Rittmaster R S, Deshwal N, Lehman L
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
J Clin Endocrinol Metab. 1993 May;76(5):1295-300. doi: 10.1210/jcem.76.5.8388405.
Hyperandrogenism, insulin resistance, and obesity are common features of polycystic ovarian syndrome (PCOS). This study was designed to investigate the relationship among these factors and how they might contribute to ovulatory dysfunction in PCOS. Adrenal androgen secretion and insulin resistance were quantified in oligomenorrheic women with PCOS and in three groups of eumenorrheic women: weight-matched hirsute women, obese nonhirsute women, and thin nonhirsute women. Adrenal androgen secretion was defined as the androstenedione response to synthetic corticotropin. Insulin resistance was estimated by calculating the area under the curve for serum insulin levels in response to a 75 g oral glucose load. The mean serum androstenedione response (nmol/L) to corticotropin in PCOS (5.6 +/- 1.3) was greater than that in eumenorrheic hirsute women (3.4 +/- 0.5; P < 0.10), obese nonhirsute women (1.8 +/- 0.8; P < 0.05), and lean nonhirsute women (1.9 +/- 0.5; P < 0.05). The serum androstenedione response was not correlated with body mass index (BMI). The area under the curve for serum insulin (mU/L.min/1000) in PCOS (29.1 +/- 5.3) was greater (P < 0.001) than in eumenorrheic hirsute women (9.1 +/- 1.7), obese nonhirsute women (5.8 +/- 1.0), and lean nonhirsute women (4.5 +/- 0.4). The serum insulin response was highly correlated with BMI (P < 0.001) in the three groups of obese women, but women with PCOS became significantly more insulin resistant with increasing BMI (P < 0.02). There was no correlation between adrenal androgen secretion and insulin resistance in any of the groups. We conclude that adrenal hyperandrogenism and insulin resistance are independent predictors of anovulation in hirsute women. These conditions are present in both oligomenorrheic and eumenorrheic hirsute women, but are present to a greater extent in anovulatory women. Obese women with PCOS also differ from eumenorrheic controls by developing a greater degree of insulin resistance as body mass increases.
高雄激素血症、胰岛素抵抗和肥胖是多囊卵巢综合征（PCOS）的常见特征。本研究旨在调查这些因素之间的关系以及它们如何导致PCOS患者排卵功能障碍。对患有PCOS的月经过少女性以及三组月经正常女性（体重匹配的多毛女性、肥胖的非多毛女性和消瘦的非多毛女性）的肾上腺雄激素分泌和胰岛素抵抗进行了量化。肾上腺雄激素分泌定义为雄烯二酮对合成促肾上腺皮质激素的反应。通过计算口服75g葡萄糖负荷后血清胰岛素水平曲线下面积来估计胰岛素抵抗。PCOS患者对促肾上腺皮质激素的平均血清雄烯二酮反应（nmol/L）为5.6±1.3，高于月经正常的多毛女性（3.4±0.5；P<0.10）、肥胖的非多毛女性（1.8±0.8；P<0.05）和消瘦的非多毛女性（1.9±0.5；P<0.05）。血清雄烯二酮反应与体重指数（BMI）无关。PCOS患者血清胰岛素曲线下面积（mU/L.min/1000）为29.1±5.3，高于月经正常的多毛女性（9.1±1.7）、肥胖的非多毛女性（5.8±1.0）和消瘦的非多毛女性（4.5±0.4）（P<0.001）。在三组肥胖女性中，血清胰岛素反应与BMI高度相关（P<0.001），但PCOS患者随着BMI增加胰岛素抵抗显著增加（P<0.02）。在任何一组中，肾上腺雄激素分泌与胰岛素抵抗均无相关性。我们得出结论，肾上腺高雄激素血症和胰岛素抵抗是多毛女性无排卵的独立预测因素。这些情况在月经过少和月经正常的多毛女性中均存在，但在无排卵女性中更为严重。患有PCOS的肥胖女性与月经正常的对照者也不同，随着体重增加，她们会出现更严重的胰岛素抵抗。
