Central-to-peripheral fat ratio,but not peripheral body fat,is related to insulin resistance and androgen markers in polycystic ovary syndrome

Background.?Overweight, hyperandrogenism and insulin resistance are cardinal features of patients with polycystic ovary syndrome (PCOS). Women with PCOS have excess accumulation of trunkal fat and metabolic complications. Recent findings suggest that peripheral fat may have metabolic protective behaviour. The aim of this study was to investigate body fat distribution in patients with PCOS and associations of peripheral fat with metabolic and hormonal profile.

Methods.?The study included 24 patients with PCOS and a control group of 13 women. Anthropometrical evaluation and dual-energy X-ray absorptiometry to determine body composition was performed. Plasma metabolic and hormonal profiles were evaluated.

Results.?Patients with PCOS have increased proportion of central to peripheral fat ratio (CPFR) when compared to controls (p?=?0.008). There was a positive correlation among trunkal fat, insulin, HOMA-IR and triglycerides (all p?<?0.05). Regarding to peripheral fat there was no difference between groups, a trend to negative correlation to insulin appeared. Positive correlation between free androgens index and CPFR (p?=?0.058) and a negative correlation between SHBG and CPFR (p?=?0.016) were appeared.

Conclusions.?Patients with PCOS showed an android pattern fat distribution when compared to controls. Peripheral fat contribution and its relations to androgens in this context could not be established. Android pattern of fat distribution showed inverse correlation to SHBG levels, suggesting that SHBG may be related to fat distribution.     

Differences in low-grade chronic inflammation and insulin resistance in women with previous gestational diabetes mellitus and women with polycystic ovary syndrome

Background. Polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) are both characterized by an increase in insulin resistance. Our goal in the present study was to measure insulin resistance (as estimated by homeostasis model assessment, sex hormone-binding globulin (SHBG) and adiponectin concentrations) and parameters of low-grade inflammation in non-diabetic, non-hyperandrogenic ovulatory women with previous GDM (pGDM) and in non-diabetic women with classic PCOS, characterized by hyperandrogenism and oligo/anovulation.

Patients and design. We evaluated 20 women with PCOS, 18 women with pGDM and 19 controls, all matched according to body mass index (BMI). Fasting blood samples were drawn in all women 3–6 days after spontaneous or dydrogesterone-induced withdrawal bleeding. Body fat distribution was assessed using dual-energy X-ray absorptiometry in all women.

Results. After adjusting for age and percent body fat, measures of insulin resistance such as SHBG and adiponectin concentrations were decreased and central obesity was increased in women with PCOS and pGDM compared with controls (all p < 0.05). Parameters of low-grade inflammation such as serum tumor necrosis factor-α and highly sensitive C-reactive protein concentrations, white blood cell and neutrophil count were increased only in women with PCOS compared with BMI-matched controls (all p < 0.05).

Conclusions. Certain markers of insulin resistance are increased in both women with PCOS and women with pGDM, while low-grade inflammation is increased only in PCOS. PCOS and GDM might represent specific phenotypes of one disease entity with an increased risk of cardiovascular disease, whereby women with PCOS demonstrate an augmented cardiovascular risk profile.     

Serum adiponectin is independently associated with the metabolic syndrome in Hong Kong,Chinese women with polycystic ovary syndrome

Objective: To evaluate the association of serum adiponectin level with the metabolic syndrome in Chinese women with polycystic ovary syndrome (PCOS).

Methods: This was a cross-sectional study carried out in Hong Kong Chinese women with PCOS at a university-affiliated tertiary hospital between January 2010 and January 2011. Clinical and biochemical parameters of the women were analysed. Prediction of the metabolic syndrome was determined by receiver–operator characteristic (ROC) curves, univariate and multivariate logistic regression analyses.

Results: A total of 116 women diagnosed to have PCOS were analysed. The area under the ROC curve of adiponectin for the prediction of metabolic syndrome was 0.820, 95% confidence interval (CI) 0.737–0.886. Univariate binary logistic regression showed that testosterone, sex hormone-binding globulin (SHBG), free androgen index (FAI), waist circumference, body mass index (BMI), quantitative insulin-sensitivity check index (QUICKI), homeostasis model assessment of insulin resistance (HOMA-IR) and adiponectin were significantly associated with the metabolic syndrome. On multivariate logistic regression analysis, adiponectin (p?= 0.020), HOMA-IR, age (p?= 0.011) and BMI (p?= 0.019) were independently associated with the metabolic syndrome, but not FAI (p?= 0.256).

Conclusions: Serum adiponectin is independently associated with the metabolic syndrome in Chinese women with PCOS. Further longitudinal follow-up studies are needed to determine whether serum adiponectin adds to the prediction of long-term cardiometabolic morbidity conferred by age, BMI and measures of insulin resistance.     

Women with polycystic ovary syndrome have greater muscle strength irrespective of body composition

Abstract

The aim of this study was to compare metabolic parameters, body composition (BC) and muscle strength of women with and without polycystic ovary syndrome (PCOS). This was a case–control study that evaluated 40 women with PCOS and 40 controls. Androgens and insulin resistance were measured. BC was based on dual-energy X-ray absorptiometry. Isometric handgrip and maximal dynamic muscle strength (1-RM) strength tests were performed. Median total testosterone (p?<?0.01), free androgen index (p?<?0.01), insulin (p?<?0.01) and homeostasis model assessment-insulin resistance (p?=?0.02) were higher and sex hormone binding globulin (SBHG) (p?=?0.04) was lower in the PCOS group. Normoweight women with PCOS had higher percentages of android body fat. However, the prevalence of android fat distribution was higher in the PCOS than in the control group (p?=?0.04). The strength 1-RM in bench press (p?<?0.01), muscle strength relative to lean muscle mass in the dominant lower limb (p?=?0.04) and isometric handgrip strength tests (p?=?0.03) was higher in the PCOS group. PCOS was a determinant of strength in the bench press exercise (p?=?0.04). The hyperandrogenism was a predictor of increased strength in biceps curl exercises (p?=?0.03) in the dominant lower limb (p?=?0.02) and isometric handgrip strength (p?=?0.03). In conclusion, women with PCOS have greater muscle strength and a higher prevalence of central obesity, but no difference in BC. Muscle strength may be related to high androgen levels in these women.     

Serum visfatin,vascular endothelial growth factor and matrix metalloproteinase-9 in women with polycystic ovary syndrome

Aim: To evaluate serum concentrations of visfatin, vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) in women with polycystic ovary syndrome (PCOS) and to investigate their possible role as early endothelial markers in PCOS.

Methods: Forty-two women with PCOS and 42 controls, matched for age and weight, were included in the study. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, total testosterone (tT), Δ₄-androstenedione (Δ₄A), dehydroepinadrosterone sulphate (DHEA-S), 17-OH-progesterone, sex hormone-binding protein (SHBG), thyroid-stimulating hormone (TSH), free thyroxine (fT₄), visfatin, VEGF and MMP-9 were measured in all women; free androgen index (FAI) was calculated as well. Receiver-operating characteristic (ROC) analysis was performed to examine if visfatin, tT or FAI can predict the clinical status (PCOS or control).

Results: LH, Δ₄A, tT and FAI concentrations were higher in PCOS than in controls (p?=?0.002, 0.029, 0.0005 and 0.014, respectively). Visfatin, VEGF and MMP-9 concentrations were higher in women with PCOS than controls (p?=?0.019, 0.001 and 0.002, respectively). In ROC analysis, area under the curve (AUC) in the prediction of clinical status was 0.641 for visfatin (p?=?0.026), 0.731 for tT (p?=?0.001) and 0.666 for FAI (p?=?0.010), with no difference among them (p?=?0.117).

Conclusions: Visfatin may induce the expression of pro-angiogenic factors, such as VEGF and MMP-9, in women with PCOS, inplying gradually development of endothelial dysfunction. Further studies are required to clarify these findings.     

The association of serum androgens and insulin resistance with fat distribution in polycystic ovary syndrome

OBJECTIVE: The aim of the study was to compare the body fat distribution of women with polycystic ovary syndrome (PCOS) with age and body mass index matched healthy controls and to investigate if androgens and insulin resistance associated with fat distribution. STUDY DESIGN: Thirty-three PCOS and 21 age and body mass index (BMI) matched healthy control women were evaluated in terms of body fat distribution with dual X-ray absorpsiometry (DEXA). Blood samples were obtained for follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, thyroid stimulating hormone (TSH), dehydroepiandrosterone-sulfate (DHEA-S), free testosterone, sex hormone binding globulin (SHBG), insulin and glucose levels. A 75 g 2 h glucose tolerance test was performed for each woman. Insulin resistance was estimated by fasting insulin level, fasting glucose/insulin ratio and 75 g 2 h glucose tolerance test. The Student's t-test and Mann-Whitney U-test were used to compare the groups. Pearson and Spearman rank correlation coefficients were calculated for normally and nonnormally distributed variables, respectively. Partial correlation coefficients were calculated using age and BMI as covariates. RESULTS: Fat mass in trunk and arms were significantly higher in patients with PCOS (p < 0.043 and 0.036, respectively). The ratio of fat mass in trunk to fat mass in legs were significantly higher in patients with PCOS (p < 0.011). Free testosterone was found to be positively correlated with fat mass in arms (r = 0.401, p < 0.05). There was still significant correlation between free testosterone and fat mass in arms (r = 0.5964, p < 0.05) after controlling for age and BMI. CONCLUSION: Free testosterone level is positively correlated with the fat mass in arms in women with PCOS.     

Serum visfatin in Asian women with polycystic ovary syndrome

Objective.?To determine serum visfatin levels in Asian polycystic ovary syndrome (PCOS) women and its correlations with various parameters.

Study design.?Case–control study.

Setting.?University hospital.

Subjects.?Eighty women were enrolled in this study. Of these, 40 women were PCOS and 40 age-matched subjects with regular menstrual cycles were controls.

Intervention.?Seventy-five gram oral glucose tolerance tests were performed in all women. Fasting venous blood samples for serum visfatin, insulin and androgen levels were obtained both from the PCOS and the control women.

Main outcome measures.?Serum concentrations of visfatin, fasting insulin (FI), fasting glucose, 2-h post-load glucose (2hPG), homeostasis model assessment insulin resistance, homeostasis model assessment beta cell function, total testosterone, free testosterone, androstenedione and dehydroepiandrosterone sulfate were measured in both groups.

Results.?Women with PCOS had significantly higher serum visfatin levels than the healthy controls [100.39 ± 41.90 vs. 45.09 ± 28.24 mg/ml, p < 0.01]. PCOS women also had significantly higher concentrations of all androgens (p < 0.01). Insulin resistance seemed to be greater in the PCOS than the control groups, but did not reach a statistically significant level. In the PCOS group, serum visfatin levels were positively correlated with 2hPG, and systolic blood pressure and diastolic blood pressure. Serum visfatin levels were negatively associated with FI (r = ?0.80, p = 0.03) and positively associated with systolic and diastolic blood pressure (r = 0.77, p = 0.04, r = 0.79, p = 0.03, respectively) in the sub-group of PCOS women with abnormal glucose tolerance (AGT).

Conclusions.?Asian PCOS women had significantly higher serum visfatin levels than age-matched healthy controls. Their levels were significantly correlated with 2hPG and blood pressure in PCOS women, and with FI and blood pressure in PCOS women with AGT.     

Testosterone is associated with insulin resistance index independently of adiposity in women with polycystic ovary syndrome

Objective: To study the associations between androgens, glucose homeostasis, inflammation and statin treatment in women with polycystic ovary syndrome (PCOS).

Design and methods: Oral glucose tolerance tests, androgens, hs-CRP and interleukin-1 receptor antagonist (IL-1Ra) were analyzed at baseline and after 6?months of atorvastatin (20?mg/d) or placebo treatment in 27 women with PCOS.

Results: Testosterone associated with insulin resistance measured with ISI_Matsuda independently of BMI, age and SHBG concentrations and the full model, including IL-1Ra, hs-CRP and HDL-C, also showed independency of BMI and waist circumference (p?≤?.042). Free androgen index (FAI) associated with ISI_Matsuda independently of adiposity (p?≤?.025) but in the full model with waist circumference the association was insignificant. ISI_Matsuda decreased with testosterone >1.2?nmol/l compared with lower levels at baseline (p?=?.043) and at six months (p?=?.003). Accordingly, 30-minute insulin levels were increased with moderately elevated testosterone independently of adiposity (p?≤?.046). Increased fasting glucose and AUC insulin associated with statin treatment independently of adiposity and the associations attenuated after adjusting for testosterone.

Conclusions: Moderately elevated testosterone concentrations together with obesity-related inflammatory factors modify glucose homeostasis by increasing insulin resistance and early insulin secretion.     

Relationship between hyperandrogenism,obesity, inflammation and polycystic ovary syndrome

This prospective study aimed to determine the status of circulating levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α), IL-27, IL-35, IL-37, α-1 acid glycoprotein in patients with polycystic ovary syndrome (PCOS) compared with controls and to evaluate their relation with hyperandrogenism and obesity. Forty-eight patients with PCOS (29 obese, 19 lean) and 40 healthy controls (20 obese, 20 lean) were enrolled. CRP, TNF-α, IL-27, IL-35, IL-37, α-1 acid glycoprotein, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-S) levels were measured. Levels of total testosterone, A4, DHEA-S were significantly higher in patients with PCOS than in controls both in the obese and lean groups, while levels of SHBG were significantly lower in all patients with PCOS than in all (p?p?p?p?p?相似文献   

Chronic inflammation and elevated homocysteine levels are associated with increased body mass index in women with polycystic ovary syndrome

Background. Women with polycystic ovary syndrome (PCOS) are insulin-resistant and have increased risk for type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). But it is controversial whether the increased risk of CHD and T2DM is associated with endocrine abnormalities occurring as a consequence of PCOS or whether it is related to obesity or metabolic changes frequently seen in women with PCOS.

Objective. Since both homocysteine (Hcy) and C-reactive protein (CRP) are supposed to predict T2DM and CHD, we investigated their possible relationship with insulin resistance, obesity, hyperandrogenemia and metabolic alterations in 44 PCOS women and 26 healthy controls matched by age and body mass index (BMI).

Results. Hcy and CRP levels were significantly elevated in PCOS women compared with controls (13.30 ± 4.81 vs. 9.02 ± 3.36 μmol/l, p < 0.05 and 4.22 ± 2.95 vs. 2.66 ± 2.49 mg/l, p < 0.05). There was no correlation between Hcy and CRP (r = 0.171, p = 0.05) as two risk markers. While plasma Hcy levels were correlated with BMI, ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH), total testosterone, free testosterone, triglyceride and insulin levels and homeostatic model assessment–insulin resistance index (HOMA-IR) (p < 0.05), CRP was correlated with BMI, total cholesterol, triglyceride, low-density lipoprotein cholesterol and insulin levels and HOMA-IR (p < 0.05). There was no correlation of CRP with parameters of PCOS such as testosterone and LH/FSH ratio (p > 0.05). Multiple regression analysis revealed BMI as the major factor examined that influenced both Hcy and CRP levels.

Conclusions. In PCOS women, plasma levels of Hcy and CRP were significantly elevated compared with age- and BMI-matched controls. Although most of the PCOS-related endocrine and metabolic changes are related to elevated plasma Hcy and CRP levels in PCOS women, BMI seems to be the major factor determining CHD and T2DM in women with PCOS.     

Papillary carcinoma of the thyroid arising in struma ovarii – report of a case and review of management guidelines

Abstract

This study was designed to determine serum human leukocyte antigen-G (HLA-G) levels and establish whether serum HLA-G level is related with insulin resistance, oxidative stress, dyslipidemia and ovarian hyperandrogenism in women with polycystic ovary syndrome (PCOS). Twenty-five patients with PCOS and 23 healthy control women were evaluated in this study. Serum HLA-G, lipid fractions, glucose, insulin, malondialdehyde (MDA), glutathione (GSH), white blood cell (WBC), sex hormone-binding globulin (SHBG) and other hormone (gonadotropins and androgens) levels were measured. The estimate of insulin resistance was calculated by homeostasis model assessment (HOMA-IR). Serum luteinizing hormone (LH), total testosterone, fasting insulin, WBC levels and LH/follicle-stimulating hormone (FSH) ratio, free androgen index (FAI) and HOMA-IR values were significantly higher in patients with PCOS compared with healthy women. However, the women with PCOS had considerably lower serum FSH, SHBG, MDA, GSH and HLA-G levels than healthy subjects. HLA-G was inversely related with HOMA-IR, FAI, LH/FSH ratio and WBC, but positively with high-density lipoprotein cholesterol. Decreased serum HLA-G level may be related with insulin resistance, ovarian hyperandrogenism and oxidative stress in women with PCOS. Nevertheless, the exact role of HLA-G in the pathogenesis of the disease remains to be elucidated.     

Vascular endothelial growth factor in females of reproductive age

Abstract

This study explores the relationship between clinical cardiovascular risk factors and clinical androgen excess, with direct comparison to radial artery intima media thickness (rIMT). rIMT of 91 patients with polycystic ovary syndrome (PCOS) were compared with 72 healthy women. Patients were divided into three groups with regard to body mass index (BMI). Group1?=?56 women (31 controls and 25 PCOS) with low BMI(18–22.49?kg/m²), Group2?=?36 women (15 controls and 21 PCOS) with normal BMI (22.5–24.99?kg/m²) and Group3?=?71 women (26 controls and 45 PCOS) with high BMI (25–30?kg/m²). rIMT was significantly higher in patients with PCOS (p?=?0.007). rIMT was significantly higher group1 and group3 in patients with PCOS compared to controls (p?=?0.007 and p?=?0.042, respectively). There was a significant positive association between rIMT levels and fT in women with PCOS in group1 (r?=?0.24, p?=?0.04). rIMT levels correlated to fT levels in women with PCOS in group3 (r?=?0.32, p?=?0.03). Modified Ferriman–Gallwey (mFG) scores demonstrated a positive association with free testosterone, total testosterone, free androgen index, waist circumference (WC), LH levels, insulin levels, Homeostasis Model Assessment index(HOMA-IR), rIMT and a negative correlation with sex hormone binding globulin in group1 and group2. mFG scores demonstrated a positive association with free testosterone (r?=?0.33, p?=?0.029) in group3, but no association was found between mFG and WC, HOMA-IR in group3. Our findings indicate that clinical androgen excess may be associated with cardiovascular disease in patients with PCOS.     

Association of anthropometric,androgenic and insulin-related features with polymorphisms in exon 8 of SHBG gene in women with polycystic ovary syndrome

ABSTRACT

Objective: Sex hormone binding globulin (SHBG) levels are often low in women with polycystic ovary syndrome (PCOS). In addition to metabolic and nutritional factors, SHBG levels are determined by genetic polymorphisms in SHBG gene. The aim of this study was to investigate the association of polymorphisms in exon 8 of SHBG gene with anthropometric and biochemical features of women with PCOS.

Design: Prospective, observational study.

Patients: One hundred and ninety-four women with PCOS.

Main outcome measure(s): Genotype analysis of exon 8 in SHBG gene was performed. Serum SHBG, total testosterone, free testosterone, 17-α-hydroxyprogesterone, TSH, PRL, glucose and insulin levels were determined.

Main finding(s): Single nucleotide polymorphism (SNP) E326K located at codon 326 in exon 8 of SHBG gene was identified. Serum SHBG levels decreased significantly with increasing copy number of the variant allele for SNP E326K after adjustment for BMI, androgenic and insulin-related traits. Genotype analysis also revealed SNP, rs6259, located at codon 327 in exon 8 of SHBG gene, which is not associated with SHBG levels.

Conclusion: SNP, E326K, in exon 8 of SHBG gene may influence the metabolism of SHBG independently of BMI, androgenic and insulin-related features in women with PCOS.     

Serum Fetuin-A levels,insulin resistance and oxidative stress in women with polycystic ovary syndrome

Abstract

This study was designed to determine serum Fetuin-A levels and establish whether serum Fetuin-A level is related with insulin resistance, oxidative stress, ovarian hyperandrogenism and dyslipidemia in women with polycystic ovary syndrome (PCOS). Twenty-two patients with PCOS and twenty-one healthy control women were evaluated in this controlled clinical study. Serum Fetuin-A, lipid fractions, glucose, insulin, malondialdehyde (MDA), myeloperoxidase (MPO), glutathione (GSH), superoxide dismutase (SOD) and other hormone (gonadotropins, androgens) levels were measured. The estimate of insulin resistance was calculated by homeostasis model assessment (HOMA-R). The women with PCOS had significantly higher serum fasting glucose, insulin, luteinizing hormone (LH), MDA, Fetuin-A levels, and LH/follicle-stimulating hormone (FSH) ratio, free androgen index (FAI), HOMA-IR than healthy women. However, sex hormone-binding globulin (SHBG) and GSH levels were significantly lower in patients with PCOS compared with controls. Fetuin-A was positively correlated with insulin, HOMA-IR and FAI. Multiple regression analysis revealed that FAI was strong predictor of serum Fetuin-A level. Serum Fetuin-A level was related with insulin resistance and ovarian hyperandrogenism in women with PCOS. These results suggest that Fetuin-A may have a role in triggering the processes leading to insulin resistance and androgen excess in PCOS.     

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

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-IRp?=?.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.     

Hyperandrogenemia influences the prevalence of the metabolic syndrome abnormalities in adolescents with the polycystic ovary syndrome

Objective.?The prevalence of the metabolic syndrome (MBS) abnormalities in Italian adolescents with polycystic ovary syndrome (PCOS) was evaluated.

Design.?Retrospective chart review.

Setting.?University outpatient clinic.

Participants.?Fifty-three adolescents with PCOS.

Interventions.?Subjects underwent a physical evaluation. Fasting blood samples were taken for the evaluation of metabolic parameters.

Main outcome measures.?The prevalence of MBS abnormalities according to de Ferranti criteria was assessed.

Results.?9.4% of adolescents with PCOS had the MBS (three abnormalities). Twelve girls (22.7%) had two abnormalities. Seventeen (32.1%) of PCOS girls have no MBS abnormalities. PCOS adolescents with the MBS were more obese, insulin resistant and they had significantly higher levels of total and free testosterone. The number of metabolic abnormalities correlated with free, total testosterone, free androgen index (FAI) and body mass index (BMI). Groups with two or three abnormalities were not differentiated by BMI, insulin, lipids, blood pressure, but they were differentiated by total and free testosterone and FAI. Adolescents with the MBS have higher total and free testosterone and FAI than girls with two MBS abnormalities.

Conclusions.?The MBS and its components are present in some adolescents with PCOS, placing them at increased risk for cardiovascular disease early in adulthood. Hyperandrogenemia is a risk factor for MBS independent of obesity.     

The association of body mass index and biochemical hyperandrogenaemia in women with and without polycystic ovary syndrome

Objective

To investigate the association between BMI and different androgen parameters in women with PCOS and normal ovulatory women.

Study design

A cross sectional, observational study was carried out. A total of 286 patients aged 20–44 years were recruited. One hundred and sixty-five women had a diagnosis of PCOS and 121 women were ovulatory with no clinical or biochemical or ultrasound evidence of PCOS. The PCOS and non-PCOS groups were sub-divided into two subgroups based on BMI (BMI ≤ 30 kg/m² and BMI > 30 kg/m²). Androgen parameters measured were testosterone, androstenedione, free androgen index and sex hormone-binding globulin (SHBG). Testosterone and androstenedione were measured using tandem mass spectrometry. Free androgen index (FAI) was calculated using the formula: (testosterone/SHBG) × 100. Spearman rank correlations were used to determine relationship between BMI and androgens.

Results

The PCOS group had a higher BMI compared with the non-PCOS group (28.9 ± 5.8, 24.5 ± 4.1). Total testosterone, androstenedione, and FAI were significantly higher while SHBG was lower in the PCOS group. A correlation between BMI and total testosterone was not observed in either group. Positive correlations were observed between BMI and FAI in both PCOS (p < 0.001) and non-PCOS groups (p = 0.02) while a positive correlation was observed between BMI and androstenedione in the PCOS group (p = 0.001). SHBG correlated negatively with BMI in both groups.

Conclusion

A strong correlation exists between BMI and FAI but not with total testosterone, possibly due to the mediation of SHBG. Hyperandrogenaemia in the form of androstenedione seems to be augmented in PCOS with increasing BMI. A direct causal relationship between BMI and androgenaemia was not established.     

Serum leptin levels correlate with clinical and biochemical indices of insulin resistance in women with polycystic ovary syndrome

Objectives To compare serum leptin levels in women with polycystic ovary syndrome (PCOS) and healthy subjects, and to evaluate the relationship between leptin concentration and insulin resistance.

Methods Forty-five women with PCOS and 20 controls were included in the study. Serum levels of leptin, testosterone, immune-reactive insulin (IRI), sex hormone-binding globulin, dehydroepiandrosterone sulfate, cortisol, LH and FSH were measured. Free androgen index (FAI) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. Body mass index (BMI) and waist-to-hip ratio (WHR) were assessed.

Results Serum leptin levels in PCOS patients were higher than in the control group independently of BMI, WHR and waist circumference. In PCOS patients there was a strong positive correlation between leptin and IRI (r = 0.592, p < 0.01) on the one hand, and leptin and HOMA-IR, on the other (r = 0.637, p < 0.01). In PCOS patients with more pronounced insulin resistance (IR) the correlation between leptin levels and HOMA-IR is independent of BMI, WHR and waist circumference. We did not find any correlation between leptin and other hormonal indices in PCOS patients.

Conclusions Our study confirms the existence of a significant positive correlation between serum leptin levels and clinical and hormonal indices of IR. The hyperleptinaemia is probably due to leptin resistance and may be characteristic of the syndrome. The lack of correlation with other hormonal parameters is probably due to the heterogeneity of the PCOS group.     

Classic PCOS phenotype is not associated with deficiency of endogenous vitamin D and VDR gene polymorphisms rs731236 (TaqI), rs7975232 (ApaI), rs1544410 (BsmI), rs10735810 (FokI): a case–control study of lower Silesian women

Abstract

Context: The role of endogenous vitamin D and vitamin D receptor (VDR) gene polymorphism in polycystic ovary syndrome (PCOS) is still controversial.

Objective: The objective of this study was to investigate for the first time in women with “classic” PCOS phenotype and healthy controls the role of the serum endogenous vitamin D level and VDR gene polymorphisms in PCOS etiology.

Design: Ninety-two women with “classic” PCOS phenotype and 85 controls from lower Silesia with comparable body mass index (BMI) were studied. In all women the waist circumference, android/gynoid fat deposit, parameters of lipid and glucose metabolism, testosterone, free androgen index, sex hormone binding globulin (SHBG) and vitamin D were evaluated. Also, VDR gene polymorphisms rs731236, rs7975232, rs1544410 and rs10735810 were assessed.

Results: Serum vitamin D levels in both groups were comparable. Also high, comparable frequencies of hypovitaminosis and vitamin D deficiency in both groups were observed. Women with “classic” PCOS phenotype had statistically significantly higher values of all measured parameters, except serum SHBG and high-density lipoprotein (HDL)-cholesterol, which were lower. The frequency of VDR genotype polymorphism was also comparable in both groups.

Conclusions: For the first time, we show that endogenous vitamin D deficiency and VDR polymorphisms are not associated with homogeneous “classic” PCOS phenotype.     

Effect of metformin on the clinical and metabolic assessment of women with polycystic ovary syndrome

A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS), aged 27.20?±?5.02 years and treated with metformin (1500?mg/day) for 8 weeks. The patients were assessed for spontaneous menstruation, weight, body mass index (BMI), waist circumference, waist/hip ratio (WHR), glucose and insulin concentrations under fasting conditions and after a 75-g glucose tolerance test, lipid profile, testosterone, androstenedione, dehydroepiandrosterone sulfate, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF)-I. Spontaneous menstruation was observed in 81% of the women treated with metformin, with no changes in weight or BMI. Waist measurement and the WHR were reduced. The quantitative insulin sensitivity check index (QUICKI) improved from 0.33?±?0.03 to 0.35?±?0.04 (p?<?0.005), and serum total cholesterol and low-density lipoprotein-cholesterol were reduced, while high-density lipoprotein-cholesterol was increased. Serum testosterone concentrations were also reduced. There were no differences in serum triglycerides, SHBG or IGF-I. The occurrence of spontaneous menstruation and changes in the pattern of body fat distribution, the reduction in serum testosterone concentrations, the improvement in lipid profile and the reduction of insulinemia with the use of metformin permit us to conclude that treatment with this drug is of benefit to women with PCOS.