Polycystic ovarian disease: Endocrinological parameters with specific reference to growth hormone and somatomedin-C

Abstract

Thirty-three women (22-38 years old) with polycystic ovarian disease (PCOD) were included in this study. The criteria for diagnosis were: an LH/FSH ratio greater than 2.0; polycystic ovaries, diagnosed by means of palpation and ultrasound; androgenism and menstrual cycle abnormalities. Using endocrine parameters, we attempted to define distinct forms of PCOD. The patients were placed in three groups according to serum levels of testosterone (T) and 17 alpha-hydroxyprogesterone (17 alpha OHP) and the estrone/androstendione (E1/delta 4A) ratio. Patients in group I (n = 18) had an elevated T level (greater than 1.0 ng/ml) and a 17 alpha OHP level under 4.0 ng/ml. This type of POCD was called the "androgen" type. Patients in group II (n = 7) had normal T- and 17 alpha OHP levels under 4.0 ng/ml and an elevated (E1/delta 4A) ratio. This type of PCOD was called the "estrogen" type. Group III (n = 8) comprised patients with 17 alpha OHP levels over 4.0 ng/ml. This type of PCOD was called the "adrenocortical" type. In two patients of this group, a modified ACTH test revealed late-onset congenital hyperplasia. The endocrine parameters of the patients with PCOD were compared with those of 17 adult without signs of PCOD. Statistical evaluation was done by variance analysis. Women with acromegaly often show signs of androgenism as well as menstrual cycle abnormalities. This may indicate an association between the growth factors human growth hormone (HGH) and somatomedin-C (Sm-C) and the biosynthese and metabolism of steroid hormone. Recent experiments have demonstrated such associations. Our study showed an association between the HGH and Sm-C levels and abnormal steroid hormone concentrations in women with androgen type PCOD (group I). These patients had a significantly decreased HGH level, a significantly decreased HGH/Sm-C ratio, and an increased average Sm-C level. These data suggest that elevated Sm-C levels can, by a negative-feedback mechanism, inhibit pituitary HGH production. We discuss the possible mechanisms causing elevation of plasma Sm-C, HGH, steroid hormones, excessive food intake, and possibly prolactin seem responsible for the clinical manifestation of increased Sm-C production in adolescence and for its level in the fertile years of patients.

Acromegaloid bone changes in severe polycystic ovarian disease: an effect of hyperinsulinaemia? Case report

“…Our patient's basal and post‐glucose GH concentrations were not elevated, excluding GH excess as the cause of the radiological findings. Indeed GH was undetectable in her fasting sample, consistent with the finding of GH hyposecretion in women with PCOD (Urdl 1988).…”

Plasma Levels of Insulin-Like Growth Factor-I and Its Binding Protein in Polycystic Ovary Syndrome

“…Urdl [20] recently reported that PCOS patients with elevated testosterone had signifi cantly decreased GH levels with decreased GH/IGF-I ratio. Although IGF-I levels were not significantly higher in these patients, these results indicated that elevated IGF-I levels inhibited pituitary GH production by nega tive feedback.…”

Insulin resistance, insulin‐like growth factor I and breast cancer: A hypothesis

“…In one view, insulin resistance is the primary defect, and leads to increased IGF-I action upon target tissues by directly binding to IGF-I receptors (to which insulin can bind with low affinity via specificity spillover) or by suppressing serum IGFBP-1 levels (Suikkari et al, 1989;Barbieri et al, 1988;Nestler et al, 1989b). Alternatively, a developmental abnormality in the establishment of the "setpoint" for IGF-I activity in various tissues, possibly related to nutritional factors early in life, has been proposed (Urdl, 1988;Kazer, 1989). Such an abnormality could be characterized by increased availability of IGF-I (in either an endocrine or paracrine context), increased target tissue sensitivity to IGF-I, an increase in the size of various IGF-I-dependent tissue compartments, or some combination of the three.…”