Metabolic Characteristics In The Subgroups Of Polycystic Ovary Syndrome

Aim: Polycystic ovary syndrome (PCOS) is a heterogenous disease that is characterized with chronic anovulation, menstrual irregularities and hyperandrogenism. In the present study we aimed to compare the metabolic features of PCOS'subgroups based on revised Rotterdam diagnostic criterias.
Materials and Methods: Ninety-five women with PCOS were enrolled into the study and divided into four groups. Group 1; oligomenorrhea and/or anovulation with biochemical hyperandrogenemia and/or hyperandrogenism, group 2; biochemical hyperandrogenemia and/or hyperandrogenism with polycystic ovaries, group 3; oligomenorrhea and/or anovulation with polycystic ovaries and group 4; polycystic ovaries with oligomenorrhea and/or anovulation with biochemical hyperandrogenaemia and/or hyperandrogenism. Body mass indeces (kg/m2) and waist to hip ratios were calculated in all study patients. Fasting glucose, lipid levels, kidney and liver function tests were measured after 12 hours fasting. Oral glucose tolerance test (OGTT) was performed to evaluate the responses of glucose and insülin. Hormone levels were measured during the follicular phase of the menstrual cycle. Adrenocorticotrophic hormone (ACTH) (0.5 mg Synacthen IM) and gonadotrophin-releasing hormone agonist (buserelin) tests were performed in order to evaluate adrenal and ovarian hyperandrogenemia. Ovarian ultrasonography was performed on all study patients to define PCO morphology.
Results: The frequency of the classical PCOS phenotype was higher than the non-classical PCOS phenotype (74.7% and 25.2%, respectively). Body mass indexes, waist-hip ratios, serum total, LDL and HDL-cholesterol levels were similar in all groups. Serum triglyceride levels were found to be significantly lower in group 2 compared to other groups (p< 0.01). Peak insulin and AUC insulin levels were significantly lower in group 2 (p< 0.05). The prevalence of impaired fasting glucose and impaired glucose tolerance was similar in all groups. Free testosterone and androstenedione levels were significantly lower in group 3 compared to group 4.
Conclusion: Metabolic disturbances of patients with PCOS without hyperandrogenism (OA+PCO; group 3) were similar to the classical PCOS groups contrary to the expectations. The metabolic disturbances found in patients with PCOS without menstrual dysfunction (HA+PCO; group 2) were found to be milder in terms of lipid levels and insulin resistance. These findings support that newly developed HA+PCO and OA+PCO groups are the part of wide PCOS spectrum and also it supports that PCO morphology is one of the diagnostic criterias of PCOS.