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Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective.
J Clin Endocrinol Metab. 2016 05; 101(5):2013-22.JC

Abstract

OBJECTIVE

This study was designed to assess the steroid profiling by liquid chromatography coupled with tandem mass spectrometry in PCOS women with different phenotypes.

DESIGN

Cross-sectional study.

SETTING

University hospital of Bologna, Italy.

PATIENTS AND METHODS

A total of 156 PCOS women and 141 controls comparable for age were investigated. All underwent a steroid profiling by liquid chromatography coupled with tandem mass spectrometry. Metabolic parameters were also investigated and hirsutism was measured by the modified Ferriman-Gallwey (mF-G) score.

RESULTS

Three distinct phenotypes were initially defined according to the combination of hirsutism (mF-G ≥ 8) and/or high testosterone (T) (HA), oligo-amenorrhea (OA), and polycystic ovarian morphology (PCOm); OA + PCOm (n = 43), HA + OA (n = 65), and HA + OA + PCOm (n = 45). T, androstenedione (A), and free androgen index (FAI) levels progressively increased in the 3 PCOS phenotypes with respect to the controls, with the highest values in the HA + OA + PCOm phenotype. The various combinations of hirsutism, high T, high A, and high FAI made it possible to categorize the 3 original phenotypes into 8 hyperandrogenic subgroups, characterized by divergent additional steroid profile and metabolic pattern. A total of 90% of patients with PCOS thus proved hyperandrogenic. Interestingly, half the PCOS women originally classified as having the OA-PCOm phenotype were categorized in a hyperandrogenic subgroup. No significant correlation was found between T, A, and the mF-G score. In contrast, significant correlation was found between A and both T and FAI.

CONCLUSIONS

This study provides evidence that, by including a steroid profile in the definition of hyperandrogenemia, the majority of women with PCOS are hyperandrogenic, although a clinical and biochemical heterogeneity exists. In addition, these data demonstrate that hirsutism and high androgen levels cannot be used indifferently to define hyperandrogenism.

Authors+Show Affiliations

Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.Division of Endocrinology (R.P., L.Z., F.F., M.M., A.F., A.M.M.L., A.R., D.R., A.G.), Department of Medical and Surgical Sciences, and Centre for Applied Biomedical Sciences (F.F., M.M., A.F.), University Alma Mater Studiorum, Sant'Orsola-Malpighi Hospital, Bologna, 40138 Italy.

Pub Type(s)

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

Language

eng

PubMed ID

26964728

Citation

Pasquali, Renato, et al. "Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: a Challenging Perspective." The Journal of Clinical Endocrinology and Metabolism, vol. 101, no. 5, 2016, pp. 2013-22.
Pasquali R, Zanotti L, Fanelli F, et al. Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective. J Clin Endocrinol Metab. 2016;101(5):2013-22.
Pasquali, R., Zanotti, L., Fanelli, F., Mezzullo, M., Fazzini, A., Morselli Labate, A. M., Repaci, A., Ribichini, D., & Gambineri, A. (2016). Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective. The Journal of Clinical Endocrinology and Metabolism, 101(5), 2013-22. https://doi.org/10.1210/jc.2015-4009
Pasquali R, et al. Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: a Challenging Perspective. J Clin Endocrinol Metab. 2016;101(5):2013-22. PubMed PMID: 26964728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective. AU - Pasquali,Renato, AU - Zanotti,Laura, AU - Fanelli,Flaminia, AU - Mezzullo,Marco, AU - Fazzini,Alessia, AU - Morselli Labate,Antonio Maria, AU - Repaci,Andrea, AU - Ribichini,Danilo, AU - Gambineri,Alessandra, Y1 - 2016/03/10/ PY - 2016/3/12/entrez PY - 2016/3/12/pubmed PY - 2017/6/9/medline SP - 2013 EP - 22 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 101 IS - 5 N2 - OBJECTIVE: This study was designed to assess the steroid profiling by liquid chromatography coupled with tandem mass spectrometry in PCOS women with different phenotypes. DESIGN: Cross-sectional study. SETTING: University hospital of Bologna, Italy. PATIENTS AND METHODS: A total of 156 PCOS women and 141 controls comparable for age were investigated. All underwent a steroid profiling by liquid chromatography coupled with tandem mass spectrometry. Metabolic parameters were also investigated and hirsutism was measured by the modified Ferriman-Gallwey (mF-G) score. RESULTS: Three distinct phenotypes were initially defined according to the combination of hirsutism (mF-G ≥ 8) and/or high testosterone (T) (HA), oligo-amenorrhea (OA), and polycystic ovarian morphology (PCOm); OA + PCOm (n = 43), HA + OA (n = 65), and HA + OA + PCOm (n = 45). T, androstenedione (A), and free androgen index (FAI) levels progressively increased in the 3 PCOS phenotypes with respect to the controls, with the highest values in the HA + OA + PCOm phenotype. The various combinations of hirsutism, high T, high A, and high FAI made it possible to categorize the 3 original phenotypes into 8 hyperandrogenic subgroups, characterized by divergent additional steroid profile and metabolic pattern. A total of 90% of patients with PCOS thus proved hyperandrogenic. Interestingly, half the PCOS women originally classified as having the OA-PCOm phenotype were categorized in a hyperandrogenic subgroup. No significant correlation was found between T, A, and the mF-G score. In contrast, significant correlation was found between A and both T and FAI. CONCLUSIONS: This study provides evidence that, by including a steroid profile in the definition of hyperandrogenemia, the majority of women with PCOS are hyperandrogenic, although a clinical and biochemical heterogeneity exists. In addition, these data demonstrate that hirsutism and high androgen levels cannot be used indifferently to define hyperandrogenism. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/26964728/Defining_Hyperandrogenism_in_Women_With_Polycystic_Ovary_Syndrome:_A_Challenging_Perspective_ DB - PRIME DP - Unbound Medicine ER -