The relationships of sex hormone‐binding globulin, total testosterone, androstenedione and free testosterone with metabolic and reproductive features of polycystic ovary syndrome

Simons, Pomme I H G; Valkenburg, Olivier; Bons, J; Stehouwer, Coen D. A.; Brouwers, Martijn C.G.J.

doi:10.1002/edm2.267

Cited by 12 publications

(6 citation statements)

References 46 publications

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“…Previous studies have shown that FAI and androstenedione are associated with MS in PCOS 17–21 . In this work, we showed that these two androgens are independently related to siMS in women with PCOS and thus, could contribute to MS in PCOS through different pathophysiological pathways.…”

Section: Discussionsupporting

confidence: 60%

Assessing the androgenic and metabolic heterogeneity in polycystic ovary syndrome using cluster analysis

Deshmukh

Akbar²,

Bhaiji³

et al. 2022

Clinical Endocrinology

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Introduction Some but not all women with polycystic ovary syndrome (PCOS) develop the metabolic syndrome (MS). The objective of this study was to determine if a subset of women with PCOS had higher androgen levels predisposing them to MS and whether routinely measured hormonal parameters impacted the metabolic syndrome score (siMS). Methods We included data from a discovery (PCOS clinic data) and a replication cohort (Hull PCOS Biobank) and utilized eight routinely measured hormonal parameters in our clinics (free androgen index [FAI], sex hormone‐binding globulin, dehydroepiandrosterone sulphate (DHEAS), androstenedione, luteinizing hormone [LH], follicular stimulating hormone, anti‐Müllerian hormone and 17 hydroxyprogesterone [17‐OHP]) to perform a K‐means clustering (an unsupervised machine learning algorithm). We used NbClust Package in R to determine the best number of clusters. We estimated the siMS in each cluster and used regression analysis to evaluate the effect of hormonal parameters on SiMS. Results The study consisted of 310 women with PCOS (discovery cohort: n = 199, replication cohort: n = 111). The cluster analysis identified two clusters in both the discovery and replication cohorts. The discovery cohort identified a larger cluster (n = 137) and a smaller cluster (n = 62), with 31% of the study participants. Similarly, the replication cohort identified a larger cluster (n = 74) and a smaller cluster (n = 37) with 33% of the study participants. The smaller cluster in the discovery cohort had significantly higher levels of LH (7.26 vs. 16.1 IU/L, p < .001), FAI (5.21 vs. 9.22, p < .001), androstenedione (3.93 vs. 7.56 nmol/L, p < .001) and 17‐OHP (1.59 vs. 3.12 nmol/L, p < .001). These findings were replicated in the replication cohort. The mean (±SD) siMS score was higher in the smaller cluster, 3.1 (±1.1) versus 2.8 (±0.8); however, this was not statistically significant (p = .20). In the regression analysis, higher FAI (β = .05, p = .003) and androstenedione (β = .03, p = .02) were independently associated with a higher risk of SiMS score, while higher DHEAS levels were associated with a lower siMS score (β = −.07, p = .03) Conclusion We identified a subset of women in our PCOS cohort with significantly higher LH, FAI, and androstenedione levels. We show that higher levels of androstenedione and FAI are associated with a higher siMS, while higher DHEAS levels were associated with lower siMS.

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Section: Discussionsupporting

confidence: 60%

Assessing the androgenic and metabolic heterogeneity in polycystic ovary syndrome using cluster analysis

Deshmukh

Akbar²,

Bhaiji³

et al. 2022

Clinical Endocrinology

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“…However, a study that excluded all abnormal BMIs when selecting study participants reported a free T value significantly lower than the other literature values and the subreddit value [ 35 ]. It has been reported in several PCOS studies that elevated free androgens are strongly associated with elevated BMI [ 47 - 49 ]. Thus, it is logical that the only study to exclude patients with an abnormal BMI is the only one to report a significantly lower free T value.…”

Section: Discussionmentioning

confidence: 99%

“…The larger studies reported higher SHBG values than the subreddit values, but the normal BMI study found a lower SHBG value. SHBG levels are lower in populations with PCOS [ 50 ], but this is especially true in those who also possess a high BMI [ 47 - 49 ]. Since the subreddit BMI was often lower than the literature values, it is expected that the subreddit SHBG would be higher than the literature values that did not exclude based on BMI but lower than the literature values that only took normal-BMI participants.…”

Section: Discussionmentioning

confidence: 99%

Comparing Literature- and Subreddit-Derived Laboratory Values in Polycystic Ovary Syndrome (PCOS): Validation of Clinical Data Posted on PCOS Reddit Forums

Emanuel¹,

Docherty²,

Lunt³

et al. 2023

JMIR Form Res

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Background Polycystic ovary syndrome (PCOS) is a heterogeneous condition that affects 4% to 21% of people with ovaries. Inaccessibility or dissatisfaction with clinical treatment for PCOS has led to some individuals with the condition discussing their experiences in specialized web-based forums. Objective This study explores the feasibility of using such web-based forums for clinical research purposes by gathering and analyzing laboratory test results posted in an active PCOS forum, specifically the PCOS subreddit hosted on Reddit. Methods We gathered around 45,000 posts from the PCOS subreddit. A random subset of 5000 posts was manually read, and the presence of laboratory test results was labeled. These labeled posts were used to train a machine learning model to identify which of the remaining posts contained laboratory results. The laboratory results were extracted manually from the identified posts. These self-reported laboratory test results were compared with values in the published literature to assess whether the results were concordant with researcher-published values for PCOS cohorts. A total of 10 papers were chosen to represent published PCOS literature, with selection criteria including the Rotterdam diagnostic criteria for PCOS, a publication date within the last 20 years, and at least 50 participants with PCOS. Results Overall, the general trends observed in the laboratory test results from the PCOS web-based forum were consistent with clinically reported PCOS. A number of results, such as follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone, were concordant with published values for patients with PCOS. The high consistency of these results among the literature and when compared to the subreddit suggests that follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone are more consistent across PCOS phenotypes than other test results. Some results, such as testosterone, sex hormone–binding globulin, and homeostasis model assessment–estimated insulin resistance index, were between those of PCOS literature values and normal values, as defined by clinical testing limits. Interestingly, other results, including dehydroepiandrosterone sulfate, luteinizing hormone, and fasting glucose, appeared to be slightly more dysregulated than those reported in the literature. Conclusions The differences between the forum-posted results and those published in the literature may be due to the selection process in clinical studies and the possibility that the forum disproportionally describes PCOS phenotypes that are less likely to be alleviated with medical intervention. However, the degree of concordance in most laboratory test values implied that the PCOS web-based forum participants were representative of research-identified PCOS cohorts. This validation of the PCOS subreddit grants the possibility for more research into the contents of the subreddit and the idea of undertaking similar research using the contents of other medical internet forums.

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“…The meta-analysis also suggested that women with PCOS and lower SHBG levels were more likely to have hyperandrogenism, metabolic issues and infertility ( 118 ). SHBG levels are especially lower in those who also possess a high BMI ( 121 – 123 ). Figure 10 shows how SHBG is dysregulated in PCOS.…”

Section: Metabolic Hormone Changesmentioning

confidence: 99%

A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions

et al. 2022

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Polycystic ovary syndrome (PCOS) affects up to 20% of women but remains poorly understood. It is a heterogeneous condition with many potential comorbidities. This review offers an overview of the dysregulation of the reproductive and metabolic systems associated with PCOS. Review of the literature informed the development of a comprehensive summarizing ‘wiring’ diagram of PCOS-related features. This review provides a justification for each diagram aspect from the relevant academic literature, and explores the interactions between the hypothalamus, ovarian follicles, adipose tissue, reproductive hormones and other organ systems. The diagram will provide an efficient and useful tool for those researching and treating PCOS to understand the current state of knowledge on the complexity and variability of PCOS.

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The relationships of sex hormone‐binding globulin, total testosterone, androstenedione and free testosterone with metabolic and reproductive features of polycystic ovary syndrome

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 12 publications

References 46 publications

Assessing the androgenic and metabolic heterogeneity in polycystic ovary syndrome using cluster analysis

Assessing the androgenic and metabolic heterogeneity in polycystic ovary syndrome using cluster analysis

Comparing Literature- and Subreddit-Derived Laboratory Values in Polycystic Ovary Syndrome (PCOS): Validation of Clinical Data Posted on PCOS Reddit Forums

A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions

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