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Normal ovulatory women with polycystic ovaries have hyperandrogenic pituitary-ovarian responses to gonadotropin-releasing hormone-agonist testing.
J Clin Endocrinol Metab. 2000 Mar; 85(3):995-1000.JC

Abstract

Women with polycystic ovary syndrome (PCOS) have chronic anovulation and hyperandrogenism and frequently have abnormalities in their lipid profiles and insulin/insulin-like growth factor axis that increase their lifetime risk for cardiovascular disease. Normal ovulatory women may have polycystic ovaries on ultrasonography and yet lack the clinical features of PCOS. To further explore whether ovulatory women without clinical/biochemical hyperandrogenism but with polycystic appearing ovaries (ov-PAO) have subclinical features of PCOS, we prospectively characterized 26 ov-PAO women and matched them by age and body mass index to 25 ovulatory women with normal appearing ovaries (ov-NAO) and to 22 women with PCOS. After an overnight fast, all women had baseline endocrine and metabolic assessments. In addition, a subset of each group of women underwent GnRH-agonist (leuprolide acetate 1 mg s.c.) testing, ACTH stimulation, and an insulin tolerance test (ITT). At baseline, ov-PAO and ov-NAO women had similar endocrine profiles (LH, LH:FSH, androstenedione, and DHEAS). Compared with ov-NAO, 31% of ov-PAO women had reduced glucose responses after insulin (K(itt)), suggesting mild insulin resistance, and 35% had high density lipoprotein levels below 35 mg/dL, a level considered to represent significant cardiovascular risk. After GnRH-agonist, ov-PAO women had response patterns in LH, total testosterone, and 17-hydroxyprogesterone (17-OHP) that were intermediate between ov-NAO and women with PCOS. Ovarian responses were above the normal range in 30-40% of women with ov-PAO. In ov-PAO, peak responses of LH after leuprolide correlated with triglyceride levels (P < 0.05) and peak responses of 17-OHP correlated inversely with Kitt values (P < 0.05). No significant differences were noted with ACTH testing. In conclusion, occult biochemical ovarian hyperandrogenism may be uncovered using GnRH-agonist in ovulatory women with ov-PAO, while adrenal responses remain normal. Subtle metabolic abnormalities may also be prevalent.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA. pc174@columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10720029

Citation

Chang, P L., et al. "Normal Ovulatory Women With Polycystic Ovaries Have Hyperandrogenic Pituitary-ovarian Responses to Gonadotropin-releasing Hormone-agonist Testing." The Journal of Clinical Endocrinology and Metabolism, vol. 85, no. 3, 2000, pp. 995-1000.
Chang PL, Lindheim SR, Lowre C, et al. Normal ovulatory women with polycystic ovaries have hyperandrogenic pituitary-ovarian responses to gonadotropin-releasing hormone-agonist testing. J Clin Endocrinol Metab. 2000;85(3):995-1000.
Chang, P. L., Lindheim, S. R., Lowre, C., Ferin, M., Gonzalez, F., Berglund, L., Carmina, E., Sauer, M. V., & Lobo, R. A. (2000). Normal ovulatory women with polycystic ovaries have hyperandrogenic pituitary-ovarian responses to gonadotropin-releasing hormone-agonist testing. The Journal of Clinical Endocrinology and Metabolism, 85(3), 995-1000.
Chang PL, et al. Normal Ovulatory Women With Polycystic Ovaries Have Hyperandrogenic Pituitary-ovarian Responses to Gonadotropin-releasing Hormone-agonist Testing. J Clin Endocrinol Metab. 2000;85(3):995-1000. PubMed PMID: 10720029.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Normal ovulatory women with polycystic ovaries have hyperandrogenic pituitary-ovarian responses to gonadotropin-releasing hormone-agonist testing. AU - Chang,P L, AU - Lindheim,S R, AU - Lowre,C, AU - Ferin,M, AU - Gonzalez,F, AU - Berglund,L, AU - Carmina,E, AU - Sauer,M V, AU - Lobo,R A, PY - 2000/3/17/pubmed PY - 2000/4/1/medline PY - 2000/3/17/entrez SP - 995 EP - 1000 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 85 IS - 3 N2 - Women with polycystic ovary syndrome (PCOS) have chronic anovulation and hyperandrogenism and frequently have abnormalities in their lipid profiles and insulin/insulin-like growth factor axis that increase their lifetime risk for cardiovascular disease. Normal ovulatory women may have polycystic ovaries on ultrasonography and yet lack the clinical features of PCOS. To further explore whether ovulatory women without clinical/biochemical hyperandrogenism but with polycystic appearing ovaries (ov-PAO) have subclinical features of PCOS, we prospectively characterized 26 ov-PAO women and matched them by age and body mass index to 25 ovulatory women with normal appearing ovaries (ov-NAO) and to 22 women with PCOS. After an overnight fast, all women had baseline endocrine and metabolic assessments. In addition, a subset of each group of women underwent GnRH-agonist (leuprolide acetate 1 mg s.c.) testing, ACTH stimulation, and an insulin tolerance test (ITT). At baseline, ov-PAO and ov-NAO women had similar endocrine profiles (LH, LH:FSH, androstenedione, and DHEAS). Compared with ov-NAO, 31% of ov-PAO women had reduced glucose responses after insulin (K(itt)), suggesting mild insulin resistance, and 35% had high density lipoprotein levels below 35 mg/dL, a level considered to represent significant cardiovascular risk. After GnRH-agonist, ov-PAO women had response patterns in LH, total testosterone, and 17-hydroxyprogesterone (17-OHP) that were intermediate between ov-NAO and women with PCOS. Ovarian responses were above the normal range in 30-40% of women with ov-PAO. In ov-PAO, peak responses of LH after leuprolide correlated with triglyceride levels (P < 0.05) and peak responses of 17-OHP correlated inversely with Kitt values (P < 0.05). No significant differences were noted with ACTH testing. In conclusion, occult biochemical ovarian hyperandrogenism may be uncovered using GnRH-agonist in ovulatory women with ov-PAO, while adrenal responses remain normal. Subtle metabolic abnormalities may also be prevalent. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/10720029/Normal_ovulatory_women_with_polycystic_ovaries_have_hyperandrogenic_pituitary_ovarian_responses_to_gonadotropin_releasing_hormone_agonist_testing_ DB - PRIME DP - Unbound Medicine ER -