Risk of Insulin Resistance and Metabolic Syndrome in Women with Hyperandrogenemia: A Comparison between PCOS Phenotypes and Beyond

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in premenopausal women, with a wide spectrum of possible phenotypes, symptoms and sequelae according to the current clinical definition. However, there are women who do not fulfill at least two out of the three commonly used “Rotterdam criteria” and their risk of developing type 2 diabetes or obesity later in life is not defined. Therefore, we addressed this important gap by conducting a retrospective analysis based on 750 women with and without PCOS. We compared four different PCOS phenotypes according to the Rotterdam criteria with women who exhibit only one Rotterdam criterion and with healthy controls. Hormone and metabolic differences were assessed by analysis of variance (ANOVA) as well as logistic regression analysis. We found that hyperandrogenic women have per se a higher risk of developing insulin resistance compared to phenotypes without hyperandrogenism and healthy controls. In addition, hyperandrogenemia is associated with developing insulin resistance also in women with no other Rotterdam criterion. Our study encourages further diagnostic and therapeutic approaches for PCOS phenotypes in order to account for varying risks of developing metabolic diseases. Finally, women with hyperandrogenism as the only symptom should also be screened for insulin resistance to avoid later metabolic risks.

HIIT'ing or MISS'ing the Optimal Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of High- Versus Moderate-Intensity Exercise Prescription

“…Finally, despite PCOS having multiple phenotypes, only four studies (Jedel et al, 2011;Almenning et al, 2015;Ribeiro et al, 2020;Benham et al, 2021) explicitly reported phenotypical subgroups within their analyses. Previous data suggest that the different phenotypical presentations of PCOS may respond differently to exercise stimuli hence this is an important area for further study (Borzan et al, 2021).…”

Autoimmunity to the Follicle-Stimulating Hormone Receptor (FSHR) and Luteinizing Hormone Receptor (LHR) in Polycystic Ovarian Syndrome

“…The cohort of PCOS patients consisted of n = 550 individual serum samples, collected in Graz, Austria, under highest quality standards, and stored at Biobank Graz [55]. The Rotterdam criteria for PCOS diagnosis were applied according to the literature [59,60]. Blood sampling was performed in the morning after an overnight fast.…”

Exercise Programming for Polycystic Ovary Syndrome

“…Polycystic ovary syndrome is an endocrine disorder defined as having 2 of the 3 following clinical symptoms: chronic menstrual irregularity (oligomenorrhea or anovulation), elevated levels of androgens (hyperandrogenism), and ovarian cysts detected by pelvic ultrasound (PCO) (2,8,11,13,22). Diagnosed women are categorized into 1 of 4 standard phenotypes: (a) complete phenotype-menstrual irregularity/hyperandrogenism/PCO; (b) ovulatory phenotype-hyperandrogenism and PCO; (c) nonhyperandrogenic phenotype-menstrual irregularity and PCO; and (d) the nonpolycystic ovary phenotype-menstrual irregularity and hyperandrogenism (7,8,14).…”

“…An estimated 20% of women of reproductive age have PCOS, making it one of the more common endocrine disorders (1,8,19,23,26). Despite this estimation, it may be possible that up to 70% of PCOS women are undiagnosed (30,42).…”