Heterogenous origins of hyperandrogenism in the polycystic ovary syndrome in relation to body mass index and insulin resistance

Abstract

Background: Insulin resistance and obesity are not universal features of polycystic ovary syndrome (PCOS). We planned to assess the differences between patients with nonobese /insulin-sensitive phenotype vs. obese/ insulin-resistant phenotype in terms of the potential mechanisms underlying their hyperandrogenism.

Materials and methods: A total of 52 women satisfying Androgen Excess Society (AES) criteria were included. Hormonal and metabolic profile including prolactin, dehydroepiandrosterone sulfate (DHEAS), free testosterone, sex hormone binding globulin (SHBG), fasting plasma glucose and insulin were measured in follicular phase.

Results: DHEAS was found to be higher in the nonobese patients as compared to the obese (p = 0.01). There was also a strong trend for a higher DHEAS among patients with lower insulin resistance by homeostatic model assessment (HOMA-IR< 2.3) (p = .06).While the total testosterone (p = .044) and SHBG (p = .007) were found to be lower in the more insulin-resistant group (HOMA-IR ≥ 2.3), the free testosterone levels were similar. However, the percentage of free testosterone was higher in the more insulin-resistant group (p = .005).

Conclusions: The hyperandrogenic state in PCOS appears to have heterogenous origins. Nonobese patients with PCOS have adrenal hyperandrogenism as the underlying mechanism while their obese/ insulin-resistant counterparts have low SHBG and hence an increased fraction of free testosterone.

Chinese abstract

背景：胰岛素抵抗和肥胖并不是多囊卵巢综合征（PCOS）的普遍特征。我们计划评估非肥胖/胰岛素敏感型与肥胖/胰岛素抵抗型患者之间高雄激素血症潜在机制的差异。

材料与方法：纳入符合雄激素过多协会（AES）标准的女性52人。在卵泡期测量激素和代谢情况, 包括催乳素, 脱氢表雄酮硫酸盐（DHEAS）, 游离睾酮, 性激素结合球蛋白（SHBG）, 空腹血糖和胰岛素。

结果：非肥胖患者DHEAS较肥胖者高（p = 0.01）。稳态模型评估表明, 胰岛素抵抗较弱（HOMA-IR <2.3）的患者DHEAS较易升高（p = 0.06）, 然而在胰岛素抵抗较强组（HOMA-IR ≥2.3）, 总睾酮（p=.044）以及SHBG（p=.007）较低, 两组的游离睾酮水平相似。而胰岛素抵抗较强组中游离睾酮指数较高（p = .005）。

结论：PCOS高雄激素状态似乎有不同的起源。非肥胖多囊卵巢综合征患者是因为肾上腺雄激素过多, 而肥胖/胰岛素抵抗患者由于SHBG较低, 游离睾酮指数增加。

Keywords:

• Adrenal hyperandrogenism
• PCOS
• insulin resistance
• obesity
• DHEAS

Disclosure statement

The authors report no conflict of interest

Additional information

Funding

Sri Balaji Arogya Varaprasadini (SBAVP) Scheme of Tirumala Tirupati Devasthanams.