正常体重多囊卵巢综合征女性中皮质醇、睾酮与腹部脂肪量的相互作用
Interplay of Cortisol, Testosterone, and Abdominal Fat Mass in Normal-weight Women With Polycystic Ovary Syndrome.
作者信息
Dumesic Daniel A, Turcu Adina F, Liu Haiping, Grogan Tristan R, Abbott David H, Lu Gwyneth, Dharanipragada Devyani, Chazenbalk Gregorio D
机构信息
Department of Obstetrics and Gynecology, University of California, Los Angeles, 1Los Angeles, CA 90095, USA.
Division of Metabolism, Endocrinology, Nutrition and Diabetes, University of Michigan, Ann Arbor, MI 48103, USA.
出版信息
J Endocr Soc. 2023 Jun 7;7(8):bvad079. doi: 10.1210/jendso/bvad079. eCollection 2023 Jul 3.
CONTEXT
Ovarian and adrenal steroidogenesis underlie endocrine-metabolic dysfunction in polycystic ovary syndrome (PCOS). Adipocytes express aldo-keto reductase 1C3 and type 1 11β-hydroxysteroid dehydrogenase, which modulate peripheral androgen and cortisol production.
OBJECTIVES
To compare serum adrenal steroids, including 11-oxygenated androgens (11-oxyandrogens), cortisol, and cortisone between normal-weight women with PCOS and body mass index- and age-matched ovulatory women with normal-androgenic profiles (controls), and assess whether adrenal steroids associate with abdominal adipose deposition.
DESIGN
Prospective, cross-sectional, cohort study.
SETTING
Academic medical center.
PATIENTS
Twenty normal-weight women with PCOS and 20 body mass index-/age-matched controls.
INTERVENTIONS
Blood sampling, IV glucose tolerance testing, and total-body dual-energy x-ray absorptiometry.
MAIN OUTCOME MEASURES
Clinical characteristics, hormonal concentrations, and body fat distribution.
RESULTS
Women with PCOS had higher serum total/free testosterone (T) and androstenedione (A4) levels and a greater android/gynoid fat mass than controls (androgens < .001; android/gynoid fat mass ratio, = .026). Serum total/free T and A4 levels correlated positively with android/gynoid fat mass ratio in all women combined ( < .025, all values). Serum 11ß-hydroxyA4, 11-ketoA4, 11ß-hydroxyT, 11-ketoT, cortisol, and cortisone levels were comparable between female types and unrelated to body fat distribution. Serum 11-oxyandrogens correlated negatively with % total body fat, but lost significance adjusting for cortisol. Serum cortisol levels, however, correlated inversely with android fat mass ( = .021), with a trend toward reduced serum cortisol to cortisone ratio in women with PCOS vs controls ( = .075), suggesting diminished 11β-hydroxysteroid dehydrogenase activity.
CONCLUSION
Reduced cortisol may protect against preferential abdominal fat mass in normal-weight PCOS women with normal serum 11-oxyandrogens.
背景
多囊卵巢综合征（PCOS）患者的内分泌代谢功能障碍与卵巢和肾上腺类固醇生成有关。脂肪细胞表达醛糖还原酶1C3和1型11β-羟基类固醇脱氢酶，可调节外周雄激素和皮质醇的生成。
目的
比较体重正常的PCOS女性与体重指数和年龄匹配、雄激素水平正常且有排卵的女性（对照组）的血清肾上腺类固醇，包括11-氧化雄激素（11-氧雄激素）、皮质醇和可的松，并评估肾上腺类固醇是否与腹部脂肪沉积有关。
设计
前瞻性横断面队列研究。
地点
学术医疗中心。
患者
20名体重正常的PCOS女性和20名体重指数/年龄匹配的对照组女性。
干预措施
采血、静脉葡萄糖耐量试验和全身双能X线吸收法。
主要观察指标
临床特征、激素浓度和体脂分布。
结果
PCOS女性的血清总睾酮/游离睾酮（T）和雄烯二酮（A4）水平高于对照组，男性型/女性型脂肪量也高于对照组（雄激素P <.001；男性型/女性型脂肪量比值，P =.026）。在所有女性中，血清总睾酮/游离睾酮和A4水平与男性型/女性型脂肪量比值呈正相关（P <.025，所有值）。血清11β-羟基A4、11-酮A4、11β-羟基T、11-酮T、皮质醇和可的松水平在两组女性中相当，且与体脂分布无关。血清11-氧雄激素与全身脂肪百分比呈负相关，但在调整皮质醇后失去显著性。然而，血清皮质醇水平与男性型脂肪量呈负相关（P =.021），PCOS女性与对照组相比，血清皮质醇与可的松比值有降低趋势（P =.075），提示11β-羟基类固醇脱氢酶活性降低。
结论
在血清11-氧雄激素正常的体重正常的PCOS女性中，皮质醇降低可能有助于预防腹部脂肪量增加。
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