Assessment of Metabolic and Hormonal Disturbances in the Different Polycystic Ovary Syndrome Phenotypes
Author: Nyagolova, Presiyana V.1, Mitkov, Mitko D.2, Koleva, Daniela Iv.1, Orbetzova, Maria M.1, Terzieva, Dora D.3
1 Section/Clinic of Endocrinology and Metabolic Disease, “Sv. Georgy” University Hospital Medical Faculty,
Medical University, Plovdiv
2 Clinic of Endocrinology and Metabolic Disease, University Hospital “Pulmed”, Medical Faculty, Medical
3 Central Clinical Laboratory, University Hospital “Sv. Georgy”, Faculty of Pharmacy, MU, Plovdiv
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age. The different clinical manifestations allow separation of the syndrome carriers into 4 main groups with certain phenotypic characteristics.
The aim of this study was to characterize and compare the metabolic and hormonal changes in the 4 phenotypes
of women with PCOS.
Materials and methods: The study included 87 women with established PCOS according to the ESHREASRM
criteria and a control group of 27 clinically healthy women. Fasting plasma glucose (FPG), total cholesterol (TC), HDL-cholesterol (HDL-C), triglycerides (TG), insulin, thyroid-stimulating hormone (TSH), free thyroxine (FT4), anti-thyrooperoxidase (TPO) and anti-thyroglobulin (Tg) antibodies, luteinizing hormone (LH), follicle-stimulating
hormone (FSH), oestradiol (E2), androstenedione (A4), dehydroepiandrosterone sulfate (DHEA-S), testosterone (T) and prolactin (PRL) were determined, and a standard oral glucose tolerance test (oGTT) was performed. BMI, free androgen index (FAI), glucose insulin ratio (GIR) and HOMA index (HOMA-IR) were calculated.
Results: The PCOS women were subdivided into 4 phenotypes – A (oligoanovulation, hyperandrogenism and polycystic ovaries) (n=33), B (oligoanovulation and hyperandrogenism) (n=20), C (hyperandrogenism and polycystic ovaries) (n=19), and D (oligoanovulation and polycystic ovaries) (n=15). The patients of the 4 subgroups did not differ in age (P=0.615) and BMI (P=0,223). The comparison of the carbohydrate and lipid metabolism parameters did not reveal significant differences among the different phenotypes: TC (Р=0,672), HDL-C (Р=0,083), LDL-C (Р=0,786), TG (Р=0,552), glucose at 0. min. (P=0,465), glucose at 60. min. (P=0,291), glucose
at 120. min. (P=0,385), insulin at 0. min. (P=0,259), insulin at 120. min. (P=0,511), HOMA-IR (P=0,432), GIR (P=0,429). When comparing the 7 criteria used for detecting insulin resistance, the best marker was the 5-time increase of insulin during the oGTT above the baseline levels. We found significantly higher T levels in patients with phenotype A than those in patients with phenotype D (P=0,028) and also higher levels of DHEA-S in the
phenotype B compared to the phenotype D (P=0,045).
Conclusion: There was a comparable risk profile concerning the presence of insulin resistance and concomitant
hyperinsulinaemia among the four PCOS phenotypes when the groups were adjusted for BMI. Determining
the phenotype of women with PCOS is of a particular importance for clinical practice with a view to comprehensive
and accurate assessment of the general condition, prevention of metabolic complications and the
timely choice of appropriate therapeutic behaviour in women with PCOS.
Key words: bone metabolism, osteoblast, osteocyte, sclerostin, Wnt signal pathway