Dehydroepiandrosterone sulfate and insulin resistance in patients with polycystic ovary syndrome
Received 27 September 2007; received in revised form 4 February 2008; accepted 8 February 2008. published online 25 April 2008.
Objective
To test the hypothesis that increasing DHEAS levels is associated with improved insulin resistance in patients with polycystic ovary syndrome (PCOS).
Design
Cross-sectional cohort analysis.
Setting
Academic medical center.
Patient(s)
Three hundred fifty-two women with PCOS.
Intervention(s)
Patients presenting for evaluation of symptoms related to androgen excess were evaluated physically and biochemically through laboratory analysis.
Main Outcome Measure(s)
Circulating DHEAS, total T, free T, sex hormone-binding globulin (SHBG), and 17-hydroxyprogesterone (17-OHP) levels, and calculated homeostasis model assessment of insulin resistance (HOMA-IR).
Result(s)
Bivariate analysis indicated that all parameters were associated with HOMA-IR, except 17-OHP and age, and confirmed a negative correlation between DHEAS and HOMA-IR. Multivariate analysis indicated that increases in DHEAS, SHBG, 17-OHP, and age were associated with decreasing HOMA-IR, whereas increases in free T, body mass index (BMI), and waist-to-hip ratio (WHR) were associated with increasing HOMA-IR. In decreasing order of importance, the following variables predicted insulin resistance: BMI > WHR > age > DHEAS > free T > SHBG > 17-OHP.
Conclusion(s)
DHEAS is negatively correlated to insulin resistance in patients with PCOS, and in our model ranked just behind other well-established predictors including BMI, WHR, and age. Whether this is due to a direct beneficial effect on insulin action by adrenal androgens such as DHEA, or whether DHEAS simply reflects the circulating levels of hyperinsulinemia, remains to be determined.
aDepartment of Obstetrics and Gynecology, the David Geffen School of Medicine at UCLA, Los Angeles, California
bDepartment of Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, California
cDepartment of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
Reprint requests: Ricardo Azziz, M.D., M.P.H., M.B.A., Department of Ob/Gyn and Center for Androgen Related Disorders, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 160W, Los Angeles, CA 90048 (FAX: 310-423-3470).
R. A. is a consultant for Merck & Co., Pfizer, Procter & Gamble, and Quest Diagnostics. K.B. has nothing to disclose. A.H. has nothing to disclose.
Supported in part by National Institutes of Health grants R01-HD2364 and K24-HD01346-01, and the Helping Hand of Los Angeles, Inc., Los Angeles, California.
Presented in part at the 62nd Annual Meeting of the American Society for Reproductive Medicine, New Orleans, LA, October 21–25, 2006.
ABSTRACT