Endocrine Abstracts

Background: Hirsutism is a major feature of the polycystic ovary syndrome (PCOS) and the only accepted clinical sign of hyperandrogenism for its diagnosis, according to the androgen excess society (AES) recommendations. Previous studies demonstrated that hirsutism can be influenced by factors other than hyperandrogenism per se.

Aim: To detect factors influencing hirsutism severity in PCOS.

Patients and methods: Hundred and seventy-five PCOS patients (AES criteria), of Romanian origin. Hirsutism was defined as a modified Ferriman–Gallwey (mFG) score of ≥8. Other clinical and laboratory parameters were assessed, including total testosterone (TT), free androgen index (FAI), DHEA-S, 17-hydroxyprogesterone (17OH-P), fasting glycemia, insulinemia and calculated homeostatic assessment for insulin resistance (HOMA-IR). Androgen receptor (AR) CAG repeat genotyping and X-chromosome inactivation analysis were performed in a subset of 94 PCOS.

Results: Univariate correlations revealed that mFG score was significantly associated with fasting insulin (r²=0.11, P<0.01) and HOMA-IR (P<0.01), after adjustment for BMI. A multiple regression model using androgens (TT and DHEA-S) as independent variables and mFG score as dependant was significant (r²=0.11, P<0.01), but mFG univariate associations with FAI, DHEA-S were non-significant. AR CAG repeat number biallelic means and X-weighted biallelic means did not differ significantly between hirsute and non-hirsute PCOS and were not correlated with mFG scores.

In a multivariate regression mFG model including fasting insulinemia, TT, DHEA-S, BMI and age as independent variables, only insulin was associated significantly with mFG score, while the whole model did not reach significance (r²=0.21, P=0.068).

Conclusions: Our results show that both hyperinsulinism and hyperandrogenism are determinants of the degree of hirsutism in PCOS, but insulinemia appears as a better marker of hirsutism than serum androgens. Androgen-sensitivity, evaluated by the AR CAG repeat genotypes is not associated with mFG score.

Acknowledgments: This work was partly funded by the Romanian Ministry of Education, Research and Youth (grants no TE 227/2010 and CNCSIS 1333/2007).

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.