Opposing effects of dehydroepiandrosterone sulfate and free testosterone on metabolic phenotype in women with polycystic ovary syndrome

Capsule:
In studying the association of adrenal and ovarian androgens with metabolic parameters in women with polycystic ovary syndrome, distinguishing between adrenal and ovarian hyperandrogenism is important to evaluate metabolic risk.

Authors:
Elisabeth Lerchbaum, M.D., Verena Schwetz, M.D., Albrecht Giuliani, M.D., Thomas R. Pieber, M.D., Barbara Obermayer-Pietsch, M.D.

Volume 98, Issue 5, Pages 1318-1325.e1, November 2012

Abstract:

Objective:
To study the association of adrenal and ovarian androgen levels with metabolic parameters in a large cohort of PCOS women.

Design:
Cross-sectional study.

Setting:
Outpatient clinic of an academic hospital.

Patients:
Six hundred twenty-two women with PCOS.

Interventions:
None.

Main outcome measures:
Analysis of the association of endocrine dehydroepiandrosterone sulfate (DHEAS) and free testosterone (FT) parameters with metabolic measurements.

Results:
In multivariate adjusted logistic regression analyses, OR for insulin resistance was significantly higher (4.42 (2.26-8.67)) for PCOS women with elevated FT levels compared to women with normal DHEAS and FT levels (reference group). We found no significant differences when PCOS women with elevated DHEAS or a combined elevation of DHEAS and FT levels were compared to the reference group (p>0.05). PCOS women with high DHEAS/FT-ratios had a more beneficial metabolic profile compared to women with low DHEAS/FT-ratios. In multivariate adjusted binary logistic regression analyses, we found a significantly lower risk for insulin resistance in PCOS women in the highest DHEAS/FT-ratio quartile compared to PCOS women in the lowest quartile (OR 0.35 (0.14-0.89)).

Conclusions:
Our results suggest that the distinction between adrenal and ovarian hyperandrogenism is important when evaluating metabolic risk in PCOS.