Determination of Source of Hyperandrogenism and Comparisons of Hormonal and Metabolic Profile in Different Phenotype of PCOS: A Hospital Based Study

Abstract

Objective: Metabolic parameters in polycystic ovary syndrome (PCOS) correlate to their phenotypic presentations and sources of hyperandrogenism. Till date no studies have evaluated the source of hyperandrogenism among phenotypic variants of PCOS. Therefore we determined the sources of hyperandrogenism and compared the metabolic parameters in different phenotypes of PCOS. Result: This study had 2 phenotypic presentations i.e. PHO (80%) and OH (20%) out of 4 phenotypic presentations described by Rotterdam among all PCOS (may be due to referral bias). Among obese PCOS 87.5% had PHO and 12.5% had OH phenotypes, while it was 75% and 25% in normal weight PCOS. PHO phenotypes had adrenal and ovarian source of hyperandrogenism. Fasting insulin and HOMA-IR were higher in non-obese PHO than obese PHO but statistically insignificant. Serum DHEAS (delta steroid) had a negative but serum testosterone (keto steroid) had positive correlation with IR in PCOS. Conclusion:Both adrenal and ovarian hyperandrogenism was found in PHO as compared to OH phenotype that had only ovarian hyperandrogenism. Normal weight PCOS had less chance of getting ultrasound abnormalities compared to obese PCOS. PHO phenotypes, who had a greater degree of serum DHEAS had a better metabolic profile despite a greater BMI. So our result suggests that distinction between source of hyperandrogenism and evaluation of different phenotype is beneficial in predicting metabolic risk and future management.