SFEBES2014 Poster Presentations Steroids (39 abstracts)
Hyperandrogenaemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione
Michael O’Reilly 1 , Angela Taylor 1 , Nicola Crabtree 2 , Beverly Hughes 1 , Farfia Capper 3 , Rachel Crowley 1 , Paul Stewart 1 , Jeremy Tomlinson 1 & Wiebke Arlt 1
1CEDAM, University of Birmingham, Edgbaston, Birmingham, UK; 2Department of Nuclear Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK; 3Wellcome Trust/NIHR Clinical Research Facility, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Polycystic ovary syndrome (PCOS) is a clinical triad of anovulation, insulin resistance, and androgen excess. Hyperandrogenism may correlate with metabolic risk but PCOS consensus criteria currently define androgen excess on the basis of serum testosterone only. Here we studied the utility of the androgen precursor serum androstenedione in conjunction with serum testosterone as a predictor of metabolic dysfunction in PCOS.
86 PCOS patients fulfilling Rotterdam diagnostic consensus criteria and 43 age- and BMI-matched controls underwent an oral glucose tolerance test (OGTT), with calculation of HOMA-IR and an insulin sensitivity index (ISI). Serum androgens were measured by liquid chromatography–tandem mass spectrometry (LC/MS). We analysed 24-h urine androgen excretion by gas chromatography/mass spectrometry (GC/MS).
PCOS patients had higher levels of serum androgens and urinary androgen metabolites than controls (all P<0.0001). Within the PCOS cohort, both serum androstenedione and testosterone were positively correlated with the free androgen index and total androgen metabolite excretion (all P<0.0001). All PCOS subjects with testosterone above the normal reference range (high testosterone (HT)) also had high androstenedione (HA/HT group, n=56). The remaining 30 patients had normal testosterone levels, either in the presence of high androstenedione (HA/NT; n=20) or normal androstenedione (NA/NT; n=10). The groups did not differ in age or BMI. HA/HT and HA/NT had higher total androgen excretion than NA/NT (P<0.01 and P<0.05, respectively). The incidence of dysglycemia on OGTT increased with severity of androgen phenotype (NA/NT 0%; HA/NT 14%; HA/HT 25%, P=0.03). Multiple linear regression showed a strong negative association between serum androstenedione and insulin sensitivity index (coeff. −2.69, 95% and CI −1.57, −3.81), which was not observed with serum testosterone.
Simultaneous measurement of serum testosterone and androstenedione represents a useful tool for predicting metabolic risk in PCOS women. High androstenedione levels are a sensitive indicator of PCOS-related androgen excess.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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