Assessment of insulin resistance in lean women with polycystic ovary syndrome

Morciano, Andrea; Romani, Federica; Sagnella, Francesca; Scarinci, Elisa; Palla, Carola; Moro, Francesca; Tropea, Anna; Policola, Caterina; Casa, Silvia Della; Guido, Maurizio; Lanzone, Antonio; Apa, Rosanna

doi:10.1016/j.fertnstert.2014.04.004

Cited by 42 publications

(38 citation statements)

References 39 publications

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“…However, Stepto et al [24] included patients diagnosed using the Rotterdam criteria in their study (2 of the 3 criteria: oligo/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound were used). Nevertheless, another large study found that only 53 out of 201 (26.3%) lean PCOS women (body mass index [BMI] less than 25) had IR, suggesting that ethnic background and dietary composition might play a role in the metabolic factors among these women [25]. …”

Section: A Pathophysiologymentioning

confidence: 99%

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

Ibáñez¹,

et al. 2017

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This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)¹. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.

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Section: A Pathophysiologymentioning

confidence: 99%

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

Ibáñez¹,

et al. 2017

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“…The IR is closely associated with the hyperandrogen, which could not only stimulate the ovary to produce more androgen, but also reduce the binding between the sex hormone and protein, therefore, the insulin sensitizer is considered to have great potential for PCOS treatment. Morciano et al (33) performed a retrospective analysis and found that obese or non-obese PCOS women, who had undergone an oral glucose tolerance test and had a recorded IR index, all exhibited the metabolic disorder of IR. Thus, the study recommended that all PCOS women should be examined for IR.…”

Section: Wet Weight G ----------------------------------------------mentioning

confidence: 99%

Bak Foong pills combined with metformin in the treatment of a polycystic ovarian syndrome rat model

Liu

et al. 2015

Oncology Letters

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Abstract. The aim of the present study was to investigate the treatment effects and associated mechanism of Bak Foong pills (BFPs) combined with metformin in the treatment of polycystic ovarian syndrome (PCOS). BFPs and/or metformin were administrated to treat the PCOS rats, and the weights and morphologies of the ovary, uterus and adrenal gland were measured. The levels of fasting blood glucose (FBG), serum testosterone (T), luteinizing hormone, fasting insulin (FIN) and insulin-like growth factor-1 were also measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The expression level of androgen receptor (AR) in the ovarian tissue, and the cytochrome P450 cholesterol side-chain cleavage enzyme (P450scc) mRNA levels in the ovary and adrenal tissues were detected. The levels of T, FIN, FBG and HOMA-IR in the combination group were significantly reduced; the wet weights of the ovary and the adrenal gland were decreased significantly, while that of the uterus was increased, and the histological morphology benignly recovered. The rats of each treatment group all experienced restored ovulation. The AR expression level in the treatment group was reduced, and the P450scc mRNA levels in the ovary and the adrenal gland of the combined treatment group were decreased. BFPs combined with metformin significantly affected PCOS, and the possible mechanism involved in the treatment may have been through the reduction of P450scc generation. BFPs may reduce the androgen levels, thus allowing the ovary to restore ovulation.

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“…The HOMA-IR was calculated as the product of the fasting insulin level (mIU/L) and the fasting glucose level (mg/dL) divided by 405. The modified HOMA-M y indices were calculated as follows: HOMA-M y = G y (mg/dL) × I y (mIU/L)/405, where y and I y indicate 120-minute glucose and insulin values from the OGTT, respectively [4]. …”

Section: Methodsmentioning

confidence: 99%

“…IR evaluation in lean women with PCOS could be underestimated owing to the absence of obesity. Recently, the homeostasis-model assessment (HOMA)-M 120 was reported as a simple and reliable measure of IR for lean European women with PCOS [4]. However, the efficacy of HOMA-M 120 for estimating IR in lean women with PCOS has not been evaluated in an Asian population.…”

Section: Introductionmentioning

confidence: 99%

Insulin resistance according to β-cell function in women with polycystic ovary syndrome and normal glucose tolerance

et al. 2017

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BackgroundPolycystic ovary syndrome (PCOS) is associated with insulin resistance (IR) and compensatory hyperinsulinemia. IR is recognized as a major risk factor for the development of type 2 diabetes mellitus. However, few studies have investigated IR in women with PCOS and normal glucose tolerance. The objective of this study was to evaluate IR and β-cell function in women with PCOS and normal glucose tolerance. Additionally, we sought to evaluate the usefulness of oral glucose tolerance test (OGTT)-derived IR indices in lean women with PCOS.MethodsWe recruited 100 women with PCOS and normal glucose tolerance and 100 age- and BMI-matched women as controls. IR and insulin secretory indices, including the homeostasis-model assessment (HOMA)-IR, HOMA-M120, HOMA-F and the Stumvoll index, were calculated from an OGTT. Increased β-cell function was defined as>75th percentile for the HOMA-F in control women.ResultsWomen with PCOS had higher values for post-load 2-hour glucose, fasting insulin, post-load 2-hour insulin, HOMA-IR, HOMA-M120, HOMA-F and lower values for the Stumvoll index than the controls (all Ps<0.05). Women with PCOS and increased β-cell function showed lower Stumvoll index values than the matched controls (P<0.05). The HOMA-F was significantly associated with the HOMA-M120 and Stumvoll index when adjusted for age and BMI in a multiple regression analysis (all Ps<0.05). The HOMA-M120 was positively correlated with triglycerides and free testosterone, and the Stumvoll index was negatively correlated with triglycerides and free testosterone in lean women with PCOS (all Ps<0.05).ConclusionsWomen with PCOS and normal glucose tolerance showed higher IR than controls matched for age, BMI, and β-cell function. β-cell function was increased in women with PCOS when compared to the matched controls, but not when the lean subjects were compared to the matched controls separately. Therefore, early evaluation of IR in women with PCOS and normal glucose tolerance may be needed.

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Assessment of insulin resistance in lean women with polycystic ovary syndrome

Cited by 42 publications

References 39 publications

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

Bak Foong pills combined with metformin in the treatment of a polycystic ovarian syndrome rat model

Insulin resistance according to β-cell function in women with polycystic ovary syndrome and normal glucose tolerance

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