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Submitted on November 22, 2004
Accepted on February 13, 2005
Department of Clinical Medicine, University of Palermo, Palermo, Italy; Department of Obstetrics and Gynecology, Columbia University, New York
* To whom correspondence should be addressed. E-mail: ral35{at}columbia.edu.
In hyperandrogenic women, several phenotypes may be observed. This includes women with classic polycystic ovary syndrome (C-PCOS), those with ovulatory (OV) PCOS and women with idiopathic hyperandrogenism (IHA), which occurs in women with normal ovaries. Where other causes have been excluded, we categorized 290 hyperandrogenic women, who were seen consecutively for this complaint between 1993 to 2004, into these 3 subgroups. The aim was to compare the prevalence of obesity, insulin resistance, dyslipidemia, as well as increases in c-reactive protein and homocysteine in these different phenotypes compared with age matched ovulatory controls of normal weight (n = 85) and others matched for BMI with women with C-PCOS (n = 42). Although, BMI affected fasting serum insulin and QUICKI, these markers of insulin resistance were greatest in C-PCOS (n = 204), followed by OV-PCOS (n = 50) and then IHA (n = 33). Androgen levels were similar in OV-PCOS and IHA but were higher in C-PCOS, while gonadotropins were similar in all groups. Lipid abnormalities were highest in C-PCOS and OV-PCOS and were normal in IHA. C-reactive protein was elevated in C-PCOS and OV-PCOS but not in IHA. Homocysteine was only elevated in C-PCOS. Overall, the prevalence of obesity (BMI>30) was 29% in C-PCOS, 8% in OV-PCOS and 15% in IHA and of insulin resistance (QUICKI < 0.33) was 68% in C-PCOS, 36% in OV-PCOS and 26% in IHA. The prevalence of having at least one elevated cardiovascular risk marker was 45% in C-PCOS 38% in OV-PCOS and was not increased on IHA (6%). These results suggest that among hyperandrogenic women the prevalence of abnormal metabolic and cardiovascular risk parameters is greatest in C-PCOS, followed by OV-PCOS and then women with IHA. Moreover in that in OV-PCOS and IHA ages and weights were similar yet the prevalence of metabolic and CV was greater in OV-PCOS, the finding of polycystic ovaries may be a significant modifying factor.
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