Endocrine Abstracts

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and is frequently associated with insulin resistance and type 2 diabetes mellitus. At present, women with type 1 diabetes mellitus (T1DM) are being treated with supraphysiological doses of exogenous insulin with the aim of providing a strict metabolic control. The prevalence of PCOS in women with T1DM varies depending on the diagnostic criteria employed and on the ethnicity of the population studied. In 2000 Escobar-Morreale et al., using National Institutes of Health (NIH) 1990 diagnostic criteria, reported a prevalence of 18.8%.

Design: We’ll describe three profiles of PCOS in women (age 34, 31, 30 years old) with T1DM that is controlled by high dose of insulin. They have a normal level of SHBG. The PCOS is treated by modification in life style and metformin therapy.

Results: The physiopathology of PCOS in T1DM is unclear. It has been suggested that the use of exogenous insulin at high doses daily to treat T1DM may contribute to the development of PCOS by stimulating the synthesis of ovarian androgens. The normal levels of SHBG in T1DM (insulin concentrations at the portal vein are the main regulators of SHBG) explain both why the most sensitive serum marker of hyperandrogenism here is total testosterone levels, and the milder hyperandrogenic symptoms. The use of metformine permits a significant reduction in the insulin dose administered while providing an improvement in metabolic control.

Conclusions: Every effort must be made for the early detection and treatment of hyperandrogenic disorders in T1DM women because of the large prevalence of PCOS in these women. Future studies should evaluate the consequences of PCOS in women with T1DM and compare the different therapeutic options.