ABSTRACT
BACKGROUND: In women with polycystic ovary syndrome (PCOS), despite a high prevalence of insulin resistance, hyperandrogenemia, and disturbances in the secretion of gonadotrophin, the principal causes of biochemical abnormalities and the best endocrine markers for PCOS have not been fully identified. SUBJECTS AND METHODS: Serum levels of insulin, glucose, follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, estrogen, sex hormone-binding capacity (SHBG), and other related indices such as homeostasis model assessment, insulin glucose ratios, LH/FSH ratios, and the free androgen index (FAI) were determined and compared in women with PCOS (n = 50) and women without PCOS (n = 50). RESULTS: In multivariate logistic regression analyses, among all insulin resistance indices, only hyperinsulinemia (odds ratio [OR] = 2.6; confidence interval [CI]: 1.3-5.2; P = 0.008) was significantly and independently associated with PCOS when adjusted for body mass index (BMI), hyperandrogenemia, and LH/FSH ratios. The LH/FSH ratio (OR = 5.4; CI: 1.2-23.0, P = 0.03) was the only marker among those indices for inappropriate gonadotrophin secretion that significantly and independently associated with PCOS when adjusted for BMI and hyperinsulinemia. Among those indices for hyperandrogenemia, FAI (OR = 1.1; CI: 1.0-2.7; P = 0.02) and SHBG (OR = 1.2; CI: 1.2-3.4; P = 0.03) were significantly and independently associated with PCOS when adjusted for BMI and hyperinsulinemia. In addition, receiver operating characteristic analysis showed that the best predictive markers for PCOS were insulin (area under the curve [AUC] = 0.944; CI: 0.887-0.989), FAI (AUC = 0.932; CI: 0.895-0.993), SHBG (AUC = 0.924; CI: 0.87-0.978), and LH/FSH ratios (AUC = 0.906; CI: 0.821-0.965). CONCLUSION: For insulin and LH/FSH ratios, FAI, and SHBG seemed the best predictors and markers for insulin resistance, inappropriate gonadotrophin secretion, and hyperandrogenemia, respectively, with high sensitivity and specificity for identifying Bahraini women with and without PCOS.
ABSTRACT
OBJECTIVE: Hyperinsulinemia and adipokines such as leptin and adiponectin with respective proatherogenic and antiatherogenic properties are reported to be the major contributors to pathogenesis of polycystic ovary syndrome (PCOS), including to the development of type 2 diabetes and coronary artery disease. In this study, the association of hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, high leptin-to-adiponectin (L/A) and adiponectin-to-leptin (A/L) ratios as risk factors associated with PCOS in Bahraini women was investigated. PARTICIPANTS AND METHODS: Serum levels of insulin, leptin, adiponectin, cholesterol, triglyceride, A/L and L/A ratios were compared in women with PCOS and controls to investigate tentative and potential diagnostic markers for women with PCOS. RESULTS: Insulin was significantly higher in PCOS cases than controls (15.0±3.0 vs. 6.5±1.72, P<0.001). Leptin was significantly higher in PCOS cases than in controls (39.9±4.6 vs. 26.4±3.4, P<0.001), whereas adiponectin was significantly lower in PCOS cases than in controls (8.7±3.0 vs. 11.1±3.6, P<0.001). In addition, L/A ratios were significantly higher in PCOS cases than in controls (4.8±2.7 vs. 2.3±1.6, P<0.001), whereas A/L ratios were significantly lower in PCOS cases than in controls (0.25±0.08 vs. 0.50±0.1, P<0.001). In multivariate logistic regression analyses, insulin [odds ratio (OR)=2.1, confidence interval (CI) 1.2-3.8, P=0.01], A/L (OR=1.6, CI 1.4-7.2, P=0.03), and L/A (OR=1.4, CI 1.2-2.0, P=0.04) were independently associated with PCOS. Receiver operating characteristic analyses showed that the best predictive markers for PCOS were insulin [area under the curve (AUC)=0.937, CI 0.887-0.989] L/A and A/L ratios (AUC=0.861, CI 0.786-0.936), indicating their high sensitivity and specificity for diagnosis of PCOS. CONCLUSION: In Bahraini women with PCOS, insulin, L/A, and A/L ratios seem to be the best markers to distinguish women with and without PCOS.
