte androgen synthesis through the presence of the androgen precursor progesterone, as well as the steroid-converting enzyme 17α-hydroxylase. Furthermore, we found the controlled secretion of androstenedione in vitro and that insulin treatment caused levels to increase. Continued examination of a localised source of androgen production is therefore of clinical relevance due to its influence on adipocyte metabolism, its negative impact on female steroidogenic homeostasis, and the possible aggravation this may have when associated to obesity and obesity related metabolic abnormalities such as hyperinsulinaemia.
    Molecular Genetics and Metabolism Reports 12/2014; 1(1):254–263. DOI:10.1016/j.ymgmr.2014.05.002
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    • "Acié n et al. demonstrated an association between insulin, androgens and BMI in women with PCOS and without PCOS, especially in obese women. 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 hypertriglyceridaemic [20]. As anticipated, HDL cholesterol was significantly lower in obese patients with PCOS compared with normal-weight patients with PCOS and controls, whereas LDL cholesterol was significantly higher. "
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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.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 09/2014; 180(1):46–50. DOI:10.1016/j.ejogrb.2014.06.018 · 1.70 Impact Factor
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    • "However, it is well known that obesity generates a decrease in the sexual hormone-binding globulin, and therefore an increase in the levels of free androgens [22, 40]. Other studies have found that obesity generates an increase of testosterone levels in PCOS patients (Figure 3) [40, 47, 48]. In contrast, dynamic studies have shown lower androstenedione levels in obese PCOS patients than in non obese PCOS patients [33, 48]. "
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    ABSTRACT: Obesity or overweight affect most of patients with polycystic ovary syndrome (PCOS). Phenotypes are the clinical characteristics produced by the interaction of heredity and environment in a disease or syndrome. Phenotypes of PCOS have been described on the presence of clinical hyperandrogenism, oligoovulation and polycystic ovaries. The insulin resistance is present in the majority of patients with obesity and/or PCOS and it is more frequent and of greater magnitude in obese than in non obese PCOS patients. Levels of sexual hormone binding globulin are decreased, and levels of free androgens are increased in obese PCOS patients. Weight loss treatment is important for overweight or obese PCOS patients, but not necessary for normal weight PCOS patients, who only need to avoid increasing their body weight. Obesity decreases or delays several infertility treatments. The differences in the hormonal and metabolic profile, as well as the different focus and response to treatment between obese and non obese PCOS patients suggest that obesity has to be considered as a characteristic for classification of PCOS phenotypes.
    International Journal of Endocrinology 07/2012; 2012(1):317241. DOI:10.1155/2012/317241 · 1.95 Impact Factor
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