The evaluation of metabolic parameters and insulin sensitivity for a more robust diagnosis of the polycystic ovary syndrome (original) (raw)
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Clinical Endocrinology, 2020
Background: Different polycystic ovary syndrome (PCOS) phenotypes are correlated with different clinical severity levels. Insulin resistance correlates with higher severity. In a retrospective study, 130 patients with polycystic ovary syndrome were examined for insulin resistance. The aim of the study was to investigate relationships between glucose metabolism and different PCOS phenotypes and to identify biomarkers or combinations thereof to obtain information on the type of metabolic disorder or the severity of PCOS. Methods: 130 patients with PCOS were included in the study. Biometric data such as weight, height, cycle day and cycle length were compared with glucose metabolism parameters such as fasting glucose, insulin before and 60 and 120 min after 75 g glucose intake, intact proinsulin, C-peptide and ovarian function parameters including Anti-Müllerian hormone (AMH) and the soluble AMH receptor (sAMHR2). The parameters were correlated and their diagnostic performance with respect to different expressions of PCOS was evaluated. Results: The biomarkers of impaired glucose metabolism showed strong significant difference in HOMA-Index, adiponectin, proinsulin and body mass index (BMI) and Insulin levels in 0-60-120 minute of glucose tolerance test but also with parameters of ovarian function as AMH, AMH z-score sAMHR2, and sAMHR2/AMH ratio. A strong correlation between sAMHR2 and adiponectin (r=0.818, p<0.0001) was found indicating a relationship between the degree of glucose metabolic impairment and ovarian function. Conclusions: The parameters glucose, insulin, insulin 60 min after intake of 75 g glucose and adiponectin or sAMHR2 enable a biochemical classification of PCOS patients that correlates with morphological PCOS phenotypes. By determining biomarkers, it is possible to classify PCOS patients into subgroups that correlate with different PCOS phenotypes and the clinical severity.
Is insulin resistance an essential component of PCOS?: The influence of confounding factors
Human Reproduction, 2004
Insulin resistance is often considered a regular component of polycystic ovary syndrome (PCOS). Many interventional studies assume a state of insulin resistance in all patients. However, the evidence is based on small samples that are often insuf®cient to adjust for signi®cant confounding factors. Moreover, several studies have not con®rmed differences in insulin sensitivity between women with PCOS and healthy controls, especially in non-obese patients. This debate article provides an overview of the data published regarding the presence of abnormal or normal insulin sensitivity in PCOS. In conclusion, available data offer evidence that a substantial subgroup of women with PCOS have insulin sensitivity comparable with healthy controls if matched carefully for potential confounding factors.
Assessment of relationship between hormones and insulin resistance in PCOS
IP innovative publication pvt. ltd, 2019
Introduction: Polycystic ovarian syndrome (PCOS) is the most common heterogenous disorder of reproductive age. Increased frequency of GnRH pulses from hypothalamus elevates LH levels this in turn causes increased androgen production. The chronic hyperandrogenic state have multiple long and short term complications which includes DM and CVD. Insulin resistance can be characterized as impaired action of insulin on glucose metabolism which increases risk of developing T2DM. Hyperandrogenism with hyperinsulinemia also leads to dyslipidemia. Aim: To estimate LH/FSH ratio, testosterone in PCOS patients and to correlate its significance with the insulin resistance. Materials and Methods: This case-control study was conducted on clinically, diagnosed 50 PCOS patients, aged 15 to 35 years were included as cases. Age-matched 50 apparently heal thy women were included as controls. Serum leutinising hormone(LH), Follicle stimulating hormone(FSH), testosterone, serum insulin were analysed by chemiluminiscence immunoassay(CLIA) on Maglumi 1000. Mindray BS 300, fully automated analyser was used for estimation of Total cholesterol(TC), High density lipoprotein(HDL), Triglyceride(TG), Fasting Blood Glucose (FBG), Low density lipoprotein (LDL) was calculated using Friedewald’s formula. Insulin resistance was assessed by HOMA IR. Descriptive statistics analysis was done using unpaired student’s t-test. Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale. Pearson’s correlation coefficient was applied to analyse the correlation. p value <0.05 was considered statistically significant. Results: In our study the LH /FSH ratio, HOMA IR and Testosterone was increased in cases compared to controls with p 0.01 and for testosterone p 0.001. In contrast HDL decreased in cases compared to controls (p<0.001). Triglyceride (p<0.01) was higher in cases compared to controls in our study. However LDL and Total cholesterol were not significantly increased in cases however we can find that LDL was still increased in cases. Average BMI was within the normal range (p=0.06). On correlation study FSH showed a negligible negative correlation with HOMA IR and mild negative correlation with BMI. LH showed a positive correlation with both HOMA IR(r 0.45,p<0.01) and BMI(r 0.61, p<0.01). Whereas testosterone showed no correlation. LH/FSH ratio was positively correlated with HOMA IR(r 0.42, p<0.01) and also BMI(r 0.53, p <0.001). TC(r 0.31, p 0.02) showed significant positive correlation whereas LDL(r 0.18,p 0.21), TG(r 0.16,p 0.26) though positive showed negligible correlation with HOMA IR. BMI showed a significant positive correlation with HOMA IR (r 0.43,p <0.01). Conclusion: In our study we propose that in PCOS cases IR seems to underlie many clinical features of PCOS. It encompasses long term health problems like CVD, DM and increased exposure to estrogen can lead to endometrial carcinoma. It is need of the time to follow up the patient to early identify and prevent the consequences of this syndrome.
Determining the insulin resistance rate in Polycystic Ovary Syndrome patients (PCOs
Background: Polycystic ovarian syndrome is the most common endocrine disorder of reproductive-age women. Object: to detect Insulin resistance rate among PCOs patients in AUHOG .during May 2014 to December 2015. Study design: Prospective Observational case-control Study. Materials and methods: Patients included in the study are PCOs patients that are diagnosed according to Rotterdam Criteria 2003 after excluding the co-morbidities. We compare the results with women had the same age and weight. Study method is based on: Fasting glucose and fasting insulin as well as Oral Glucose tolerance test. Results: our results demonstrated that 60% of the patients were obese with BMI more than 25 kg/m 2. Clinically: Signs and symptoms of hyper-androgenism: 77 % of patients suffer from Hirsutism, whereas 60% suffer from Obesity. Laboratory finding: 12 cases had elevated testosterone levels. Fasting glucose was abnormal in18% compared with 4% in controls. OGTT test was abnormal in 6% compared with3% in controls. Fasting insulin was above 20 IU/ml in (16%) compared with 4% in controls (P<0.05). Patients who G/I ratio was below 4.5 were (13%). compared with 1% in controls. Insulin resistance according to G/I ratio at cut off value of 4.5 was 13% (P<0.05). Conclusion: Insulin resistance was existed only in 18%patients of PCOs. Comparison with 4%in control study, so there is no evidence to use Insulin-Sensitizing Agents in treatment patients.
Human Reproduction, 2012
background: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by oligo-or anovulation (ANOV), biochemical or clinical manifestations of hyperandrogenemia (HA) and PCOs. Four phenotypes of PCOS exist [phenotype 1 (ANOV + HA + PCO), phenotype 2 (ANOV + HA), phenotype 3 (HA + PCO) and phenotype 4 (ANOV + PCO)] but the differences between them are not well studied. We compared markers of insulin resistance (IR) and endocrine characteristics between the different PCOS phenotypes. methods: We prospectively studied 1212 consecutive women with PCOS and 254 BMI-matched healthy women. results: Phenotypes 1-4 were present in 48.2, 30.7, 9.7 and 11.4% of patients, respectively. BMI did not differ between the four phenotypes and controls. Both normal weight and overweight/obese women with phenotypes 1 and 2 were more insulin resistant than controls. Overweight/obese, but not normal weight, women with phenotype 4 were more insulin resistant than controls, while IR in women with phenotype 3 did not differ from controls regardless of obesity. In normal weight subjects, women with phenotypes 1 and 2 were more insulin resistant than women with phenotype 4. In overweight/obese subjects, women with phenotype 1 were more insulin resistant than women with phenotypes 2 and 3 and women with phenotype 4 were more insulin resistant than those with phenotype 3. Circulating androgens were higher in normal weight and overweight/obese PCOS patients with phenotypes 1-3 compared with those with phenotype 4, and higher in normal weight PCOS patients with phenotype 1 than in those with phenotype 2.
Fertility and Sterility, 1999
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). Design: Retrospective study of normal and obese women with and without PCOS. Setting: Gynecologic endocrinology units of Elche, San Juan, and Alicante Hospitals and Hormone Laboratory at Alicante University Hospital ("Miguel Hernández" University). Patient(s): A total of 212 women were studied: 137 with PCOS and 75 without PCOS. Intervention(s): BMI, gonadotropins, insulin, androgens (T, androstenedione, DHEAS), 17␣-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.
Human Reproduction, 2013
Is it possible to distinguish metabolically healthy polycystic ovary syndrome (MH-PCOS) from metabolically unhealthy PCOS (MU-PCOS) by simple diagnostic tools such as body mass index (BMI), waist/hip ratio (WHR), at-risk category suggested by Androgen Excess Society (AES) and visceral adiposity index (VAI)? summary answer: VAI could be an easy and useful tool in clinical practice and in population studies for assessment of MU-PCOS. what is known already: VAI is a good indicator of insulin sensitivity and cardiometabolic risk in oligo-ovulatory women with PCOS. study design, size, duration: We conducted a cross-sectional study of 232 women with PCOS in a university hospital setting. participants/materials, setting, methods: Anthropometric, hormonal and metabolic parameters were evaluated. An oral glucose tolerance test measured areas under the curve (AUC) for insulin (AUC 2h insulin) and for glucose (AUC 2h glucose). Homeostasis model assessment of insulin resistance (HOMA2-IR), the Matsuda index of insulin sensitivity (ISI), the oral dispositional index (DIo) and VAI were determined. main results and the role of chance: The prevalence of MU-PCOS according to the different criteria was: BMI, 56.0%; WHR, 18.1%; at-risk criteria of AES, 72.0% and VAI, 34.5%. The likelihood that a woman would exhibit MU-PCOS (except when diagnosed by the WHR criterion) showed a significant positive association with high HOMA2-IR [
Divergences in Insulin Resistance Between the Different Phenotypes of the Polycystic Ovary Syndrome
The Journal of Clinical Endocrinology & Metabolism, 2013
Context/Objective: Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women.