Endocrine abnormalities in ovulatory women with polycystic ovaries on ultrasound

Polycystic-appearing ovaries (PAO) on ultrasound have been described in avariety of endocrinopathies and also occur in ovulatory women. By someinvestigators this is merely referred to as 'PCO' (polycystic ovaries).Although there is controversy in this regard, we do not consider women withPAO/PCO who have no known endocrine disturbance to have polycystic ovarysyndrome (PCOS) and therefore prefer not to use the term 'PCO' which isoften equated with PCOS. We studied 15 ovulatory women withnormal-appearing (NAO) ovaries on ultrasound and 15 matched ovulatory womenwith PAO/PCO. Compared to ovulatory women, 25 other women were studied whowere considered to have PCOS. Of these, 15 were overweight and 10 were ofnormal weight. All the PCOS women had serum concentrations of luteinizinghormone (LH), testosterone, unbound testosterone, androstenedione anddihydroepiandrosterone sulphate (DHEAS) which were significantly higher (P< 0.01) than values in the normal women, regardless of ovarianmorphology. These values were similar in the two groups of ovulatory womenwith NAO and PAO/PCO. Fasting insulin was elevated in women with PCOS withincreased body weight (P < 0.01) and was higher than in ovulatory womenwith NAO and PAO/PCO and than in women of normal weight with PCOS. Seruminsulin- like growth factor (IGF)-I and binding protein (BP)-3 were similarin all groups but serum IGFBP-1 was significantly (P < 0.01) lower inthose women with PCOS with increased body weight, compared to all othergroups. Compared to values in ovulatory women with NAO, serum IGFBP-1 wasalso significantly (P < 0.05) lower in women with PAO/PCO and thosewomen with PCOS of normal weight. These lower values were similar in womenwith PAO/PCO and in normal weight women with PCOS. On an individual basis,an elevation of at least one serum androgen value was found in 33% of womenwith PAO/PCO. These data confirm that increased body weight accentuates themetabolic alterations in PCOS, but suggest that subtle endocrinedisturbances, similar to those that are found in PCOS, may be uncovered inup to a third of ovulatory women with PAO/PCO. It appears that adisturbance of the IGF/IGFBP-1 axis is common and apparently closelyassociated with alterations in ovarian morphology.