An 1 h-OGLT is an Appropriate Approach for the Determination of Glucose and Insulin Dynamics in Female Functional Androgenization (Including “Polycystic Ovary Syndrome”)

Abstract

Female functional androgenization syndrome (FAS) is subdivided into 4 groups corresponding to their predominant organ pathology: I (ovary), II (adrenal gland), III (ovary, adipose tissue, liver, pancreas) and IV (residual dysfunctions). Group-specific variable clusters are defined by BMI, hormones, glucose and insulin during oral glucose loading test (OGLT: 0-, 1 h-, 2 h-values), and sonographic ovarian morphology. Abdominal circumference (AC), serum lipids, and blood pressure are used for individual characterization. We investigated which tests assess best the prevalence of pathologic glucose and insulin dynamics in androgenized women. 89 FAS patients were consecutively enrolled. Including a control (n=16), prevalence of insulin resistance (IR) described by OGLT, HOMA-IR, QUICKI, insulin sensitivity index (ISI) or AUC 2h-insulin was analyzed. Uni-and multivariate correlation between insulin and additional variables used by the FAS classification system were performed. Regarding the prevalence of IR markers, the 1 h-insulin value was allocated above the individual cutoff value in 66.7%, 62.5% and 22.2% in FAS III, IV, and II patients, respectively. The prevalence of impaired fasting glucose or glucose tolerance was 7 and 14% in FAS III women only. In ROC analysis, insulin 1 h at a cutoff value of 99 mU/L predicted metabolic syndrome with a specificity of 74% and sensitivity of 70%. Furthermore, 1 h-insulin was highly significantly correlated with ISI and AUC 2h-insulin. Testosterone correlated significantly with BMI, AC, insulin, HOMA-IR, ISI, glucose and triglycerides. The variance of insulin (0, 1 h, 2 h) was significantly explained by AC, HDLcholesterol and testosterone. In conclusion, the high prevalence of IR in accurately defined androgenized women supports the FAS classification system comprising an OGLT with the analysis of both glucose and insulin. For screening of IR in androgenized patients, an OGLT of 1h (including insulin) appears to be a reliable test approach particularly considering time and cost consumption in this special group of patients at fertile age.