Ovarian hyperandrogenism in adolescent girls with menstrual disorders

OBJECTIVES: In women with polycystic ovaries (PCO) hyperandrogenemia, an increased LH-concentration and a hightened ratio of LH/FSH are common. In adolescent hirsute girls with menstrual disorder, which may herald PCO in adulthood, ovarian hyperandrogenemia was under scrutiny. In most of them functional ovarian hyperandrogenism (FOH) is present in response to challenge with GnRH analog. It is not known whether FOH is involved in the pathogenesis of menstrual disorders in adolescent girls without hirsutism. MATERIAL AND METHODS: 24 girls with menstrual disorder in the mean age of 17.5 +/- 1.6 years old were investigated and compared to the age matched group of girls with regular menses. Basal and GnRH stimulated levels of ovarian androgens and gonadotropins were measured and USG of the ovaries were performed in all girls. RESULTS: In over 50% of girls with menstrual disorder basal and stimulated 17 OH progesteron and androstenedione levels were found significantly higher as compared to the control groups. In all girls but three they were not associated with the polycystic structure of the ovaries. Only half of these girls had an increased LH/FSH ratio. CONCLUSIONS: Functional ovarian hyperandrogenism may be present in adolescent girls with menstrual disorder in spite of the absence of the clinical signs of hirsutism and polycystic structure of the ovaries.     

Polycystic ovary syndrome: a new ultrasonographic and color Doppler pattern.

The aim of this study was to evaluate whether patients with partial bilateral polycystic ovaries show different ovarian and uterine blood flow to those with complete bilateral polycystic ovaries, and to investigate whether there is a correlation between ultrasonographic and hormonal parameters. Fifteen patients with partial polycystic ovaries and eighteen patients with complete bilateral polycystic ovaries underwent clinical, biochemical, gray-scale and color Doppler ultrasonographic evaluation. Hormonal (luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH concentration ratio, estradiol, prolactin, androstenedione, testosterone), clinical (body mass index, Ferriman-Gallwey score), ultrasonographic (ovarian volume, number and distribution of subcapsular follicles, stromal score) and Doppler (uterine artery and intraparenchymal vessels pulsatility index, ovarian stromal vascularization) parameters were evaluated, in the early follicular phase (cycle day 3-5) in oligomenorrheic patients, or at random in amenorrheic patients. Significantly higher androstenedione plasma levels and LH/FSH concentration ratios were observed in complete bilateral polycystic ovaries. In partial polycystic ovaries, gray-scale and color Doppler ultrasonography showed different features in affected and unaffected areas of the ovary, similar to polycystic and normal ovary appearance respectively. In conclusion, PCOS does not predetermine a single ultrasonographic or Doppler pattern.     

多囊卵巢综合征病理生理的一些新认识

多囊卵巢综合征（PCOS）是以长期无排卵及高雄激素为特征的内分泌综合征,以不孕、多毛、无排卵、月经不调等为主要临床表现。PCOS超声下卵巢呈明显多囊性改变,并伴促性腺激素分泌异常。雄激素过多合成在PCOS发病中起关键性作用,膜细胞对颗粒细胞反应性增高、垂体分泌促黄体激素增多以及高胰岛素血症可能是卵巢雄激素合成过多的机制。胰岛素抵抗和肥胖的出现则可能使PCOS临床症状加剧。雄激素、胰岛素、促性腺激素和肥胖间的相互作用促成PCOS患者的生殖表型。     

Primary amenorrhea and hirsutism associated with hyperinsulinemia type A]

Hyperinsulinemia type A, which is a very rare disease, is often manifested in menstrual disorders and/or anovulation. Recently, a 19-year-old woman diagnosed with hyperinsulinemia and acanthosis nigricans, visited our outpatient clinic complaining primarily of amenorrhea and hirsutism. Endocrinological studies revealed normal LH and FSH levels, low estradiol (42.3pg/ml) and high androgens (testosterone: Over 150ng/ml, delta androstenedione: 4.8ng/ml) in serum. Her fasting insulin level was excessively high (over 320 microU/ml). UST showed bilateral polycystic ovaries. These data support the hypothesis of a pathogenic mechanism of ovarian dysfunction in patients with hyperinsulinemia; that is, too much insulin stimulates ovaries directly, followed by the production of androgens and the formation of polycystic ovaries. Strict dietary management of this patient failed to cause spontaneous vaginal bleeding. Progesterone administration did not cause withdrawal vaginal bleeding. These findings suggest that the higher that insulin level is, the more difficult it is to induce ovulation.     

Polycystic ovary syndrome: a new ultrasonographic and color Doppler pattern

The aim of this study was to evaluate whether patients with partial bilateral polycystic ovaries show different ovarian and uterine blood flow to those with complete bilateral polycystic ovaries, and to investigate whether there is a correlation between ultrasonographic and hormonal parameters.

Fifteen patients with partial polycystic ovaries and eighteen patients with complete bilateral polycystic ovaries underwent clinical, biochemical, gray-scale and color Doppler ultrasonographic evaluation.

Hormonal (luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH concentration ratio, estradiol, prolactin, androstenedione, testosterone), clinical (body mass index, Ferriman–Gallwey score), ultrasonographic (ovarian volume, number and distribution of subcapsular follicles, stromal score) and Doppler (uterine artery and intraparenchymal vessels pulsatility index, ovarian stromal vascularization) parameters were evaluated, in the early follicular phase (cycle day 3–5) in oligomenorrheic patients, or at random in amenorrheic patients.

Significantly higher androstenedione plasma levels and LH/FSH concentration ratios were observed in complete bilateral polycystic ovaries. In partial polycystic ovaries, gray-scale and color Doppler ultrasonography showed different features in affected and unaffected areas of the ovary, similar to polycystic and normal ovary appearance respectively.

In conclusion, PCOS does not predetermine a single ultrasonographic or Doppler pattern.     

Doppler, ultrasonographic and endocrinological environment with regard to the number of small subcapsular follicles in polycystic ovary syndrome.

The aim of this study was to evaluate how, in patients with polycystic ovary syndrome, the number of small subcapsular follicles correlates with uterine and ovarian blood flow and with specific hormonal parameters. At an ultrasonographic evaluation, 30 patients with polycystic ovary syndrome showed 5-10 (group I; n = 14) or > 10 (group II; n = 16) small follicles. These patients underwent ultrasonographic (ovarian volume and stroma echodensity; number, diameter and distribution of follicles) and color Doppler (uterine and intraovarian vessels) analyses, and hormonal assay. In group II, significantly lower pulsatility index values than in group I were observed in the ovarian stromal arteries. The Ferriman-Gallwey score, plasma androstenedione level and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio results were significantly higher in group II than in group I. Androstenedione plasma levels correlated with the number of small follicles. Furthermore, the LH/FSH ratio correlated with both the number of small follicles and the stromal artery pulsatility index. The combined assessment of ovarian morphology by transvaginal ultrasound and color Doppler may provide insight into the pathological state of polycystic ovary syndrome.     

Ovarian enlargement as a possible marker of androgen activity in polycystic ovary syndrome.

This study has been carried out in an attempt to analyze clinical, hormonal and ultrasonography data and to evaluate their possible interrelationships in a group of 72 women with polycystic ovary syndrome (PCOS). Seventeen (23.6%) PCO women were found to have ovarian volume within normal range, while 72.2% had enlarged ovaries. Serum testosterone, androstenedione and DHEAS levels were higher in PCO women with enlarged ovaries when compared to patients who had ovarian volume within normal range, although the difference was not significant. However, when PCO patients were divided into subgroups according to the degree of ovarian enlargement, it was found that patients with the most enlarged ovaries had significantly higher serum androstenedione levels than those with normal ovarian volume (p = 0.039). Significant positive correlation was established between serum androstenedione concentration and ovarian volume (r = + 0.23, p less than 0.05). Hirsutism was found to be equally present in patients with normal ovarian volume (70.6%) and in patients with enlarged ovaries (71.2%) while oligomenorrhea was present more frequently among PCO women who had ovarian volume within normal range (64.7% vs. 40.4%). The results of our study allow us to suggest ovarian enlargement as a marker of excessive androgen production and disturbances of menstrual cycle in polycystic ovary syndrome.     

Blood flow changes in the ovarian and uterine arteries in women with normal and polycystic ovaries

This review summarizes the haemodynamic changes in the ovarian and uterine arteries, as revealed by transvaginal colour Doppler ultrasonography, (i) in women with normal ovaries (group 1), (ii) in women with the polycystic ovary syndrome who ovulate in response to clomiphene citrate (group 2) and (iii) in women with polycystic ovaries who have a regular ovulatory menstrual cycle (group 3). In each group blood flow velocities in the intraovarian arteries increased during the menstrual cycle in the dominant ovary and remained high in the mid-luteal phase. There was no significant change in pulsatility index. In group 2, the longitudinal haemodynamic changes in the intraovarian arteries were similar to those seen in women with normal ovaries. However, the follicular and ovarian stromal blood flow velocities were greater in group 2 compared with the normal group. There was a significant increase in the pulsatility index of the uterine artery during the follicular phase of the menstrual cycle and a subsequent decrease into the mid-luteal phase. Uterine artery pulsatility index was also significantly greater at the baseline ultrasound scan in group 2. In group 3, the longitudinal haemodynamic changes in the intraovarian arteries were similar to those in group 1. Furthermore, the intraovarian vascular changes were similar to those in group 2, but velocities were significantly greater than in group 1. There was an increase in uterine artery pulsatility index during the follicular phase of the menstrual cycle and a subsequent decrease into the mid-luteal phase. The uterine artery Doppler changes were similar to those seen in group 2. In conclusion, women with polycystic ovaries have significant differences in ovarian and uterine artery haemodynamics. Increased ovarian stromal blood flow within the polycystic ovary may help to explain the increased ovarian re-sponsiveness that women with polycystic ovaries show after administration of gonadotrophins.     

Blood flow changes in the ovarian and uterine arteries in women with normal and polycystic ovaries

This review summarizes the haemodynamic changes in the ovarian and uterine arteries, as revealed by transvaginal colour Doppler ultrasonography, (i) in women with normal ovaries (group 1), (ii) in women with the polycystic ovary syndrome who ovulate in response to clomiphene citrate (group 2) and (iii) in women with polycystic ovaries who have a regular ovulatory menstrual cycle (group 3). In each group blood flow velocities in the intraovarian arteries increased during the menstrual cycle in the dominant ovary and remained high in the mid-luteal phase. There was no significant change in pulsatility index. In group 2, the longitudinal haemodynamic changes in the intraovarian arteries were similar to those seen in women with normal ovaries. However, the follicular and ovarian stromal blood flow velocities were greater in group 2 compared with the normal group. There was a significant increase in the pulsatility index of the uterine artery during the follicular phase of the menstrual cycle and a subsequent decrease into the midluteal phase. Uterine artery pulsatility index was also significantly greater at the baseline ultrasound scan in group 2. In group 3, the longitudinal haemodynamic changes in the intraovarian arteries were similar to those in group 1. Furthermore, the intraovarian vascular changes were similar to those in group 2, but velocities were significantly greater than in group 1. There was an increase in uterine artery pulsatility index during the follicular phase of the menstrual cycle and a subsequent decrease into the mid-luteal phase. The uterine artery Doppler changes were similar to those seen in group 2. In conclusion, women with polycystic ovaries have significant differences in ovarian and uterine artery haemodynamics. Increased ovarian stromal blood flow within the polycystic ovary may help to explain the increased ovarian responsiveness that women with polycystic ovaries show after administration of gonadotrophins.     

Acne and hirsutism in polycystic ovary syndrome: clinical, endocrine-metabolic and ultrasonographic differences.

The aim of this study was to investigate whether the absence or presence of acne or hirsutism in 248 women with polycystic ovary syndrome was associated with different clinical, endocrine, metabolic and ultrasonographic factors. Patients were divided into three groups: 96 (38.7%) without any androgenic symptoms; 94 (37.9%) with only hirsutism; and 58 (23.4%) with only acne. The cycle alterations (oligomenorrhea or amenorrhea) and the echographic ovarian morphology (polycystic or multifollicular ovaries) showed no significant differences between the three groups. Hirsutism was associated with a greater incidence of obesity and insulin resistance, with an increase of 17-hydroxyprogesterone, ovarian and adrenal androgens, 3alpha-androstanediol glucuronide, insulin, insulin-like growth factor-I and low luteinizing hormone, sex hormone binding globulins and insulin-like growth factor binding protein-1 levels. Acne was associated only with the lowest 3alpha-androstanediol glucuronide levels. Therefore, two different pathogenetic mechanisms may play a role in the onset of acne and hirsutism.     

Polycystic ovaries--their ultrasonic diagnosis

Polycystic ovaries are present like a two type: peripheral and cystic form. At the first cystic formations are disposed subcapsularis, at the second they are in the stromal zone. To have polycystic ovary syndrome the patient must have polycystic ovaries on (MI ultrasound and one or more of the following: oligo/amenorrhea, hirsutism/acne, raised LH:FSH ratio, higher of 2.5 or raised circulation androgens. The LH:FSH ration is higher in patient--with peripheral form. The basal morphological changes for estimation of the ovarian structure are: doubly ovarian volume, approximately in 50%, increased in number of atretic follicules, 30% increased the cortical stroma and five enlarging of the medullar stroma. Early Doppler studies have demonstrated increased stromal vascularity if correlated with raised LH/FSH ratio and raised androgens level. It was found increased impedance in uterine artery and decreased of PI (pulsatility index). There are difference between patient with peripheral and cystic form on Doppler examinations. In the first group have lower pulsatility index in the ovarian artery, higher stromal vascularity and LH/FSH ratio and increased score 2. All present results of investigations determine the criteria to present ovarian structure in context of PCOS as using conventional and Doppler ultrasonographic.     

Clinical and Biochemical Evaluation of Patients with Hirsutism

Summary: Patients with moderate to severe hirsutism presenting over an 18-month period to an endocrine clinic were assessed by clinical evaluation and hormone measurements. Hair growth rate was estimated by a photographic technique and the severity of hirsutism graded using an objective scale. Of 43 patients, 9 had polycystic ovaries and the remainder were considered to have idiopathic hirsutism. The most severely affected group had significantly increased hair growth rates compared with less clinically affected subjects, and 47% of this group showed objective features of virilization. However, apart from a significantly higher 24-hr urine 17-ketosteroid excretion all other hormonal patterns were not significantly different between severely and mildly affected patients. Serum levels of testosterone (T), sex hormone-binding globulin (SHBG), free T (calculated from T and SHBG values), and androstenedione (A) were abnormal in 44%, 51%, 60% and 60% of patients respectively, whereas plasma levels of the specific adrenal androgen DHAS were increased in 40% of patients. There was an overlap between patients with elevated hormone levels, although isolated elevation of T, A or DHAS were seen in 9%, 19% and 3% of patients respectively. In 19% of patients all serum androgen measurements were normal. Gonadotrophin levels were significantly lower in the more severely affected group. Thus androgen levels in patients with idiopathic hirsutism or polycystic ovaries, show considerable overlap with measurements in normal subjects, and elevated plasma androgens may be of adrenal (DHAS) or combined adrenal/ovarian (T, A) origin.     

Correlation of the ultrasonic appearance of the ovaries in polycystic ovarian disease and the clinical, hormonal, and laparoscopic findings

The ovarian ultrasonic appearance in 20 patients with polycystic ovarian disease was studied and correlated to the clinical, hormonal, and laparoscopic findings. Ultrasound studies showed that both ovaries were enlarged in 15 patients (15.46 +/- 2.5 cm3). Maximum ovarian surface area was 9.75 +/- 3.38 cm2. Three ultrasonic patterns were detected: (1) isoechoic, with no discernible cysts (four patients); (2) hypoechoic, with multiple small cysts of less than 1 cm (11 patients); (3) hypoechoic, with single cyst of greater than 1 cm (five patients). Ultrasonic estimation of ovarian size was superior to clinical assessment and equal to that of laparoscopic examination. Subtle differences existed between the ultrasonic appearance of the ovaries in hyperprolactinemic subgroups of polycystic ovarian disease compared to normoprolactinemic ones. However, no significant relationship was found between the ovarian size and any of the hormones studied. Obesity, amenorrhea, hirsutism, hyperprolactinemia, and elevated testosterone and dehydroepiandrosterone sulfate levels were more common in the group with enlarged ovaries, whereas oligomenorrhea, elevated luteinizing hormone/follicle-stimulating hormone ratio, and elevated androstenedione and estrone levels occurred more frequently in the group with normal-sized ovaries. The value of ultrasound studies in the management of polycystic ovarian disease is emphasized.     

Plasma homocysteine, fasting insulin, and androgen patterns among women with polycystic ovaries and infertility

OBJECTIVE: To measure plasma homocysteine, androgen, and insulin concentrations in women with normal and polycystic-appearing ovaries in an infertility setting. METHODS: Among women referred for infertility evaluation (n = 54), homocysteine, androstenedione, DHEAS, total testosterone, fasting insulin/glucose and methyltetrahydrofolate reductase (MTHFR) polymorphism status (C677T mutation) were studied. Ovaries were examined via transvaginal sonogram by one observer and scored as either normal (n = 18) or polycystic (n = 36). RESULTS: When polycystic ovaries were identified, mean total testosterone was significantly higher than when non-polycystic ovaries were present (p = 0.01), although no measured androgen was outside the normal reference range in either group. Average BMI was higher in the polycystic group, but the difference was not significant (p = 0.10). We observed a trend toward higher mean fasting insulin levels in women with polycystic ovaries, but this increase did not reach statistical significance (p = 0.07). Median plasma homocysteine was identical (7.0 mmol/l) in both populations, and no study subject exceeded the current recommended maximum reference value. CONCLUSIONS: In this population, the presence of polycystic ovaries was associated with higher serum androgens (especially total testosterone) although none of the measured androgens were above the normal range. While fasting insulin levels were also higher in this group, median plasma homocysteine levels were similar irrespective of ovarian morphology. Concomitant plasma homocysteine derangements in this population of young, lean patients with polycystic-appearing ovaries seem unlikely. Further studies are needed to clarify the role(s) of homocysteine in human reproductive physiology.     

Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome?

OBJECTIVE: Our purpose was to determine the prevalence of adrenal hyperandrogenism and insulin resistance in patients with hyperandrogenic chronic anovulation, also called polycystic ovary syndrome, living in the United States, Italy, and Japan. STUDY DESIGN: Seventy-five women with polycystic ovary syndrome, 25 each from the United States, Italy, and Japan, and 10 ovulatory controls were studied. Hirsutism, obesity, and the presence of cystic ovaries were assessed, as were blood levels for estrogen, luteinizing hormone, testosterone, adrenal androgens, and insulin. All patients received an insulin tolerance test to assess insulin resistance. RESULTS: Women from Japan were less obese (p < 0.05) and did not have hirsutism, although the percentage of cystic ovaries (68% to 80%) was comparable. Serum luteinizing hormone, testosterone, and estradiol were similar, but levels of 3 alpha-androstanediol glucuronide, which was elevated in women from the United States and Italy, was normal in women from Japan. The adrenal androgens, dehydroepiandrosterone sulfate and 11 beta-hydroxyandrostenedione were elevated in 48% to 64% of the patients and by a similar percentage in the three groups. Fasting insulin was elevated in all groups, but was significantly higher in women from the United States and Italy compared with women from Japan (p < 0.05). However, insulin resistance as assessed by dissociation constant of insulin tolerance test values was significantly elevated but similar in the three groups and occurred in 68% to 76% of patients. CONCLUSION: In polycystic ovary syndrome, although obesity and hirsutism vary according to dietary, genetic, and environmental factors, the prevalence of adrenal androgen excess and insulin resistance appear to be fairly uniform. These results suggest that these factors may be involved in the pathophysiologic features of the disorder.     

多囊卵巢综合征病理生理的一些新认识

多囊卵巢综合征（PCOS）是以长期无排卵及高雄激素为特征的内分泌综合征,以不孕、多毛、无排卵、月经不调等为主要临床表现。PCOS超声下卵巢呈明显多囊性改变,并伴促性腺激素分泌异常。雄激素过多合成在PCOS发病中起关键性作用,膜细胞对颗粒细胞反应性增高、垂体分泌促黄体激素增多以及高胰岛素血症可能是卵巢雄激素合成过多的机制。胰岛素抵抗和肥胖的出现则可能使PCOS临床症状加剧。雄激素、胰岛素、促性腺激素和肥胖间的相互作用促成PCOS患者的生殖表型。     

Acne and hirsutism in polycystic ovary syndrome: clinical,endocrine–metabolic and ultrasonographic differences

The aim of this study was to investigate whether the absence or presence of acne or hirsutism in 248 women with polycystic ovary syndrome was associated with different clinical, endocrine, metabolic and ultrasonographic factors. Patients were divided into three groups: 96 (38.7%) without any androgenic symptoms; 94 (37.9%) with only hirsutism; and 58 (23.4%) with only acne. The cycle alterations (oligomenorrhea or amenorrhea) and the echographic ovarian morphology (polycystic or multifollicular ovaries) showed no significant differences between the three groups. Hirsutism was associated with a greater incidence of obesity and insulin resistance, with an increase of 17-hydroxyprogesterone, ovarian and adrenal androgens, 3α-androstanediol glucuronide, insulin, insulin-like growth factor-I and low luteinizing hormone, sex hormone binding globulins and insulin-like growth factor binding protein-1 levels. Acne was associated only with the lowest 3α-androstanediol glucuronide levels. Therefore, two different pathogenetic mechanisms may play a role in the onset of acne and hirsutism.     

The androgenic profile of women with non-insulin-dependent diabetes mellitus

OBJECTIVE: To evaluate the androgenic profile of women with non-insulin-dependent diabetes mellitus. STUDY DESIGN: This case-control study evaluated the clinical, hormonal and ultrasonographic characteristics of women of reproductive age with non-insulin-dependent diabetes mellitus and compared them with those of age- and weight-matched controls. Radioimmunoassays were used for total testosterone, estradiol, dehydroepiandrosterone sulfate (DHEAS) and androstenedione. Sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicle stimulating hormone (FSH) were analyzed by fluoroimmunoassays. Ovarian appearance and volume were assessed by transvaginal or transabdominal ultrasonography. RESULTS: The prevalence of polycystic ovary syndrome was higher in diabetic patients than in the general population as reported earlier. Hirsutism was also more prevalent in diabetic patients (p < 0.05). The serum levels of FSH, LH, estradiol, total testosterone, androstenedione and DHEAS were significantly higher in diabetic patients than in the control group (p < 0.05). In contrast, the levels of SHBG were lower in diabetic patients (p < 0.05). The rates of ultrasonographically apparent polycystic ovaries and greater ovarian volumes were also higher in diabetic patients (p < 0.05). CONCLUSION: Women with non-insulin-dependent diabetes mellitus seem to have biochemical and clinical hyperandrogenism when compared with nondiabetic controls.     

Do polycystic-appearing ovaries affect the risk of cardiovascular disease among women with polycystic ovary syndrome?

OBJECTIVE: To determine if polycystic-appearing ovaries (PAO) are associated with differences in risk factors for cardiovascular disease among women with polycystic ovary syndrome (PCOS). DESIGN: Case-control sub-study. SETTING: Division of Reproductive Endocrinology, Magee-Womens Hospital. PATIENT(S): Women with PCOS (n = 63) and non-PCOS controls (n = 56). INTERVENTION: Transvaginal ultrasonography and single sample venipuncture. MAIN OUTCOME MEASURE(S): Ultrasound ovarian appearance, fasting insulin, lipoproteins, androgens, LH/FSH ratio, anthropomorphic measurements, and blood pressure. RESULT(S): Women with PCOS had higher androgen and fasting insulin levels, a more adverse lipid profile, greater waist-hip and LH/FSH ratios, and a larger ovarian volume than controls. Thirty-three percent of the cases with PCOS, but only 5% of controls, showed PAO on ultrasound study (P<.01). PCOS cases with and without PAO had comparable levels of fasting insulin, lipids, and blood pressures. PCOS cases with PAO had a higher LH/FSH ratio (P=.028), increased levels of serum androstenedione (P=.029) and testosterone (P=.055), and greater ovarian volume (P=.024) compared to non-PAO patients. CONCLUSION: Women with PCOS have greater cardiovascular risk than controls. Within PCOS cases, however, the ultrasound appearance of polycystic ovaries does not appear to further intensify the cardiovascular disease risk profile of these women.     

Hyperinsulinemia in polycystic ovary disease.

OBJECTIVE: To evaluate the prevalence of hyperinsulinemia and insulin resistance in women with polycystic ovary disease (PCOD). STUDY DESIGN: Forty women with clinical and biochemical evidence of PCOD and 20 with regular menstrual cycles were studied prospectively. All women underwent a three-hour oral glucose tolerance test following a 100-g glucose load. Plasma sugar and insulin levels were measured. RESULTS: The one-, two- and three-hour insulin values were significantly higher in women with PCOD. The sum insulin, cumulative insulin, peak insulin and area under the insulin response curve were similarly higher in women with PCOD than in the controls. The presence of hirsutism was more often associated with hyperinsulinemia and insulin resistance, but body mass index and menstrual irregularity were not. CONCLUSION: Hyperinsulinemia and insulin resistance seem to be commonly associated with PCOD.