Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome?

https://doi.org/10.1016/0002-9378(92)91779-AGet rights and content

Abstract

OBJECTIVE: Our purpose was to determine the prevalence of adrenal hyperandrogenism and insulin resistance in patients with hyperandrogenic chronic anovulation, also called polycystic ovary syndrome, living in the United States, Italy, and Japan.

STUDY DESIGN: Seventy-five women with polycystic ovary syndrome, 25 each from the United States, Italy, and Japan, and 10 ovulatory controls were studied. Hirsutism, obesity, and the presence of cystic ovaries were assessed, as were blood levels for estrogen, luteinizing hormone, testosterone, adrenal androgens, and insulin. All patients received an insulin tolerance test to assess insulin resistance.

RESULTS: Women from Japan were less obese (p \lt 0.05) and did not have hirsutism, although the percentage of cystic ovaries (68% to 80%) was comparable. Serum luteinizing hormone, testosterone, and estradiol were similar, but levels of 3α-androstanediol glucuronide, which was elevated in women from the United States and Italy, was normal in women from Japan. The adrenal androgens, dehydroepiandrosterone sulfate and 11 β-hydroxyandrostenedione were elevated in 48% to 64% of the patients and by a similar percentage in the three groups. Fasting insulin was elevated in all groups, but was significantly higher in women from the United States and Italy compared with women from Japan (p \lt 0.05). However, insulin resistance as assessed by dissociation constant of insulin tolerance test values was significantly elevated but similar in the three groups and occurred in 68% to 76% of patients.

CONCLUSION: In polycystic ovary syndrome, although obesity and hirsutism vary according to dietary, genetic, and environmental factors, the prevalence of adrenal androgen excess and insulin resistance appear to be fairly uniform. These results suggest that these factors may be involved in the pathophysiologic features of the disorder. (AM J OBSTET GYNECOL 1992;167:1807-12.)

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    Citation Excerpt :

    In 15 out of the 23, hormone measurements were made in the same laboratory. Twelve studies did not reveal any differences in serum androgen based on ethnicity (Table 1) (Carmina et al., 1992; Dunaif et al., 1993; Kauffman et al., 2002; Carmina et al., 2003; Ehrmann et al., 2005; Kumar et al., 2005; Ladson et al., 2011; Guo et al., 2012; Wang et al., 2013; Chang et al., 2016; Chan et al., 2017; Sarkar et al., 2018). In two studies that assessed wPCOS and saPCOS, serum testosterone concentrations were comparable but sex hormone-binding globulin (SHBG) concentrations were lower and free androgen index was higher in saPCOS (Wijeyaratne et al., 2002; Wijeyaratne et al., 2004).

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Presented in part at the Thirty-ninth Annual Meeting of the Society for Gynecologic Investigation, San Antonio, Texas, March 18-21, 1992.

a

From the Cattedra di Endocrinologia, Universita di Palermo

b

From the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, School of Medicine

c

From the Department of Obstetrics and Gynecology, University of Southern California School of Medicine

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