Dumesic Daniel A, Turcu Adina F, Liu Haiping, Grogan Tristan R, Abbott David H, Lu Gwyneth, Dharanipragada Devyani, Chazenbalk Gregorio D
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.
J Endocr Soc. 2023 Jun 7;7(8):bvad079. doi: 10.1210/jendso/bvad079. eCollection 2023 Jul 3.
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.
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.
Prospective, cross-sectional, cohort study.
Academic medical center.
Twenty normal-weight women with PCOS and 20 body mass index-/age-matched controls.
Blood sampling, IV glucose tolerance testing, and total-body dual-energy x-ray absorptiometry.
Clinical characteristics, hormonal concentrations, and body fat distribution.
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.
Reduced cortisol may protect against preferential abdominal fat mass in normal-weight PCOS women with normal serum 11-oxyandrogens.
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。
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。
前瞻性横断面队列研究。
学术医疗中心。
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。
采血、静脉葡萄糖耐量试验和全身双能X线吸收法。
临床特征、激素浓度和体脂分布。
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。
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。
