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PubMed2006

Lower insulin sensitivity differentiates hirsute from non-hirsute Sicilian women with polycystic ovary syndrome.

OBJECTIVE: It is well known that hyperandrogenism and insulin-resistance with or without compensatory hyperinsulinism are closely associated, but the Rotterdam Consensus has concluded that principally obese women with polycystic ovary syndrome (PCOS) should be evaluated for the metabolic syndrome. Our aim was to study insulin sensitivity in PCOS women with hirsutism regardless of obesity. METHODS: Clinical characteristics, sex hormones and fasting- and after OGTT-glycemia and insulinemia, homeostatic model of insulin resistance (HOMA IR), and Matsuda index of insulin sensitivity were analyzed in 130 women with PCOS. Hirsutism has been evaluated through the Ferriman-Gallwey (FG) map scoring system. RESULTS: PCOS women with hirsutism (57.7% of participants) showed significant higher values of total testosterone levels (P = 0.016), free testosterone (P = 0.027), DHEA sulfate (P = 0.017), and Delta4androstenedione (P = 0.018). They had similar body mass index (BMI) (P = 0.073) and were significantly less insulin sensitive (P = 0.002) than those without hirsutism (42.3% of participants). In women with PCOS and hirsutism, there was a significant correlation between FG score and insulin-sensitivity indexes (HOMA IR, rho = 0.33, P = 0.005; Matsuda index, rho = -0.34, P = 0.003) but not with the androgen levels. Moreover, women with hirsutism showed a significantly greater insulin (P = 0.019), C-peptide (P = 0.002), and glucose (P = 0.024) areas under the curve (auc2h). CONCLUSIONS: Our study suggests that the increased responsiveness of the pilo-sebaceous unit to androgens seems to be influenced by insulin sensitivity and that insulin resistance should be assessed in all hirsute women with PCOS regardless of their BMI, as insulin resistance was found in hirsute women irrespective of whether they were overweight or obese.

Adolescent↗

PubMed2006

[Polycystic ovary syndrome, metabolic syndrome, cardiovascular risk and the role of insulin sensitizing agents].

The Polycystic Ovary Syndrome (PCOS) affects 6 to 10% of women of childbearing age. Insulin resistance and hyperinsulinemia are present in nearly all PCOS patients and play a central role in the development of both hyperandrogenism and metabolic syndrome (MS). MS occurs in approximately 43% of PCOS patients, raising the cardiovascular risk to up seven fold in these patients. Several serum, functional and structural markers of endothelial dysfunction and subclinical atherosclerosis were described in PCOS patients, even those young and non-obese. However, despite the fact that PCOS adversely affects the cardiovascular profile, long-term studies did not demonstrate a consistent raise in cardiovascular mortality, which seems to be more observed in the post-menopausal period. Recently, oral contraceptives are being substituted for insulin sensitizing agents (metformin and glitazones) in the PCOS treatment, due to their effects on insulin resistance and cardiovascular risk.

Atherosclerosis↗

PubMed2006

Polycystic ovary syndrome in adolescents: current and future treatment options.

Polycystic ovary syndrome (PCOS) is a very common disorder affecting 5-10% of women of reproductive age. The pivotal endocrine abnormalities of this syndrome are insulin resistance and ovarian and, to a lesser degree, adrenal hypersensitivity to hormonal stimulation. PCOS may manifest itself as early as the first decade of life by premature pubarche or menarche. Oligoamenorrhea in the first postpubarchal years, although very common, may be an early symptom of PCOS, especially in overweight girls with hirsutism or acne. Girls with low birth weight as well as a family history of diabetes mellitus or premature cardiovascular disease are at high risk for developing PCOS. Circulating bioavailable testosterone levels are usually elevated, while total testosterone may be normal due to low levels of sex hormone-binding globulin. The typical sonographic appearance of PCOS ovaries consists of high ovarian volume (>10 mL) and the presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter. However, this finding is not specific, since it may occur in >20% of healthy girls. The therapeutic goals in adolescents with PCOS is first to restore bodyweight and menses and to reduce the signs of hyperandrogenism. The reduction of bodyweight in this young age group may require the collaboration of the pediatrician, dietitian, and psychotherapist. The adolescent should be urged to adopt a healthy lifestyle with the aim to maintain a normal body mass index throughout adolescence and adult life. The choice of medical therapy depends on the clinical presentation. Oral contraceptives are a good option when acne and hirsutism are the principal complaints. Adolescents with isolated cycle irregularity may be placed on a cyclical progestin regimen to induce withdrawal bleeding. Metformin, by decreasing insulin resistance, alleviates many of the hormonal disturbances and restores menses in a considerable proportion of patients. It may be used alone or in combination with oral contraceptives. Independently of medical treatment, restoration and maintenance of bodyweight within normal range is of paramount importance.

Adolescent↗

PubMed1989

Dopamine might not be involved in the pathogenesis of polycystic ovary syndrome.

The possible alteration in dopamine (DA) metabolism as an etiological factor was investigated in 31 normoprolactinemic patients with typical polycystic ovary syndrome (PCOS) in comparison with 14 normal women (early follicular phase). Subjects were submitted to intravenous infusion of 4 micrograms/kg DA per minute over a period of 3 hours and blood samples were collected every 30 minutes over a period of 5 hours. Two days later subjects were submitted to intravenous infusion of 10 mg metoclopramide (MCP) as a bolus and blood samples were collected every 15 minutes over a period of 2 hours. Dopamine infusion caused a similar maximum decrease (MD) in LH levels in both the PCOS and control groups (50.9% and 47.5%, respectively). No changes in plasma LH levels were observed in either group after MCP infusion. Dopamine caused a 50.2% and 60.4% MD in prolactin (PRL) in the PCOS and control groups, respectively, the difference being statistically non-significant. Metoclopramide increased PRL levels by 1261.0% and 1832.0% in the PCOS and control groups, respectively (not significant). In a double-blind study, the PCOS patients were treated with 5 mg/day bromocriptine (n = 16) or placebo (n = 15) over a period of 3 months and evaluated in clinical and laboratory terms during and after treatment. Seven patients in each group had monthly menstrual periods, but only 1 in each group had an ovulatory cycle (progesterone greater than 5 ng/ml). During treatment, median plasma PRL levels were significantly decreased only in bromocriptine-treated patients (10.8 vs 7.3 ng/ml). The present results lead us to question whether dopamine is indeed involved in the pathogenesis of normoprolactinemic PCOS and whether bromocriptine treatment is of benefit in this type of patients.

Adolescent↗

PubMed1991

Response of gonadotropins to pituitary stimulation with luteinizing hormone releasing hormone is a more specific than sensitive parameter for the polycystic ovary syndrome.

Gonadotropin response to exogenous luteinizing hormone-releasing hormone (LHRH) was studied in two groups of patients with the polycystic ovary syndrome (PCOS). Group I (n = 44) was diagnosed as 'overt PCOS' based on clinical and endocrine abnormalities, and the typical ultrasonic picture of multicystic changes in an increased amount of ovarian stroma. Group II patients (n = 34), with similar clinical and hormonal changes, were classified as 'borderline PCOS' because endosonography of the ovaries was not conclusive. Serum gonadotropins were followed 15, 30, 45 and 60 min after administration of 100 micrograms LHRH intravenously. Plasma LH and the peak ratio of luteinizing hormone to follicle stimulating hormone (LH/FSH peak) after LHRH were significantly higher in Group I and II patients (p less than 0.001) than in controls (n = 11). There was a significant positive correlation between LH (r = 0.73 and 0.68, p less than 0.05) and LH/FSH ratio peaks (r = 0.61 and 0.68, p less than 0.05) after LHRH, and the basal values in each group. However, hyperreactivity of LH and the LH/FSH ratio after LHRH (defined as values exceeding the 95th percentile of control values) was only present in Group I in 38.6 and 56.8%, and in Group II in 47.1 and 73.5% of patients. It is concluded that: exaggerated LH release after LHRH is a typical yet not unique feature of PCOS and its sensitivity is inferior to its specificity; a higher rate for sensitivity is achieved when the LH/FSH ratio after LHRH (instead of LH release alone) is used; and that hyperreactivity of LH after LHRH is neither correlated with the plasma concentrations of total testosterone, free plasma testosterone or androstenedione, nor with the ultrasonic picture of the ovaries as significantly higher (p less than 0.05) LH and LH/FSH ratio peaks were found in borderline PCOS patients. While the heterogeneity of gonadotropin response to LHRH clearly limits its routine diagnostic use, the FSH and LH response is useful in patients with inconsistent clinical and ultrasonic features suggestive of PCOS.

Adolescent↗

PubMed1997

Leptin levels and insulin sensitivity in obese and non-obese patients with polycystic ovary syndrome.

The study was conducted to assess leptin levels and insulin sensitivity in obese and non-obese patients with polycystic ovary syndrome (PCOS). Twenty-two women with PCOS and 19 control healthy women were included in the study, divided into obese and non-obese groups. Leptin was determined using Linco Research radio-immunoassay while insulin sensitivity was calculated from intravenous glucose tolerance tests with frequent blood sampling using MINMOD analysis. Significantly higher basal leptin levels were found in obese compared to non-obese PCOS (31.76 +/- 3.06 vs. 10.42 +/- 2.31 ng/ml; p < 0.05) as well as in obese in comparison to non-obese controls (29.16 +/- 5.06 vs 8.51 +/- 0.88 ng/ml; p < 0.05). A negative correlation was found between insulin sensitivity and leptin levels in both obese (r = -0.2480; p > 0.05) and non-obese PCOS groups (r = -0.4620; p > 0.05). In conclusion, high serum leptin, insulin and testosterone levels together with reduced insulin sensitivity were found in obese PCOS women, suggesting that high leptin levels could be a characteristic of the obese PCOS phenotype.

Adult↗

PubMed1998

Insulin and polycystic ovary syndrome: a new look at an old subject.

In recent years the metabolic implications of polycystic ovary syndrome (PCOS) have received a great deal of attention; in fact 50% of women with PCOS are obese and a similar percentage of subjects was found to show exaggerated insulin secretion and reduced insulin-stimulated glucose uptake. The presence of these features in women with PCOS has profound clinical implications in terms of morbidity due to diabetes mellitus, dyslipidemia, hypertension and cardiovascular disease. Moreover, hyperinsulinemia has recently been proposed as a possible independent risk factor for endometrial and breast cancer. In the light of these considerations, the importance of metabolic screening in patients with PCOS in order to improve their quality of life cannot be underestimated. In this review we analyze all the clinical pathologies in which hyperinsulinemia of PCOS could be involved. Furthermore, in order to clarify the possible mechanisms leading to the insulin disorders of the syndrome, we review the available data about the insulin receptor abnormalities, as well as those concerning the insulin resistance and the exaggerated insulin secretion. Finally, we examine the main therapeutic strategies to ameliorate the insulinemic status of PCOS patients in order to potentially be able to prevent the long-term consequences of this syndrome.

Female↗

PubMed2006

[Clinical observation on treatment of 43 women with polycystic ovary syndrome based on syndrome differentiation].

OBJECTIVE: To investigate the therapeutic effect of treatment based on syndrome differentiation and its influence on the serum levels of testosterone and insulin in women with polycystic ovary syndrome (PCOS). METHODS: Forty-three women, diagnosed with PCOS as well as syndrome of kidney yin deficiency or syndrome of spleen qi deficiency, were enrolled in the study. Twenty-five PCOS women with syndrome of kidney yin deficiency were treated with traditional Chinese herbs for nourishing yin to reduce fire (nourishing yin group), and 18 PCOS women with syndrome of spleen qi deficiency were treated with herbs for invigorating spleen and replenishing qi (replenishing qi group). Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC), and the serum levels of insulin and testosterone before and after treatment were detected. RESULTS: Among the 43 cases, 20 cases had high serum testosterone level, in which 13 cases with syndrome of kidney yin deficiency, 7 cases with syndrome of spleen qi deficiency, but the difference had no statistic significance; 17 cases had high serum insulin level, in which 11 cases with syndrome of spleen qi deficiency, 6 cases with syndrome of kidney yin deficiency, the difference had statistic significance (P<0.05). In nourishing yin group, the serum levels of insulin and testosterone declined after treatment (P<0.05), and BMI, WHR and WC showed no significant changes. In replenishing qi group, the serum level of insulin declined after treatment (P<0.01), and BMI, WHR, WC and the serum level of testosterone showed no significant changes. CONCLUSION: Traditional Chinese herbs for nourishing yin to reduce fire can significantly reduce the serum levels of testosterone and insulin in PCOS women with syndrome of kidney yin deficiency, and herbs for invigorating spleen and replenishing qi can significantly reduce the serum level of insulin in PCOS women with syndrome of spleen qi deficiency.

Adolescent↗

PubMed1999

Genetic abnormalities in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a very common endocrinopathy and is the major cause of anovulatory infertility. It is also associated with an increased risk of non insulin dependent diabetes (NIDDM) in later life. Despite the importance of PCOS to women's health, little is known about its aetiology. Because of the well-known familial clustering of cases of PCOS, recent studies in our department have focused on clinical and molecular genetic studies in an attempt to identify key genes which may be involved in its aetiology. We have found evidence that a polymorphism in the regulatory region of CYP11a (encoding P450 cholesterol side chain cleavage, also an important enzyme in the steroidogenic pathway) is associated with and linked to PCOS. In examination of the insulin gene (INS), we have shown, in three separate populations, that class III alleles in the INS-VNTR (the minisatellite in the regulatory region of the insulin gene) are associated with PCOS. Variation in this element has also been implicated in the aetiology of NIDDM. We propose that PCOS is an oligogenic disorder in which a small number of key genes interact with environmental factors (notably dietary), the balance of which factors determine, the typically heterogeneous, clinical and biochemical phenotype.

Cholesterol Side-Chain Cleavage Enzyme↗

PubMed1999

[The evaluation of blood flow in uterine arteries in girls with polycystic ovary syndrome by transvaginal color Doppler ultrasonography].

OBJECTIVE: The aim of this study was to evaluate of blood flow in uterine arteries in girls with PCOS and to determine whether uterine blood flow variations are associated with endocrine findings typical of PCOS. METHODS: Seventy two girls with clinical, endocrinologic and ultrasonographic features of PCOS (mean age 18.8 +/- 1.3 years) were examined. The control subject consisted of twenty girls with regular, ovulation cycles. None of these girls had received hormonal treatment for at least 6 months before the study. Pelvic ultrasound examination was made in each patient with Acuson 128 XP/10 with the 4/5/7 MHz transvaginal transducer. Examination was performed in early follicular phase. Blood flow was made in each patient in the ascending branches of uterine arteries. Index values pulsatility index (PI) and resistance index (RI) were used for the purpose of better comparison of the data. Associations between values of PI and RI and hormones (testosterone, luteinizing hormone) were examined. RESULTS: No significant differences between PI and RI of the left and right uterine artery was observed. PI in PCOS girls was mean 3.19 +/- 0.52 ranged from 2.1 to 4.3, in control girls PI was mean 2.33 +/- 0.36 ranged from 1.6 to 3.1. The PI was positively correlated (r = 0.435, p < 0.01) with testosterone and PI was positively correlated (r = 0.450, p < 0.001) with LH. The RI in PCOS patients was mean 0.87 +/- 0.04 ranged from 0.74 to 0.93, in control girls 0.72-0.87, mean 0.80 +/- 0.04. The RI was positively correlated (r = 0.466, p < 0.001) with testosterone and RI was positively correlated (r = 0.492, p < 0.001) with LH. CONCLUSIONS: The elevated uterine artery resistance was observed in girls with PCOS.

Arteries↗

PubMed1998

[Functional states of pituitary-ovary, adrenal and thyroid axes in women with polycystic ovarian syndrome].

OBJECTIVE: To assess the role of the functional states of pituitary-ovary, adrenal and thyroid axes in the pathophysiology of polycystic ovarian syndrome (PCOS). METHODS: The stimulation tests of above-mentioned three endocrine axes by luteinizing hormone releasing hormone (LRH, 100 micrograms), adrenocorticotrophin (ACTH, 250 micrograms) and thyroid releasing hormoune (TRH, 500 micrograms), respectively, were performed in each subjects of two PCOS groups [luteinizing hormone/follicle stimulating hormone (LH/FSH) > or = 3, Group 1, n = 15; LH/FSH < 3, Group 2, n = 15] and the control (n = 20). Endocrine indices of corresponding target glands were evaluated by radioimmunoassay (RIA). RESULTS: After LRH administration, the amplitude of LH responses in three groups were as follows: Group 1 > Group 2 > control while mean testosterone levels were elevated to a similar extent in two PCOS groups and remained unchanged in the control. Following ACTH stimulation, PCOS subjects, especially of Group 2 with obvious insulin resistance, showed higher responses of cortisol, dehydroepiandrosterone sulfate and testosterone as compared with the controls. However, during TRH testing, exaggerated thyroid-stimulating hormone and prolactin responses in two PCOS groups and blunted free thyroxine response at two hour point in Group 1 were observed, as compared with the control. CONCLUSION: It appears that ovarian androgen excess in women with PCOS is mainly LH-dependent in Group 1 and insulin-dependent in Group 2. Enhanced adrenal activity may contribute to both hyperandrogenism and insulin resistance in this syndrome, and subclinical hypothyroidism may exist in affected subjects, especially of Group 1.

Adult↗

PubMed1998

[The effects of FSH,LH and insulin on steroids production by granulosa cells from polycystic ovaries syndrome].

OBJECTIVES: To investigate steroids production of granulosa cells obtained from normal ovaries and polycystic ovaries from polycystic ovary syndrome (PCOS) patients under FSH, LH and insulin stimulation. METHODS: Granulosa cells of 33 folicles from 18 pairs of normal ovaries and about 100 folicles from 8 pairs of PCOS were cultured. Estrodial (E2) and progesterone (P) accumulation in the medium was determined under different incubated conditions by RIA. RESULTS: Granulosa cells from PCOS produced more E2(P < 0.05-0.01) under basal, FSH and insulin stimulation and more P (P < 0.05-0.01) under FSH, LH and insulin stimulation than controls. Insulin markedly augmented FSH and LH-stimulated steroid accumulation by two groups of granulosa cells. Granulosa cells from PCOS with peripheral insulin resistance also responded to insulin. CONCLUSION: Enzymes for steroids synthesis in granulosa cells from PCOS may be activated in vivo, and hyperinsulinisma and elevated LH levels in PCOS may be contributable.

Adult↗

PubMed2000

[Changes of plasma renin activity and angiotensin II levels in women with polycystic ovary syndrome].

OBJECTIVE: To investigate changes of plasma renin activity(PRA) and plasma angiotensin II (PANG II) in women with polycystic ovary syndrome(PCOS). METHODS: We chose thirty PCOS women as trial group and thirty normal menstrual women as control. PRA and PANG II levels during follicularphase(FP) of the two groups were measured by radioimmunoassay. RESULTS: PRA and PANG II increased in women with PCOS as compared with the normal FP. The increment of PRA and PANG II in PCOS women of high testosterone levels was correlated with serum luteinizing hormone/follicle-stimulating hormone and testosterone concentration. CONCLUSION: The elevated PRA and PANG II suggest an enhanced functional activity of ovarian renin angiotensin system in PCOS, and which may play a role in the pathologenesis of PCOS.

Adult↗

PubMedDate not supplied

Dyslipidemia with particular regard to apolipoprotein profile in association with polycystic ovary syndrome: a study among Indian women.

OBJECTIVE: To investigate putative dyslipidemia in women with polycystic ovary syndrome (PCOS) with particular emphasis on specific parameters of atherosclerotic risk, and to assess the independent influence of obesity and hyperandrogenemia on these parameters. SUBJECTS: Women investigated were among those attending the infertility clinics. Three groups of women were studied: (I) a core study group consisting of oligomenorrhoeic, chronically anovulatory women with or without obesity in whom polycystic ovaries were confirmed through ultrasound evidence, and were established to be the cause of infertility; II) a control group of non-hirsute, non-obese women with regular menstrual cycles; and (III) a group of controls consisting of women with obesity, but with normal ovarian morphology and regular menstrual cycles. METHODS: All three study groups were investigated for androgen (total testosterone) and lipid-lipoprotein profile, including apolipoproteins, ApoA1 and ApoB. Retrospective analysis of the data was carried out to assess hyperandrogenism in the study group of women with PCOS as well as to investigate changes in the lipid-lipoprotein profile, particularly the measures of cardiovascular risk, ApoA1 and ApoB. RESULTS: Triglycerides showed a significant increase in the PCOS group compared to controls, whereas HDL-cholesterol as well as HDL-carrying ApoA1 showed a significant decrease (P < .05). Also a significant finding was the decrease in ApoA1/ApoB ratio among the women with PCOS compared to both controls and obese women. A direct negative correlation of this decrease in ApoA1/ApoB ratio with the Body Mass Index was also confirmed in the study. Hyperandrogenemia in terms of significantly raised total testosterone levels was found in 30% of the PCOS women. However, no direct correlation of this increase with changes in lipid-lipoprotein profile could be observed. CONCLUSION: The study confirms the trend toward dyslipidemia among women with PCOS, particularly in parameters associated with cardiovascular risk. A significant association of obesity rather than raised testosterone with this dyslipidemia was also confirmed by the study.

Apolipoprotein A-I↗

PubMed2001

[Effect of growth hormone on the outcome of ovulation induction in patients with polycystic ovary syndrome].

OBJECTIVE: To study the effect of growth hormone (GH) on the outcome of ovulation induction in patients with polycystic ovary syndrome (PCOS). METHODS: We examined serum sex hormone, GH and insulin like growth factor-II (IGF-II) basal levels by radioimmunoassay in 130 PCOS patients and 107 normal women. In addition, we observed the effect of GH on the outcome of ovulation induction in 7 poor responders to human menopausal gonadotropin (hMG) treatment. RESULTS: The mean serum GH level is (2.50 +/- 1.33) micrograms/L and (1.04 +/- 0.47) micrograms/L respectively in nonobese and obese PCOS patients which were significantly lower than those in controls [(5.30 +/- 2.26) micrograms/L, (2.95 +/- 1.49) micrograms/L respectively, P < 0.05]. The mean serum IGF-II level is (136 +/- 27) nmol/L in the obese PCOS patients, significantly greater than those in nonobese PCOS and controls (P < 0.05). When we used GH with hMG in 7 poor responders, the total amount of hMG required decreased from 1 to 12 amples and the duration of treatment shortened as compared with hMG alone. CONCLUSION: There is abnormal GH secretion in patients with PCOS, GH may improve the outcome of ovulation induction by gonadotropin.

Adult↗

PubMed2002

[Polycystic ovary syndrome: treatment with insulin-sensitizing agents].

Polycystic ovary syndrome (PCOS) is a common disorder. Its prevalence is 5 to 10% in women of reproductive age. PCOS is associated with hyperinsulinism and insulin resistance. The pathophysiological situations has lead many authors to study the action of insulin-sensitizing agents on menses, ovulation rate, and pregnancy in patients with PCOS. Metformin (a member of the biguanide family), is used for treatment of type II diabetes mellitus in obese patients. Although metformin restores cyclic pituitary- gonadal function and improves fertility, it can decrease levels of androgen and LH and increase levels of SHBG in women with PCOS. Trooglitazone (a member of the thiazolidinedione family) has been withdrawn from use because of its liver toxicity. Troglitazone improves ovulation and hisrsutism in women with PCOS without change in body mass index. Other similar drugs with less liver toxicity may be useful for the treatment of PCOS. D-chiro-inositol is a mediator of insulin action and improves ovulatory cycles. Most of the studies reported have not been randomized but the results appear to be quite promising. These drugs may provide a substantial advance in the treatment of women with polycystic ovary syndrome.

Androgens↗

PubMedDate not supplied

[Genetics of the polycystic ovarian syndrome and therapeutic perspectives ].

PCOS is the most frequent endocrine disorder of premenopausal women. The common clinical signs of PCOS are hirsutism, menstrual irregularities with chronic anovulation and a trend toward overweight or obesity. Diagnosis is based upon high plasma levels of androgens and the ultrasound image of polycystic ovaries. The high prevalence of PCOS at first degree female relatives suggest an important genetic component of this syndrome. Linking studies in sisters presenting phenotypical traits of PCOS and in their parents allowed the investigation of certain candidate genes presumed to be involved in the physiopathology of PCOS. The genes encoding enzymes involved in androgen synthesis, protein transducers of insulin signals and the paracrine regulating factors of gonadotrophins and ovarian function have been analysed. To date, no determinant gene mutation was reported. However, several loci were detected, especially a locus within the insulin receptor. Mutations or gene polymorphisms and their function remain to be identified. These research attempts should explain the physiopathology of PCOS and open new therapeutic perspectives. The usage of medication increasing the sensitivity to insulin action is an example of applying these particular aspects.

Androgens↗

PubMed2003

Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine diseases in women. This syndrome is characterized by hyperandrogenism, chronic anovulation, infertility and obesity. The association between PCOS-related hyperandrogenemia and insulin resistance is well documented in the literature. Insulin resistance and the resulting raised plasma levels of insulin are reported to be responsible for the high androgen concentration observed in patients with PCOS. In this prospective study, blood samples for levels of testosterone (T), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH, prolactin and fasting blood sugar (FBS) before starting metformin administration were obtained randomly from 40 women who were apparently obese, had PCOS and had been referred to a university hospital. Metformin was then given at a dose of 500 mg three times a day for 8 weeks, after which time the pretreatment study was repeated. Clinical symptoms of PCOS, including acne and hirsutism score and body mass index (BMI), were assessed before and after the treatment cycle. Metformin therapy resulted in a significant decrease in total testosterone levels and FBS. There was also a significant decline in BMI, length of the menstrual cycle, acne and hirsutism score. There were no significant changes in the levels of DHEAS, prolactin, FSH or LH, or in LH/FSH. The effect of metformin on subjects with elevated DHEAS levels was different to that on individuals with normal DHEAS levels. In the latter group there were only significant improvements in the length of the menstrual cycle, BMI and testosterone and DHEAS levels. It is concluded that metformin therapy in subjects with PCOS results in a decrease in fasting blood sugar and testosterone levels, and leads to a significant improvement in the clinical manifestation of hyperandrogenism. These responses also related to the level of adrenal function.

Acne Vulgaris↗