DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175027

Metabolic syndrome and insulin resistance in PCOS phenotypes

Sheena Sobti, Rupali Dewan, Sunil Ranga

Abstract


Background: Polycystic ovary syndrome(PCOS) is an endocrine metabolic disorder which is rapidly gaining epidemic proportions. Hyperinsulinemia and insulin resistance (IR) are thought to be key pathological factors. This study was undertaken to characterize the phenotypes of PCOS and to determine the prevalence of metabolic syndrome (MetS) and insulin resistance in them.

Methods: This observational cross-sectional study was undertaken to assess the distribution of the Rotterdam PCOS phenotypes and to report the prevalence and risk factors for MetS syndrome and insulin resistance using homeostasis model assesment for insulin resistance (HOMA-IR). 90 women aged 18-35 years newly diagnosed with PCOS were classified into one of the four potential PCOS phenotypes based on history, examination and investigations.

Results: Phenotype A was the most prevalent phenotype (45.5%). Prevalence of insulin resistance in our study was 31% using HOMA- IR cutoff of 2.5, with highest prevalence in phenotype A and least in phenotype D. The overall prevalence of MetS was 36% with a two- to six-fold higher prevalence in hyperandrogenic phenotypes compared to the non-hyperandrogenic phenotype. Highest mean hs- CRP was found in phenotype A which could possibly indicate greater cardiovascular risk in future. Univariate logistic regression for predictive association of MetS parameters was significantly high for deranged parameters i.e. WC≥80cm, fasting plasma glucose ≥100mg/dl, HDL ≤50mg/dl and WHR ≥0.85. Strong positive association was found with all these parameters (p<0.001) Hirsutism (modified Ferriman Gallwey score ≥8) was strongly associated with MetS (p=0.005).

Conclusions: An appropriate diagnosis of PCOS and accurate dentification of phenotype is important as it has long-term health implications for women. We recommend screening all hyperandrogenic PCOS women for IR and metabolic abnormalities. This study has shown that HOMA-IR is a valuable tool in identifying PCOS women with metabolic syndrome and also serve to identify PCOS subtype at high risk of future metabolic syndrome.


Keywords


Insulin resistance, Metabolic syndrome, Polycystic ovary syndrome, Phenotypes

Full Text:

PDF

References


Neves EM, Fonseca AM, Bagnoli VR, Souza MA, Araújo Moraes SDT, Maciel GAR et al. Polycystic Ovary Syndrome: Correlation between Phenotypes and Metabolic Syndrome. J Steroids Hormon Sci. 2014;5:132.

Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90:1929-35.

Carmina E. Metabolic syndrome in polycystic ovary syndrome. Minerva Ginecologica. 2006;58:109-114.

Yildiz BO, Bolour S, Woods K, Moore A, Azziz R. Visually scoring hirsutism. Human Reprod Update. 2010;16(1):51-64.

Singh Y, Garg MK, Tandon N, Marwaha RK. A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents. J Clin Res Pediatr Endocrinol. 2013;5:245-51.

Lepor NE, Vogel RE. National Cholesterol Education Program Adult Treatment Panel III. Summary of the third report of the National Cholesterol Education Program Adult Treatment Panel III. Rev Cardiovas Med. 2001;2:160-5.

Grundy SM, Cleeman JL, Daniels SR, Donato KA, Eckel RH, Franklin BA et al. American Heart Association, National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: An American Heart Association/National Herat, Lung and Blood Institute Scientific Statement. Circulation. 2005;112:2735-52.

Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009 Feb; 57:163-70.

Mehrabian F, Khani B, Kelishadi R, Kermani N. The prevalence of metabolic syndrome and insulin resistance according to the phenotypic subgroups of polycystic ovary syndrome in a representative sample of Iranian females. J Res Med Sci. 2011 Jun;16(6):763-9.

Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S, Vaidya R. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India Indian J Endocrinol Metab. 2014;18:317-324.

Saxena P, Singh S, Bhattacharjee J. Endocrine and metabolic profile of different phenotypes of polycystic ovarian syndrome. J Obstet Gynecol India. 2016 ; 66:560-6.

Ramanand SJ, Ghongane BB, Ramanand JB, Patwardhan MH, Ghanghas RR, Jain SS. Clinical characteristics of polycystic ovary syndrome in Indian women. Indian J Endocr Metab. 2013;17:138-145.

Solomon CG, Hu FB, Dunaif A, Rich-Edwards J, Willett WC, Hunter DJ et al. Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. JAMA. 2001;286:2421-6.

Gorry A, White DM, Franks S. Infertility in polycystic ovary syndrome: focus on low-dose gonadotropin treatment. Endocrine. 2006;30:27-33.

Coviello AD, Legro RS, Dunaif A. Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab. 2006;91(2):492-7.

Kar S. Anthropometric, clinical, and metabolic comparisons of the four Rotterdam PCOS phenotypes: a prospective study of PCOS women. J Hum Reprod Sci. 2013;6:194-200.

Misra A, Vikram NK, Arya S, Pandey RM, Dhingra V, Chatterjee A et al. High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat. Int J Obes Relat Metab Disord. 2004;28:1217-26.

Shroff R, Syrop CH, Davis W, Van Voorhis BJ, Dokras A. Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril. 2007;88:1389-95.

Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003;107:391-7.