Adrenal Androgen Predictive Effects on Clinical and Metabolic Abnormalities of Polycystic Ovary Syndrome

Abstract

Objective To examine the possible effects of adrenal prohormones in the prediction of clinical and metabolic abnormalities in women with polycystic ovary syndrome (PCOS). Methods The present study enrolled 299 normal cycling non-PCOS, 156 normoandrogenemic, and 474 hyperandrogenemic women with PCOS. Baseline characteristics were compared using a chi-squared test or analysis of variance (ANOVA) as appropriate. The roles of adrenal prohormones and their ratios with total testosterone in predicting co-occurring morbidities in women PCOS were evaluated using univariate and multivariate logistic regression analyses. Results Adrenal hyperandrogenism per dehydroepiandrosterone sulfate (DHEAS) levels were found in 32% of women with PCOS. In non-PCOS women, dehydroepiandrosterone (DHEA) and its sulfate had no predictive role concerning clinical, anthropometric, and metabolic parameters. In PCOS women, mainly in the hyperandrogenemic group, DHEA showed to be a significant predictor against most anthropometric-metabolic index abnormalities (odds ratio [OR] = 0.36–0.97; p < 0.05), and an increase in triglycerides (TG) levels (OR = 0.76; p = 0.006). Dehydroepiandrosterone sulfate presented a few predictive effects regarding PCOS-associated disorders. In controls, DHEAS predicted against the increase in estimated average glucose (OR= 0.38; p = 0.036). In the normoandrogenic group, it predicted against elevation in the waist/hip ratio (WHR) (OR= 0.59; p = 0.042), and in hyperandrogenemic PCOS women, it predicted against abnormality in the conicity index (CI) (OR = 0.31; p = 0.028). Conclusion Dehydroepiandrosterone was shown to be a better predictor of abnormal anthropometric and biochemical parameters in women with PCOS than DHEAS. Thus, regarding adrenal prohormones, DHEA measurement, instead of DHEAS, should be preferred in PCOS management. The effects of androgen prohormones on the prediction of PCOS abnormalities are weak.

Impact of dehydroepiandrosterone sulfate and free androgen index on pregnancy and neonatal outcomes in PCOS patients

“…Notably, when DHEAS levels were ≥ 7.69umol/ml, there was a significant negative impact on the CPR and CLBR. Similarly, a separate study indicated that DHEA and DHEAS could serve as better predictors of abnormal anthropometric and biochemical parameters in women with PCOS, which may be associated with fertility issues [ 36 , 37 ].…”

Fetal Metabolic Programming in the Etiology of Polycystic Ovarian Syndrome

“…(6,18,22) Chronic exposure to androgens directs macrophages to adipocytes, which induce their hypertrophy, leading to visceral fat accumulation, causing obesity. (18,23) Obesity is present in 56% of patients with PCOS (10) and its presence can aggravate metabolic and reproductive disorders associated with it. (9) Studies have shown that patients with PCOS are 4 times more likely to have MS. (8,24) Thus, PCOS brings complex health consequences, in which it affects the quality of life of women in the short and long term.…”

“…Women with PCOS are more likely to accumulate fat, especially abdominal fat. (18,23) Free fatty acids activate Toll-like receptors (TLRs), especially TLR4, which plays an inhibitory role in the IR β-subunit pathways by increasing the phosphorylation of JNK at serine, making a vicious cycle of IR. (26,34) 2.3 Fetal Metabolic Programming and SOP Due to the multifactorial causes of PCOS, (7,11) some studies suggest that during fetal development changes occur that increase the chance that offspring will present PCOS as adolescents, (1) a process known as metabolic programming.…”