Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome

Increased frequency of the DI genotype of the angiotensin-I converting enzyme and association of the II genotype with insulin resistance in polycystic ovary syndrome

OBJECTIVE

The polycystic ovary syndrome (PCOS) is a common and complex disease with unclear pattern of inheritance, characterized by an androgen excess, while hyperinsulinemia and insulin resistance (IR) are common features of the syndrome. The angiotensin I converting enzyme (ACE) insertion (I)/deletion (D) gene polymorphism was proved to be involved in many pathophysiological conditions, including hypertension and IR.

DESIGN

The purpose of this study was to evaluate the involvement of the ACE gene polymorphism in the pathogenesis of PCOS.

METHODS

In a case-control association study involving 801 PCOS women and 266 healthy controls, hormonal determinations and ACE polymorphism genotyping were performed. The PCOS women were classified into three groups: Group A presented biochemical hyperandrogenism, combined with anovulation and polycystic ovarian morphology; Group B, clinical hyperandrogenism combined with anovulation and polycystic ovarian morphology; and Group C, chronic anovulation and polycystic ovarian morphology.

RESULTS

A significant increase in the frequency of the DI genotype of the ACE polymorphism was detected in PCOS women as a whole (P=0.035), in PCOS Group A (P=0.039) and Group B (P=0.010), while there was no difference in Group C (P=0.939). Significant difference was also observed in hyperandrogenic PCOS women as a whole (Group A+B) (P=0.017). The II genotype was positively correlated with HOMA-IR and QUICKI and with fasting insulin and glucose/insulin ratio in these groups.

CONCLUSIONS

The association study of the ACE I/D polymorphism in PCOS women demonstrates an increase in the DI genotype incidence and an association of the II genotype with IR.

Polycystic ovary syndrome: infertility, cardiovascular, metabolic and obstetrical risks, laboratory and clinical outcomes -- the PICOLO Study

OBJECTIVES

The primary objective of this multicenter study is to evaluate the relative impact of insulin resistance (IR) and body mass index (BMI) in women with polycystic ovary syndrome (PCOS) on (1) Key hemodynamic/thrombogenic variables, (2) Oocyte quality and early embryo development, (3) Fetal growth, placental function and adverse obstetric outcome.

SECONDARY OBJECTIVE

To establish a PCOS database and biobank facilitating future basic and interventional research related to PCOS.

DESIGN

A cross-sectional and longitudinal cohort study at four University Hospitals in Denmark. POPULATION INCLUSION: About 200 women fulfilling the Rotterdam Criteria and 100 women without PCOS recruited from 2010 to 2012.

METHODS

The impact of PCOS, as well as the impact of IR and BMI on the hormonal, metabolic and hemostatic key variables will be analyzed combining conventional, molecular techniques and selected gene analysis. Oocytes will be characterized by gene expression of granulosa and cumulus cells and the early embryo development will be followed by time lapse microscopy. Fetal growth will be assessed by repeated ultrasound measurements, and the pregnancy outcome compared to maternal and fetal biochemical markers of growth and inflammation and clinical pregnancy complications.

MAIN OUTCOME MEASURES

Metabolic and hemostatic risk-biomarkers, oocyte and embryo quality, adverse pregnancy outcome, fetal growth and placental function in women with PCOS.

The influence of obesity on androstenedione to testosterone ratio in women with polycystic ovary syndrome (PCOS) and hyperandrogenemia

The aim of the present study was to evaluate the impact of obesity and insulin resistance on testosterone formation from androstenedione and its contribution to biochemical hyperandrogenemia in all different phenotypic subgroups of PCOS patients. The case-control study included 1087 PCOS women and 206 regularly menstruating, ovulatory controls. The main clinical measurements included anthropometric and basal hormonal characteristics and evaluation of hyperandrogenic and insulin resistance-related features. The results were the following: In PCOS women with biochemical hyperandrogenemia, obesity significantly lowers serum A levels and increases T to A ratio. These findings were not present in PCOS women with clinical hypeandrogenemia and in normal ovulatory controls.

A randomized controlled trial of the effect of rosiglitazone and clomiphene citrate versus clomiphene citrate alone in overweight/obese women with polycystic ovary syndrome

BACKGROUND

In women suffering from polycystic ovary syndrome, correction of hyperinsulinemia results in enhanced responsiveness to ovulation induction agents. The effect of rosiglitazone was investigated on ovulation induction in obese women with PCOS.

MATERIALS AND METHODS

A randomized controlled trial was set up. One hundred women were randomly assigned. Group A (n = 46) received rosiglitazone 4 mg b.i.d. plus clomiphene citrate (CC) 100 mg on cycle days 3-7. Group B (n = 45) received CC only. Primary outcome was ovulation. Secondary outcomes included pregnancy as well as changes in fasting glucose and insulin.

RESULTS

Both groups were similar with respect to background and hormonal characteristics (age, duration of infertility, BMI, WHR, FSH, LH, E2, testosterone, fasting glucose and insulin). The cumulative ovulation rate over 12 weeks was significantly higher in group A (81.8%) than in group B (55.2%) (p < 0.001), whereas the difference in cumulative pregnancy rate was not statistically significant (30.4% versus 28.8%, respectively) in groups A and B (p = 0.946). Fasting insulin levels significantly declined after rosiglitazone therapy (p < 0.001) without change in glucose levels this resulted in normalization of the mean glucose to insulin ratio.

CONCLUSIONS

Short term administration of rosiglitazone to overweight and obese PCOS women results in enhancement of CC induced ovulation as well as improvement of insulin sensitivity.

Recent advances in cardiovascular aspects of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) has been associated with increased cardiovascular risk (CVR) markers, but population studies have not clarified whether there is an increase in cardiovascular morbidity and mortality. Four different PCOS phenotypes resulted from the Rotterdam criteria that may differ in their CVR potential, thus introducing further complexity. This has led to studies using surrogate CVR markers including biomarkers in blood and imaging such as flow-mediated vasodilatation. In PCOS, both peripheral and central insulin resistance (IR) have been shown. Weight loss has been shown to improve IR and visceral fat, while insulin sensitizer therapies with metformin or thiazolidinediones improve IR and endothelial dysfunction. IR is also found in non-alcoholic fatty liver disease that in turn is very common in PCOS; studies have suggested that IR may be improved by treatment with metformin and omega-3 fish oils. PCOS patients have a more dyslipidemic phenotype that is worse in 'classical PCOS' associated with a higher CVR. Studies with atorvastatin and simvastatin have reported a decrease in the lipid parameters and an improvement in CVR indices including IR, but it is unclear whether this is due to their lipid-lowering action or a pleiotropic effect of the statin. In this expert opinion review, the relevant literature published during the last 2 years was considered. It focuses on some recent important data that has emerged while also exposing the gaps that remain in our knowledge that need to be addressed.

Polycystic ovary syndrome and diabetes screening: a survey of gynecologists and reproductive endocrinologists

OBJECTIVES

Women with polycystic ovary syndrome (PCOS) are at high risk of developing type 2 diabetes mellitus. The purpose of this study was to assess self-reported methods used by specialists in obstetrics and gynecology (OB/GYN) and in reproductive endocrinology and infertility (REI) to screen for type 2 diabetes in women with PCOS.

STUDY DESIGN

We analyzed responses to a web-based survey of from 123 OB/GYN and 223 REI physician members of the American Society for Reproductive Medicine.

RESULTS

Initial diabetes screening of all women with PCOS was performed by fewer OB/GYNs (57%) than REIs (71%). Approximately 1/3 of both groups reported initial screening only for those with additional risk factors, and 3% reported no screening. Re-screening for diabetes was reportedly performed by similar numbers of OB/GYNs (49%) and REIs (53%). Re-screening was reportedly not performed by the remaining 51% of OB/GYNs and 47% of REIs. For initial screening, the 2h glucose tolerance test (GTT) was reportedly used by fewer OB/GYNs than REIs (59% vs 72%), fasting plasma glucose (FPG) by more OB/GYNs (22% vs 8%), and hemoglobin A1c (HbA1c) by a similar number (19% vs 20%). For re-screening, GTT was reportedly used by a similar proportion of OB/GYNs and REIs (27% vs 32%), FPG was used more by OB/GYNs (43% vs 23%), and HbA1c was used less (30% vs 45%).

CONCLUSIONS

Not all OB/GYN and REI respondents followed diabetes screening guidelines for women with PCOS. Screening rates for women with PCOS might be increased by continued educational efforts concerning their high risk for diabetes, and by the recent recommendation to use HbA1c for diabetes screening in high-risk populations.

The comparison of insulin resistance frequency in patients with recurrent early pregnancy loss to normal individuals

Background

Patients with ≥ 3 recurrent spontaneous miscarriages are classified as having RSM. Polycystic ovary syndrome (PCOS) is associated with insulin resistance (IR). The purpose of this study is to evaluate the association of IR and RMS.

Methods

Present case- control prospective study was performed on 100 women in control group (with a history of at a live birth and no history of one more abortion) and study group (with a history of ≥ 3 RMS) who were not diabetes and PCOS. Two groups matched in base of age and body mass index. Blood was withdrawn from the case and control patients for the determination of the fasting blood glucose (FG), fasting insulin (FI) levels and ultrasonography was performed on all the patients.

Results

The observed differences between age, FG and FG to FI ratio levels in case and control groups were not significant (p > 0.05) but it was significant about fasting insulin (p = 0.0119). FI of < 20 μu/ml or ≥ 20 μu/ml in case and control group was significant (Chi-square: 4.083, p: 0.0433, odds ratio: 4.4386, CI95% = 1.1541 to 17.0701), whereas the difference between absolute and proportional frequency of patients with FG to FI ratio of < 4.5 and ≥ 4.5 in case and control groups was not significant (Chi-square: 2.374, p = 0.123).

Conclusion

Current study showed that in women with RPL, in Iranian race like Americans, frequency of insulin resistance in high, therefore there is a probability of the degree of insulin resistance in women with RPL.

Four polymorphisms of the CAPN 10 gene and their relationship to polycystic ovary syndrome susceptibility: a meta-analysis

OBJECTIVE

  To investigate the association between CAPN 10 gene polymorphism and polycystic ovary syndrome (PCOS) susceptibility.

DESIGN

Meta-analysis of published case-control studies of four single nucleotide polymorphisms (SNPs) in CAPN 10 and PCOS susceptibility.

PATIENTS

  Women with PCOS.

MEASUREMENTS

  Odds ratios (ORs) and 95% confidence intervals (CIs) for heterozygous, homozygous, dominant model, recessive model and allele.

RESULTS

  A total of 11 studies were involved in the meta-analysis. UCSNP-63 was significantly associated with PCOS, with homozygous carriers (TT vs CC: OR = 0·64; 95% CI: 0·45-0·90) and recessive model (TT vs CC and CT: OR = 0·64; 95% CI: 0·45-0·90) being protective factors. In addition, UCSNP-19 was significantly associated with PCOS, with recessive model (ins/ins vs del/del and del/ins: OR = 0·72, 95% CI: 0·59-0·88) and insert allele (ins vs del: OR = 0·85, 95% CI: 0·76-0·96) being protective factors, while heterozygous carriers (del/ins vs del/del: OR = 1·56, 95% CI: 1·24-1·94) and deletion allele (del vs ins: OR = 1·18, 95% CI: 1·04-1·32) being risk factors. However, no significant associations were found between UCSNP-44, -43 and PCOS. Moreover, the results of the Rotterdam criteria subgroup analysis were similar with that of overall analysis.

CONCLUSIONS

  This is the first report on the association between CAPN 10 UCSNP-63 and PCOS in genotype, with homozygous carriers and recessive model being protective factors. Additionally, insert allele and recessive model of UCSNP-19 are protective factors, while deletion allele and heterozygous genotype are risk factors for PCOS development.

The impact of intensified exercise training on insulin resistance and fitness in overweight and obese women with and without polycystic ovary syndrome

OBJECTIVE

  To evaluate mechanisms of insulin resistance (IR) in overweight and obese women with and without polycystic ovary syndrome (PCOS) and explore relationships between IR, fitness and body mass index (BMI) at baseline and following exercise intervention.

DESIGN

  Prospective controlled intensified exercise intervention study.

PATIENTS

  A total of 20 overweight (BMI > 25 kg/m(2) ) and obese (>30 kg/m(2) ), reproductive-aged PCOS women and 13 non-PCOS overweight, healthy controls of comparable BMI and age were studied at baseline. Measures were repeated in 13 PCOS and eight control women following three 1-h exercise sessions per week over 12 weeks.

MEASUREMENTS

  Insulin resistance was measured by glucose infusion rate on euglycaemic hyperinsulinaemic clamp, and fitness was assessed by VO(2max) .

RESULTS

  At baseline, PCOS women were 46% more insulin resistant than controls (175·6 vs 257·2 mg/m(2) /min, P < 0·05) with IR independently associated with VO(2max) and BMI in the PCOS group only (P < 0·01). Postexercise IR improved across both groups (P < 0·01). In PCOS women, IR improved by 16% (P < 0·05) but was not restored to the same level as controls (P < 0·05). Improvement in IR and in VO(2max) was related to the PCOS group (r(2)  = 0·85, P < 0·05), yet change in IR and in fitness was not related. No associations were found in controls.

CONCLUSIONS

  While intensified exercise improves IR in PCOS women, a higher IR persisted following exercise in PCOS women, and a clear relationship between improved IR and improved fitness was not found. Therefore, other mechanisms of, and therapies for, IR must be explored in PCOS as IR remains higher than observed in non-PCOS controls.

Polycystic Ovary Syndrome and Chronic Inflammation: Pharmacotherapeutic Implications

Objective:

To examine the relationship between polycystic ovary syndrome (PCOS), cardiovascular risk factors, cardiovascular disease (CVD), and chronic inflammation and analyze data regarding pharmacologic therapies that are recommended to reduce CVD risk in PCOS and the impact of those therapies on chronic inflammation.

Data Sources:

A search of MEDLINE (1950-October 2011) was conducted to identify clinical studies pertaining to the identification and treatment of CVD and chronic low-grade inflammation in PCOS, Search terms included polycystic ovary syndrome, cardiovascular disease, inflammation, metformin, thiazolidinedione, and statin. Bibliographies of these studies and review articles were also examined.

Study Selection and Data Extraction:

English-language clinical studies evaluating the effect of metformin, thiazolidinediones, and statins on inflammatory markers, endothelial function, adhesion molecules, fibrinolysis, cytokines, and adipokines in PCOS were included.

Data Synthesis:

Women with PCOS have an increased prevalence of many cardiovascular risk factors including obesity, android fat distribution, insulin resistance, impaired glucose tolerance, diabetes, dyslipidemia, hypertension, and metabolic syndrome. Markers of chronic low-grade inflammation, which are associated with an increased risk of CVD, are also elevated in PCOS. Clinical guidelines recommend the use of insulin sensitizers and statins to prevent CVD in some patients with PCOS. Current literature indicates that each of these medication classes has beneficial effects on inflammation, as well. Although there are currently no studies to determine whether these treatments decrease CVD in PCOS, it can be hypothesized that drugs impacting chronic inflammation may reduce cardiovascular risk. Some studies show that metformin, thiazolidinediones, and statins have beneficial effects on inflammatory markers in PCOS; however, the data are inconsistent.

Conclusions:

There is insufficient information to recommend any pharmacologic therapies for their antiinflammatory effects in PCOS in the absence of other indications such as diabetes and dyslipidemia.

The effects of old, new and emerging medicines on metabolic aberrations in PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age that is associated with significant adverse short- and long-term health consequences. Multiple metabolic aberrations, such as insulin resistance (IR) and hyperinsulinaemia, high incidence of impaired glucose tolerance, visceral obesity, inflammation and endothelial dysfunction, hypertension and dyslipidemia are associated with the syndrome. Assessing the metabolic aberrations and their long term health impact in women with PCOS is challenging and becomes more important as therapeutic interventions currently available for the management of PCOS are not fully able to deal with all these consequences. Current therapeutic management of PCOS has incorporated new treatments resulting from the better understanding of the pathophysiology of the syndrome. The aim of this review is to summarize the effect of old, new and emerging therapies used in the management of PCOS, on the metabolic aberrations of PCOS.

Plasma plasminogen activator inhibitor-1 levels in the different phenotypes of the polycystic ovary syndrome

We aimed to evaluate plasma plasminogen activator inhibitor-1 (PAI-1) antigen levels in women with polycystic ovary syndrome (PCOS) and different levels of adiposity and PCOS phenotypes. We studied 199 women with PCOS and 50 age-matched healthy women divided in normal weight (n=100 and n=25, respectively) and overweight/obese (n=99 and n=25, respectively). Normal weight and overweight/obese patients with PCOS were further divided in patients diagnosed according to the 1990 criteria (i.e. with anovulation and hyperandrogenemia; 1990 criteria group) and in patients with the additional phenotypes introduced in 2003 (i.e. with polycystic ovaries and either anovulation or hyperandrogenemia; additional 2003 criteria group). In normal weight subjects, plasma PAI-1 levels did not differ between women with PCOS (regardless of group) and controls, or between the 1990 criteria and the additional 2003 criteria groups of PCOS. In overweight/obese subjects, plasma PAI-1 levels were higher in both the 1990 criteria and the additional 2003 criteria groups of PCOS compared with controls (p<0.001 and p=0.004, respectively), but did not differ between the 1990 criteria and the additional 2003 criteria groups of PCOS. In conclusion, plasma PAI-1 levels are elevated in overweight/obese women with PCOS but not in normal weight women with this syndrome. Plasma PAI-1 levels do not differ between the phenotypes of PCOS.

Increased plasma viscosity in young women with polycystic ovary syndrome using an oral contraceptive containing 35 μg ethinyl estradiol and 2 mg cyproterone acetate

OBJECTIVES

To investigate the influence of 6 months of treatment with an oral contraceptive (OC) containing 35 μ g ethinyl estradiol and 2 mg cyproterone acetate on plasma viscosity (PV) in young women with polycystic ovary syndrome (PCOS).

DESIGN

Patients with PCOS were assessed for PV before and after 6 months of treatment with an OC containing 35 μg ethinyl estradiol and 2 mg cyproterone acetate. PV was determined by a viscometer Type 53610/I SCHOTT-Instruments, Mainz at 37°C.

SETTINGS

Subjects were recruited from the Department of Obstetrics and Gynaecology, Division of Reproductive Endocrinology at the University Hospital of Patras, Greece.

PATIENTS

The study included 66 young women with PCOS.

MAIN OUTCOME MEASURES

PV.

RESULTS

In PCOS women as a whole, PV at baseline was 1.249 ± 0.049 mm(2)/s (n = 66). After 6 months of treatment with an OC containing 35 μg ethinyl estradiol and 2 mg cyproterone acetate, PV was increased to 1.268 ± 0.065 mm(2)/s (p = 0.038). The difference between PV before and after 6 months of treatment with an OC containing 35 μg ethinyl estradiol and 2 mg cyproterone acetate (Δviscosity) was 0.01864 ± 0.071452 mm(2)/s. ΔViscosity was related to ?fibrinogen (r = 0.270, p = 0.046), to Δhematocrit (r = 0.514, p = 0.09) and to Δtriglycerides (r = 0.292, p = 0.021).

CONCLUSION

Young women with PCOS presented an increased PV under OC treatment with 35 μg ethinyl estradiol and 2 mg cyproterone acetate.

State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS)

PCOS, a heterogeneous disorder characterized by cystic ovarian morphology, androgen excess, and/or irregular periods, emerges during or shortly after puberty. Peri- and post-pubertal obesity, insulin resistance and consequent hyperinsulinemia are highly prevalent co-morbidities of PCOS and promote an ongoing state of excess androgen. Given the relationship of insulin to androgen excess, reduction of insulin secretion and/or improvement of its action at target tissues offer the possibility of improving the physical stigmata of androgen excess by correction of the reproductive dysfunction and preventing metabolic derangements from becoming entrenched. While lifestyle changes that concentrate on behavioral, dietary and exercise regimens should be considered as first line therapy for weight reduction and normalization of insulin levels in adolescents with PCOS, several therapeutic options are available and in wide use, including oral contraceptives, metformin, thiazolidenediones and spironolactone. Overwhelmingly, the data on the safety and efficacy of these medications derive from the adult PCOS literature. Despite the paucity of randomized control trials to adequately evaluate these modalities in adolescents, their use, particularly that of metformin, has gained popularity in the pediatric endocrine community. In this article, we present an overview of the use of insulin sensitizing medications in PCOS and review both the adult and (where available) adolescent literature, focusing specifically on the use of metformin in both mono- and combination therapy.

The quantitative insulin sensitivity check index is not able to detect early metabolic alterations in young patients with polycystic ovarian syndrome

OBJECTIVE

To verify whether QUICKY is a suitable method for the identification of metabolic deterioration in normal weight patients affected by polycystic ovarian syndrome (PCOS).

DESIGN

Prospective clinical study.

PATIENT(S)

Seventy-nine PCOS normal weight adolescent subjects, 50 eumenorrheic, normal weight, non-hirsute controls matched for age and BMI.

METHOD(S)

Quantitative insulin sensitivity check index (QUICKY) and integrated secretory area under the curve of insulin values (I-AUC) during oral glucose tolerance test were calculated.

RESULT(S)

Seventy-nine PCOS and 50 controls were studied. Normal insulin sensitivity was defined as upper control 95th percentile by QUICKY values <0.31, I-AUC at 180 min < 16,645. When applying the calculated I-AUC cut-off, 41 PCOS were classified as normoinsulinemic and 38 as hyperinsulinemic, whereas using the calculated QUICKY cut-off, only 19 PCOS could be classified as insulin resistant (IR). Fifteen out of the 60 non-IR PCOS presented hyperinsulinemia; fasting glucose and insulin levels and QUICKY were not sufficient to identify these subjects. Thus, QUICKY displayed a low sensitivity (44%) and specificity (91%) in the diagnosis of the metabolic disorder disclosed by I-AUC. CONCLUSIONS.: In young normal weight patients with PCOS the prevalence of early alterations of insulin metabolism are not detectable by QUICKY studies.

Obesity and insulin resistance in women with polycystic ovary syndrome

OBJECTIVE

To evaluate the impact of obesity and various phenotypes of polycystic ovary syndrome (PCOS) on the insulin sensitivity index (ISI) and insulin resistance (IR).

METHODS

ISI and IR from 273 women in four phenotypes of PCOS and control groups were evaluated retrospectively.

RESULTS

The ISI and the percentage of IR were not significantly different among discrete phenotypes of PCOS groups and normal controls. Obesity (OR = 14.0, 95% CI (Confidence Interval), 7.5-26.5) results in a higher risk for developing insulin resistance than hyperandrogenemia (OR = 2.1, 1.3-3.6), oligomenorrhea (OR = 1.8, 1.0-3.3) and polycystic ovary morphology (PCOM) (OR = 1.4, 0.8-2.7).

CONCLUSION

The ISI did not differ significantly among the various phenotypes of PCOS. In comparison with hyperandrogenemia, chronic anovulation, and PCOM, obesity was the dominant risk factor in determining insulin resistance in women with PCOS.

Polycystic ovary syndrome: etiology, pathogenesis and diagnosis

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, with a prevalence of up to 10%. Various diagnostic criteria have been proposed, generally centered around the features of hyperandrogenism and/or hyperandrogenemia, oligo-ovulation and polycystic ovarian morphology. Insulin resistance is present in a majority of cases, with compensatory hyperinsulinemia contributing to hyperandrogenism via stimulation of ovarian androgen secretion and inhibition of hepatic sex hormone-binding globulin production. Adipose tissue dysfunction has been implicated as a contributor to the insulin resistance observed in PCOS. Environmental and genetic factors also have a role in the development of PCOS. The syndrome is associated with numerous morbidities, including infertility, obstetrical complications, type 2 diabetes mellitus, cardiovascular disease, and mood and eating disorders. Despite these morbidities, PCOS may be common in our society owing to evolutionary advantages of the syndrome in ancient times, including smaller family sizes, reduced exposure to childbirth-related mortality, increased muscle mass and greater capacity to store energy. The diagnosis of PCOS hinges on establishing key features while ruling out other hyperandrogenic or oligo-ovulatory disorders. Treatment is focused on the goals of ameliorating hyperandrogenic symptoms, inducing ovulation and preventing cardiometabolic complications.

IL-6 serum levels and production is related to an altered immune response in polycystic ovary syndrome girls with insulin resistance

Polycystic ovarian syndrome (PCOS) is frequently characterized by obesity and metabolic diseases including hypertension, insulin resistance, and diabetes in adulthood, all leading to an increased risk of atherosclerosis. The present study aimed to evaluate serum and production of inflammatory markers in adolescent Sardinian PCOS. On the basis of HOMA findings, patients were divided into noninsulin resistant (NIR) and insulin resistant (IR), and were weight- and age-matched with healthy girls. Inflammatory cytokines (TNF-α, IL-6, Il-10, TGF-β) and lipokines (leptin, adiponectin), the reactant hs-CRP, and in vitro inflammatory lympho-monocyte response to microbial stimulus were evaluated. In healthy and PCOS subjects, leptin and hs-CRP were correlated with BMI, whereas adiponectin was significantly reduced in all PCOS groups. Although cytokines were similar in all groups, Interleukin-6 (IL-6) was significantly higher in IR PCOS. Moreover, in the latter group lipopolysaccharide-activated monocytes secreted significantly higher levels of IL-6 compared to NIR and control subjects. To conclude, IR PCOS displayed increased IL-6 serum levels and higher secretion in LPS-activated monocytes, whilst revealing no differences for other inflammatory cytokines. These results suggest that in PCOS patients an altered immune response to inflammatory stimuli is present in IR, likely contributing towards determining onset of a low grade inflammation.

Exercise therapy in polycystic ovary syndrome: a systematic review

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting 8-12% of women. Lifestyle modification, including increased physical activity, is the first-line approach in managing PCOS. A systematic review was performed to identify and describe the effect of exercise as an independent intervention on clinical outcomes in PCOS.

METHODS

Five databases were searched with no time limit. A pre-specified definition of PCOS was not used. Studies were included if exercise therapy (aerobic and/or resistance) could be evaluated as an independent treatment against a comparison group. Outcomes measured included cardiovascular risk factors [insulin resistance (IR), lipid profiles, blood pressure and weight] and reproductive measures (ovulation, menstrual regularity and fertility outcomes). Quality analysis was performed based on the Cochrane Handbook of Systematic Reviews and the Quality of Reporting of Meta-Analyses checklist.

RESULTS

Eight manuscripts were identified (five randomized controlled trials and three cohort studies). All studies involved moderate intensity physical activity and most were of either 12 or 24 weeks duration with frequency and duration of exercise sessions ranging between studies. The most consistent improvements included improved ovulation, reduced IR (9-30%) and weight loss (4.5-10%). Improvements were not dependant on the type of exercise, frequency or length of exercise sessions.

CONCLUSIONS

Exercise-specific interventions in PCOS are limited. Studies vary considerably in design, intensity and outcome measures; therefore conclusive results remain elusive. Larger, optimally designed studies are needed to both gain insights into the mechanisms of exercise action and to evaluate the public health impact of exercise of PCOS.

Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society

OBJECTIVE

Women with polycystic ovary syndrome (PCOS) often have cardiovascular disease (CVD) risk factors. The Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society created a panel to provide evidence-based reviews of studies assessing PCOS-CVD risk relationships and to develop guidelines for preventing CVD.

PARTICIPANTS

An expert panel in PCOS and CVD reviewed literature and presented recommendations.

EVIDENCE

Only studies comparing PCOS with control patients were included. All electronic databases were searched; reviews included individual studies/databases, systematic reviews, abstracts, and expert data. Articles were excluded if other hyperandrogenic disorders were not excluded, PCOS diagnosis was unclear, controls were not described, or methodology precluded evaluation. Inclusion/exclusion criteria were confirmed by at least two reviewers and arbitrated by a third.

CONSENSUS PROCESS

Systematic reviews of CVD risk factors were compiled and submitted for approval to the AE-PCOS Society Board.

CONCLUSIONS

Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance, and subclinical vascular disease are at risk, whereas those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Body mass index, waist circumference, serum lipid/glucose, and blood pressure determinations are recommended for all women with PCOS, as is oral glucose tolerance testing in those with obesity, advanced age, personal history of gestational diabetes, or family history of type 2 diabetes mellitus. Mood disorder assessment is suggested in all PCOS patients. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist.

Dissociation of endothelial function and arterial stiffness in nonobese women with polycystic ovary syndrome (PCOS)

OBJECTIVE

Polycystic ovary syndrome (PCOS) is associated with cardiovascular risk but it is not clear if this is independent of obesity and insulin resistance. This study therefore investigates endothelial function and arterial stiffness in nonobese, noninsulin resistant women with PCOS.

DESIGN

This is cross-sectional case-control study.

PATIENTS

A total of 19 young women with PCOS, with body mass index (BMI) <30 kg/m(2), and 19 healthy controls matched for age and BMI were included in the study.

MEASUREMENTS

Endothelial function was assessed with flow mediated dilatation (FMD) of the brachial artery, while arterial stiffness was assessed with pulse wave velocity (PWV) and augmentation index (AI).

RESULTS

There were no significant differences between PCOS and control subjects when assessing the following clinical and biochemical variables: blood pressure, homeostasis model assessment insulin-resistance index, lipids and oestradiol. Women with PCOS had higher free androgen index scores (5.14 ± 3.47 vs. 3.25 ± 1.42, P = 0.036). The PCOS subjects had significantly lower FMD of the brachial artery compared with the controls (6.5 ± 2.9%vs. 10.5 ± 4.0%, P < 0.01). There were no significant differences in markers of arterial stiffness (PWV 5.8 ± 1.1 vs. 6.0 ± 1.0, P = 0.58, AI 16.5 ± 10.2 vs. 20.3 ± 10.2, P = 0.25).

CONCLUSIONS

Women with polycystic ovary syndrome who are young, nonobese, and have no biochemical evidence of insulin resistance, have abnormal vascular function, but normal arterial stiffness, when compared with age and weight matched control subjects. Whether this leads to a greater risk of cardiovascular disease requires further investigation.

Obesity and insulin resistance increase plasma viscosity in young women with polycystic ovary syndrome

OBJECTIVE

To investigate the plasma viscosity in young women with polycystic ovary syndrome (PCOS).

DESIGN

Patients with PCOS and healthy controls were assessed for plasma viscosity. The acquired data were tested for association with hyperandrogenemia, obesity and insulin resistance (IR) in patients with PCOS. Plasma viscosity was determined by a viscometer Type 53610/I SCHOTT-Instruments, Mainz at 37 degrees C.

PATIENTS

The study included 96 young women with PCOS and 72 healthy controls. Main outcome measures. Plasma viscosity and IR.

RESULTS

Plasma viscosity was 1.243 +/- 0.67 mm(2)/s in the control group and 1.252 +/- 0.82 in women with PCOS (p = 0.416). Using multiple regression analysis, total protein (B = 0.348, p = 0.005), area under curve for insulin (B = 0.320, p = 0.011) and BMI (B = 0.315, p = 0.013) were proven to be significantly correlated to plasma viscosity. Plasma viscosity was significantly increased in women with PCOS with IR compared to matched for age and BMI PCOS women without IR (1.300 +/- 0.055 vs. 1.231 +/- 0.049 mm(2)/s) (p = 0.004).

CONCLUSION

Young women with PCOS presented a plasma viscosity that was increased by obesity and IR. Therefore, clinical management of young overweight women with PCOS with IR should always include a serious reduction in body weight and the use of oral contraceptive treatment with cautious.

Consumption of the slow-digesting waxy maize starch leads to blunted plasma glucose and insulin response but does not influence energy expenditure or appetite in humans

Limited research in humans suggests that slowly digestible starch may blunt the postprandial increase and subsequent decline of plasma glucose and insulin concentrations, leading to prolonged energy availability and satiety, compared to more rapidly digestible starch. This study examined the postprandial metabolic and appetitive responses of waxy maize starch (WM), a slow-digestible starch. It was hypothesized that the waxy maize treatment would result in a blunted and more sustained glucose and insulin response, as well as energy expenditure and appetitive responses. Twelve subjects (6 men and 6 women) (age, 23 +/- 1 years; body mass index, 22.2 +/- 0.7 kg/m(2); insulin sensitivity [homeostatic model assessment], 16% +/- 2%; physical activity, 556 +/- 120 min/wk) consumed, on separate days, 50 g of available carbohydrate as WM, a maltodextrin-sucrose mixture (MS), or white bread (control). Postprandial plasma glucose and insulin, energy expenditure, and appetite (hunger, fullness, desire to eat) were measured over 4 hours. Compared to control, the 4-hour glucose response was not different for MS and WM, and the 4-hour insulin response was higher for MS (P < .005) and lower for WM (P < .05). Compared to MS, WM led to lower 4-hour glucose and insulin responses (P < .001). These differences were driven by blunted glucose and insulin responses during the first hour for WM. Postprandial energy expenditure and appetite were not different among treatments. These results support that WM provides sustained glucose availability in young, insulin-sensitive adults.

Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance

OBJECTIVE

To evaluate basal metabolic rate (BMR) in women with PCOS and to determine its association with insulin resistance (IR).

DESIGN

Prospective assessment of BMR in women with PCOS.

SETTING

Outpatient clinic of the Division of Reproductive Endocrinology.

PATIENT(S)

The study included 91 Greek women with PCOS and biochemical hyperandrogenemia, with mean age 24.03 +/- 0.55 years and mean body mass index (BMI) 26.67 +/- 0.69 kg/m(2), and 48 matched regularly menstruating women, with mean age 26.33 +/- 0.93 years and mean BMI 23.35 +/- 0.85 kg/m(2), as control subjects.

INTERVENTION(S)

Assessment of BMR by indirect calorimetry, IR by HOMA and QUICKI indices, fasting insulin, and fasting glucose/insulin ratio.

MAIN OUTCOME MEASURE(S)

Reduced BMR in PCOS with or without IR.

RESULT(S)

Adjusted BMR was 1,868 +/- 41 kcal/day in the control group, 1,445.57 +/- 76 in all PCOS women, 1,590 +/- 130 in PCOS women without IR and 1,116 +/- 106 in PCOS women with IR. Adjusted BMR showed a statistically significant difference between women with PCOS and control subjects, with lowest values in the group of PCOS women with IR, even after adjusting all groups for age and BMI.

CONCLUSION(S)

Women with PCOS, particularly those with IR, present a significantly decreased BMR.

Not all women diagnosed with PCOS share the same cardiovascular risk profiles

Although definitive and confirmatory data are lacking, women with polycystic ovary syndrome (PCOS) are considered to be at increased risk for cardiovascular and metabolic disease. In recent years, the diagnosis of PCOS has broadened considerably to result in several phenotypes. Here we review the evidence for cardiovascular and metabolic risks in PCOS in the classic disorder and the various phenotypes. We conclude that not all women with PCOS should be considered as being similar in terms of cardiovascular risk profiles.

Insulin attenuates the insulin-like growth factor-I (IGF-I)-Akt pathway, not IGF-I-extracellularly regulated kinase pathway, in luteinized granulosa cells with an increase in PTEN

CONTEXT

Insulin resistance is considered as part of the pathogenesis of polycystic ovary syndrome (PCOS), and PCOS patients often show hyperinsulinemia. The influence of insulin on folliculogenesis in women with PCOS has not been fully investigated.

OBJECTIVE

Our objective was to assess the induction of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expression with insulin treatment and effects of PTEN on IGF-I-induced granulosa cell proliferation as well as the correlation of PTEN levels with the concentration of insulin in follicular fluid in PCOS and non-PCOS patients. DESIGN, SETTING, PATIENTS, AND MAIN OUTCOME MEASURES: A cell proliferation assay, real-time RT-PCR, and Western blotting for PTEN, Akt, and ERK1/2 were conducted in primary cultured granulosa cells under IGF-I stimulation with or without insulin pretreatment. Phosphorylation of Akt and ERK1/2 was also determined by Western blotting. We also measured the insulin concentration in follicular fluid and the levels of PTEN expression in granulosa cells collected at the time of oocyte retrieval of in vitro fertilization in PCOS (n = 13) and non-PCOS patients (n = 37).

RESULTS

PTEN expression was induced by insulin. Pretreatment with insulin attenuated the IGF-I-induced Akt phosphorylation and cell proliferation but not ERK1/2 phosphorylation. A phosphatidylinositol 3-kinase inhibitor, LY294002, inhibited the IGF-I-induced cell proliferation. Suppression of insulin-induced PTEN expression using small interfering RNA recovered IGF-I-induced Akt phosphorylation. PTEN levels in granulosa cells, which tended to be higher in PCOS patients, were correlated with the insulin concentration in follicular fluid.

CONCLUSIONS

PTEN may influence the proliferation of human granulosa cells as well as disturbance of follicular growth in PCOS patients.

Comparison of aerobic exercise capacity and muscle strength in overweight women with and without polycystic ovary syndrome

OBJECTIVE

To assess maximal aerobic capacity (VO2max) and muscle strength in overweight and obese women with polycystic ovary syndrome (PCOS) and determine their relationship with metabolic and hormonal factors.

DESIGN

Cross-sectional study.

SETTING

Clinical Research Unit.

POPULATION

Overweight and obese women with PCOS (n = 10) and age-and weight-matched healthy controls (n = 16).

METHODS

VO2max was measured during an incremental treadmill test and maximal isometric (ImS) and isokinetic knee extensor strength (IkS) (120 degrees/second) were assessed by isokinetic dynamometry.

MAIN OUTCOME MEASURES

VO2max, ImS, IkS, waist circumference, blood lipids, glucose, insulin, insulin resistance (homeostatic model assessment [HOMA2]), C-reactive protein (CRP), hormonal profile.

RESULTS

PCOS women had higher levels of testosterone and free testosterone (P < or = 0.05), but there were no significant differences in any cardiovascular disease (CVD) risk markers between the groups. VO2max was similar in women with PCOS and healthy controls (PCOS 26.0 +/- 4.1 ml/kg/minute, controls 25.7 +/- 3.8 ml/kg/minute; P = 0.90), as was ImS (PCOS 1.50 +/- 0.54 Nm/kg, controls 1.50 +/- 0.47 Nm/kg; P = 0.96) and IkS (PCOS 1.04 +/- 0.32 Nm/kg, controls 1.16 +/- 0.23 Nm/kg; P = 0.32). VO2max was inversely related to waist circumference, insulin, HOMA2 and CRP. Waist circumference was inversely associated with ImS and IkS. No significant associations between exercise parameters and hormonal variables were identified.

CONCLUSIONS

Compared to age- and weight-matched healthy overweight and obese women with similar insulin resistance and CVD risk profiles, women with PCOS had similar aerobic capacity and muscle strength. This suggests PCOS, at least in the absence of an adverse metabolic profile is unlikely to limit physical function. Larger studies examining the effects of PCOS on exercise tolerance in a diverse range of PCOS phenotypes is required.

Diagnosis of metabolic disorders in women with polycystic ovary syndrome

Although there is a widespread on-going debate throughout the scientific community with regard to the pathogenesis of polycystic ovary syndrome, the association between this frequently observed endocrine disorder and insulin resistance has been universally acknowledged. Numerous tests have been proposed for use in assessing reduced sensitivity to insulin in women with polycystic ovary syndrome. The gold standard is represented by the euglycemic hyperinsulinemic clamp, although not yet available for application in routine clinical practice in view of its complexity and high cost. Measurement of oral glucose load and the use of several fasting tests feature a good degree of reliability and can be easily repeated. It remains to be ascertained, however, which therapeutic procedures, if any, are best suited for use in women affected by hyperinsulemia.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After reading this article, the reader should be able to outline metabolic consequences of polycystic ovarian syndrome (PCOS), conclude that testing insulin resistance is an important step in the care of women with PCOS, and recall the indications and limits of testing strategies for insulin resistance.

First evidence of genetic association between AKT2 and polycystic ovary syndrome

OBJECTIVE

Insulin resistance has been reported in up to 70% of women with polycystic ovary syndrome (PCOS). Physiologic and genetic data currently implicate post-insulin receptor signaling defects in substrates such as glycogen synthase kinase 3beta (GSK3beta). The AKT2 gene was chosen as a candidate for PCOS because its product affects glucose metabolism and mitogenic signaling, interacts with GSK3beta, and mediates cell survival in the ovary.

RESEARCH DESIGN AND METHODS

Subjects were recruited from the reproductive endocrinology clinic at the University of Alabama at Birmingham, and control subjects were recruited from the surrounding community; 287 white women with PCOS and 187 white control subjects were genotyped for four single nucleotide polymorphisms (SNPs) in AKT2. Genotyping took place at Cedars-Sinai Medical Center in Los Angeles. SNPs and haplotypes were tested for association with PCOS risk and phenotypic markers of PCOS.

RESULTS

Minor allele carriers of SNPs rs3730051 and rs8100018 had increased odds of PCOS (odds ratio [OR] 2.2, P = 0.004, and 2.4, P = 0.001, respectively). The haplotype T-G-C-T was significantly associated with PCOS (OR 2.0, P = 0.01). Carriers of the risk haplotypes for both AKT2 and GSK3B had a further increased odds of PCOS (OR 3.1, P = 0.005).

CONCLUSIONS

These data suggest that polymorphisms in two components of the insulin signaling pathway, AKT2 and GSK3B, are associated with PCOS. The presence of multiple lesions in a single pathway may confer increased risk.

Insulin response to oral glucose in healthy, lean young women and patients with polycystic ovary syndrome

BACKGROUND AND AIM

Insulin resistance and consequent hyperinsulinemia are common among patients with polycystic ovary syndrome (PCOS). Ethnicity and dietary habits affect insulin levels. There is little published information from India on insulin levels in PCOS patients. Thus the present study aimed to determine the insulin response to oral glucose in women with PCOS and healthy women.

METHODS

In a case-control study design, women with PCOS and lean healthy women without a family history of diabetes mellitus underwent oral glucose tolerance testing. Samples were collected at 0, 1 and 2 h after glucose ingestion.

RESULTS

Two hundred and eighty-five women with PCOS and 27 lean healthy young women were enrolled into the study. The mean age of controls was 22.8 +/- 4.5 years (range 15-32 years) and their mean body mass index (BMI) was 19.7 +/- 2.6 kg/m(2). Mean blood glucose at 0, 1 and 2 h was 88.2 +/- 7.2, 115.5 +/- 25.5 and 91.8 +/- 20.5 mg/dl, respectively. Corresponding plasma insulin levels were 5.8 +/- 1.1, 32.7 +/- 26.5 and 14.6 +/- 9.6 mIU/l. Peak insulin levels were seen at 1 h and these came down to less than 40% of the peak value by 2 h. Glucose/insulin ratio at 0, 1 and 2 h was 15.6 +/- 3.1, 7.0 +/- 3.1 and 11.4 +/- 7.0. Homeostasis model assessment of insulin resistance (HOMA-IR) was 1.2 +/- 0.2. The age of the PCOS women ranged from 15 to 40 years (mean 23.4 +/- 6.2 years) and their BMI ranged from 16.4 to 50.4 kg/m(2) (mean 27.7 +/- 6.3 kg/m(2)). One hundred and seventy-six (62%) PCOS patients had normal glucose tolerance (NGT), 39 (14%) had impaired fasting glucose (IFG), 49 (17%) had impaired glucose tolerance (IGT) and 21 (7%) had type 2 diabetes mellitus (T2DM). Insulin response was higher in women with PCOS. Peak insulin was observed at 1 h. The difference between 1-h and 2-h post-glucose insulin decreased with worsening glucose tolerance. Both plasma insulin and BMI showed a rising trend from NGT to IFG to IGT. There was no further increase in either insulin or BMI from IGT to T2DM. Glucose/insulin ratio at 0, 1 and 2 h was lower (8.3 +/- 4.2, 2.0 +/- 1.6 and 3.2 +/- 3.5) than that of healthy controls. HOMA-IR was 3.1 +/- 3.0.

CONCLUSION

Women with PCOS had an exaggerated insulin response to glucose. Thirty-eight percent of PCOS women had some form of abnormal glucose tolerance. Greater insulin response was seen with impairment of glucose tolerance. Obesity had no effect on fasting insulin or insulin response to oral glucose in PCOS women with NGT.

Metabolic syndrome in postmenopausal women: the influence of oral or transdermal estradiol on inflammation and coagulation markers

OBJECTIVE

The objective of the study was to determine whether the route of administration of estrogen therapy in women with metabolic syndrome (MBS) influences inflammation and coagulation parameters.

STUDY DESIGN

Fifty symptomatic postmenopausal women with MBS were randomized to receive 1 mg oral estradiol (oE(2)) or 0.05 mg transdermal E(2) (tE(2)) for 3 months. Measurements were compared with those of 20 healthy premenopausal women and 74 normal postmenopausal women.

RESULTS

Compared with both control groups, women with MBS had significantly higher levels of certain inflammation and coagulation markers, which cannot be accounted for based on weight alone. After oE(2), antithrombin III decreased from 104% to 96% (P < .01), the metalloproteinase-9/ tissue inhibitor of metalloproteinase-1 ratio increased (P < .02), and E-selectin decreased from 60 +/- 4.4 to 55 +/- 4.6 ng/mL (P < .05). With tE(2), there were no major changes noted.

CONCLUSION

Postmenopausal women with MBS have higher levels of certain coagulation and inflammation markers and different responses to oral compared with transdermal estradiol.

The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report

OBJECTIVE

To review all available data and recommend a definition for polycystic ovary syndrome (PCOS) based on published peer-reviewed data, whether already in use or not, to guide clinical diagnosis and future research.

DESIGN

Literature review and expert consensus.

SETTING

Professional society.

PATIENTS

None.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

A systematic review of the published peer-reviewed medical literature, by querying MEDLINE databases, to identify studies evaluating the epidemiology or phenotypic aspects of PCOS.

RESULT(S)

The Task Force drafted the initial report, following a consensus process via electronic communication, which was then reviewed and critiqued by the Androgen Excess and PCOS (AE-PCOS) Society AE-PCOS Board of Directors. No section was finalized until all members were satisfied with the contents, and minority opinions noted. Statements were not included that were not supported by peer-reviewed evidence.

CONCLUSION(S)

Based on the available data, it is the view of the AE-PCOS Society Task Force that PCOS should be defined by the presence of hyperandrogenism (clinical and/or biochemical), ovarian dysfunction (oligo-anovulation and/or polycystic ovaries), and the exclusion of related disorders. However, a minority considered the possibility that there may be forms of PCOS without overt evidence of hyperandrogenism, but recognized that more data are required before validating this supposition. Finally, the Task Force recognized and fully expects that the definition of this syndrome will evolve over time to incorporate new research findings.

Endothelial function and its relationship to leptin, homocysteine, and insulin resistance in lean and overweight eumenorrheic women and PCOS patients: a pilot study

OBJECTIVE

To verify if patients with polycystic ovarian syndrome (PCOS), have an increased cardiovascular risk compared with healthy controls.

DESIGN

Prospective case-control study.

SETTING

University-based practice.

PATIENT(S)

Twenty eumenorrheic controls (ten lean [group A] and ten overweight [group B]) and 24 PCOS women (14 lean [group C] and ten overweight [group D]).

INTERVENTION(S)

Cardiovascular risk markers and hormonal parameters were assessed.

MAIN OUTCOME MEASURE(S)

Androgens, fasting glucose, insulin, leptin, fibrinogen, homocysteine, endothelin-1 and flow-mediated dilatation of the brachial artery were measured to investigate their relationship to weight and to PCOS.

RESULT(S)

The brachial artery diameter and the pulsatility index, after the reactive hyperemia, showed in group A the most intense vasodilatation compared with the other groups. Homocysteine levels did not differ among the groups. Endothelin-1 was significantly higher in group A compared with groups B and D. Leptin was significantly lower in groups A and C compared with groups B and D. Insulin resistance was higher in groups B and D. Group A had significantly higher glucose-insulin ratio compared with all of the other groups; group C had significantly higher glucose-insulin ratio only compared with group D.

CONCLUSION(S)

Weight and PCOS are two independent variables affecting the endothelial function.

Polymorphism in postinsulin receptor signaling pathway is not associated with polycystic ovary syndrome

OBJECTIVE

To investigate polymorphisms in postinsulin receptor signaling. To investigate PIK3R1, SLC2A4, SLC2A4RG, and MEF2A to determine whether these genes are associated with susceptibility to polycystic ovary syndrome (PCOS) or key phenotypic features of insulin resistance in subjects with PCOS.

DESIGN

Case-control study.

SETTING

Participants with PCOS were recruited from a clinical practice database, and controls from the general community.

PATIENT(S)

One hundred seventy-three patients with PCOS conforming to the National Institutes of Health (NIH) diagnostic criteria, all of Caucasian descent; 107 normally ovulating women of white descent from the general community.

INTERVENTION(S)

Drawing of blood for DNA extraction.

MAIN OUTCOME MEASURE(S)

Frequency of PIK3R1, SLC2A4, SLC2A4RG, and MEF2A polymorphisms in case and control subjects.

RESULT(S)

No significant difference between the frequency of the polymorphisms in case and control women was identified. No single nucleotide polymorphism studied in any of these four genes was associated with the PCOS phenotype.

CONCLUSION(S)

Polymorphisms in the PIK3R1, SLC2A4, SLC2A4RG, and MEF2A genes are not associated with key PCOS phenotypes.

Adipocytes from women with polycystic ovary syndrome demonstrate altered phosphorylation and activity of glycogen synthase kinase 3

OBJECTIVE

To test the hypothesis that an abnormality in glycogen synthase kinase-3 (GSK3) is a pathogenic factor in polycystic ovary syndrome (PCOS).

DESIGN

Prospective experimental study (adipocytes).

SETTING

Tertiary-care academic medical center and teaching hospital.

PATIENT(S)

Twenty patients with PCOS and 21 healthy control women.

INTERVENTION(S)

Blood sampling, physical exam, biopsy of SC lower abdominal fat.

MAIN OUTCOME MEASURE(S)

Glucose transport and protein levels and phosphorylation state of glycogen synthase kinase (GSK)-3alpha and GSK3beta in adipocytes; assessment of GSK3beta activity.

RESULT(S)

Basal protein levels of glycogen synthase kinase (GSK3alpha and GSK3beta) did not differ between control women and women with PCOS, nor did basal or insulin-stimulated levels of serine phosphorylated GSK3alpha. However, in adipocytes of women with PCOS, insulin stimulation was not associated with increased serine phosphorylation of GSK3beta, in contrast to the case of control women. Tyrosine phosphorylation of GSK3beta also was higher in women with PCOS, compared with in control women. Consistent with the phosphorylation data, GSK3beta activity was elevated in PCOS adipocytes.

CONCLUSION(S)

These data suggest that GSK3beta is hyperactivated and resistant to down-regulation by insulin in PCOS. By using physiologic approaches, we demonstrated that abnormal GSK3beta regulation is a potential mechanism for the insulin resistance that is seen in some women with PCOS, which may contribute to their development of the syndrome.

The management of insulin resistance in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) has reproductive and metabolic implications. Insulin resistance (IR), secondary to genetic and lifestyle factors, is integral in the pathogenesis, metabolic, clinical features and the long-term sequelae in the majority of people with PCOS. Therapeutic strategies targeting IR in PCOS ameliorate clinical features and might reduce long-term sequelae including diabetes. The mainstay for improving IR is lifestyle change; however, feasibility and sustainability remain concerns. In PCOS, metformin reduces IR, improves ovarian function, regulates cycles, lowers androgens, improves clinical hyperandrogenism and potentially improves fertility. Metformin is also likely to delay diabetes onset and has a role in PCOS in those at high risk of diabetes; however, further research is needed to clarify specific target subgroups and clinical indications.

Agreement among insulin sensitivity indexes on the diagnosis of insulin resistance in polycystic ovary syndrome and ovulatory women

OBJECTIVE

The objective was to compare agreement on the diagnosis of insulin resistance (IR) among insulin sensitivity indexes in both ovulatory women and those with polycystic ovary syndrome (PCOS).

STUDY DESIGN

In an observational study, the 75-g oral glucose tolerance test was performed in 105 women with PCOS and 51 ovulatory women. The insulin sensitivity indexes used were insulin quantitative sensitivity check index (QUICKI), 1/homeostasis model assessment-insulin resistance (1/HOMA-IR), area under curve for insulin (AUC-I), and the Matsuda insulin sensitivity index (COMP). For the IR diagnosis we used cut-off values described in recent publications (insulin >12 microIU/ml, 1/HOMA-IR <0.47, QUICKI < or =0.333, AUC-I > or =7000 microIU/ml 120 min, and COMP <4.75.

RESULTS

Excellent agreement was assessed among insulin, QUICKI, and 1/HOMA-IR. However, the rate of IR detected by these indexes in the PCOS group (44.8-51.4%) was lower than expected. New cut-offs were then determined based on COMP results. Using these values, 1/HOMA-IR and QUICKI showed excellent agreement (kappa=0.83) with COMP.

CONCLUSION

The observed agreements among insulin, QUICKI and 1/HOMA-IR were higher than 93%. Therefore, clinicians may choose any of those obtaining similar results. For clinicians who prefer COMP, but are looking for a simpler test to detect IR in PCOS women, the use of QUICKI and 1/HOMA-IR with the new cut-offs seems reasonable.