This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chang, P. L. Articles by Lobo, R. A. Search for Related Content PubMed PubMed Citation Articles by Chang, P. L. Articles by Lobo, R. A.

Normal Ovulatory Women with Polycystic Ovaries Have Hyperandrogenic Pituitary-Ovarian Responses To Gonadotropin-Releasing Hormone-Agonist Testing¹

Department of Obstetrics and Gynecology (P.L.C., S.R.L., C.L., M.F., E.C., M.V.S., R.A.L.), Division of Reproductive Endocrinology, Columbia University, College of Physicians and Surgeons, New York, New York 10032; Department of Gynecology and Obstetrics (F.G.), Division of Reproductive Endocrinology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York 14214; Department of Medicine (L.B.), Columbia University, College of Physicians and Surgeons, New York, New York 10032

Address correspondence and requests for reprints to: Peter L. Chang, M.D., Assistant Professor, Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology, College of Physicians & Surgeons, Columbia University, 630 West 168th Street, PH 16–28, New York, New York 10032. E-mail: pc174{at}columbia.edu

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 sc) 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.

This article has been cited by other articles:

				M.I. Ahmed, A.J. Duleba, O. El Shahat, M.E. Ibrahim, and A. Salem Naltrexone treatment in clomiphene resistant women with polycystic ovary syndrome Hum. Reprod., November 1, 2008; 23(11): 2564 - 2569. [Abstract] [Full Text] [PDF]

				D. S. Wachs, M. S. Coffler, P. J. Malcom, S. Shimasaki, and R. J. Chang Increased Androgen Response to Follicle-Stimulating Hormone Administration in Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1827 - 1833. [Abstract] [Full Text] [PDF]

				R. Pasquali, L. Patton, P. Pocognoli, G. E. Cognigni, and A. Gambineri 17-Hydroxyprogesterone Responses to Gonadotropin-Releasing Hormone Disclose Distinct Phenotypes of Functional Ovarian Hyperandrogenism and Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., November 1, 2007; 92(11): 4208 - 4217. [Abstract] [Full Text] [PDF]

				M. K. Murphy, J. E. Hall, J. M. Adams, H. Lee, and C. K. Welt Polycystic Ovarian Morphology in Normal Women Does Not Predict the Development of Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3878 - 3884. [Abstract] [Full Text] [PDF]

				M. Mortensen, R. L. Rosenfield, and E. Littlejohn Functional Significance of Polycystic-Size Ovaries in Healthy Adolescents J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3786 - 3790. [Abstract] [Full Text] [PDF]

				E. Codner, N. Soto, P. Lopez, L. Trejo, A. Avila, F. C. Eyzaguirre, G. Iniguez, and F. Cassorla Diagnostic Criteria for Polycystic Ovary Syndrome and Ovarian Morphology in Women with Type 1 Diabetes Mellitus J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2250 - 2256. [Abstract] [Full Text] [PDF]

				R. Azziz Diagnosis of Polycystic Ovarian Syndrome: The Rotterdam Criteria Are Premature J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 781 - 785. [Abstract] [Full Text] [PDF]

				R. S. Legro, P. Chiu, A. R. Kunselman, C. M. Bentley, W. C. Dodson, and A. Dunaif Polycystic Ovaries Are Common in Women with Hyperandrogenic Chronic Anovulation but Do Not Predict Metabolic or Reproductive Phenotype J. Clin. Endocrinol. Metab., May 1, 2005; 90(5): 2571 - 2579. [Abstract] [Full Text] [PDF]

				H. F. Escobar-Morreale, M. Luque-Ramirez, and J. L. San Millan The Molecular-Genetic Basis of Functional Hyperandrogenism and the Polycystic Ovary Syndrome Endocr. Rev., April 1, 2005; 26(2): 251 - 282. [Abstract] [Full Text] [PDF]

				E Carmina, F Orio, S Palomba, T Cascella, R A Longo, A M Colao, G Lombardi, and R A Lobo Evidence for altered adipocyte function in polycystic ovary syndrome Eur. J. Endocrinol., March 1, 2005; 152(3): 389 - 394. [Abstract] [Full Text] [PDF]

				J. M. Adams, A. E. Taylor, W. F. Crowley Jr., and J. E. Hall Polycystic Ovarian Morphology with Regular Ovulatory Cycles: Insights into the Pathophysiology of Polycystic Ovarian Syndrome J. Clin. Endocrinol. Metab., September 1, 2004; 89(9): 4343 - 4350. [Abstract] [Full Text] [PDF]

				M. E. Silfen, M. R. Denburg, A. M. Manibo, R. A. Lobo, R. Jaffe, M. Ferin, L. S. Levine, and S. E. Oberfield Early Endocrine, Metabolic, and Sonographic Characteristics of Polycystic Ovary Syndrome (PCOS): Comparison between Nonobese and Obese Adolescents J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4682 - 4688. [Abstract] [Full Text] [PDF]

				R. S. Legro Polycystic Ovary Syndrome and Cardiovascular Disease: A Premature Association? Endocr. Rev., June 1, 2003; 24(3): 302 - 312. [Abstract] [Full Text] [PDF]

				M. Ferin, M. Morrell, E. Xiao, L. Kochan, F. Qian, T. Wright, and M. Sauer Endocrine and Metabolic Responses to Long-Term Monotherapy with the Antiepileptic Drug Valproate in the Normally Cycling Rhesus Monkey J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2908 - 2915. [Abstract] [Full Text] [PDF]