Endocrine Abstracts

Hyperandrogenism is the main characteristic of PCOS therefore hyperandrogenism in women is best addressed when studying this highly prevalent syndrome. Besides the clinical features of oligomenorrhea, hirsutism and infertility, PCOS patients are often insulin resistant (IR), obese, they have arterial hypertension, dyslipidemia, an increased pro-thrombotic state, impaired glucose tolerance or frank type 2 diabetes (T2D). The prevalence of metabolic syndrome is doubled as compared to non-PCOS population. Obesity, particularly of visceral origin, plays a crucial role in both the development and maintenance of PCOS and significantly influences the severity of cardiovascular risk profile. At least 30% of women with PCOS are obese, and in some series, up to 75% are obese. About 50–60% of women with PCOS have central body fat distribution. Metabolic disease in PCOS should be considered as a continuous variable, with metabolic dysfunction worsening with severity of androgen excess. Increasing androgen burden is associated with an adverse metabolic phenotype. Androstenedione (A) has been shown to be in better correlation with IR than testosterone (T) in PCOS women. Recent data suggest that biochemical androgen excess poses a higher risk of liver disease, IR, and subclinical atherosclerosis in PCOS compared with those women with anovulation and polycystic ovaries alone. Serum A is a more sensitive indicator of PCOS-related androgen excess than serum total T concentrations. Concurrent measurement of both A and T discovers a PCOS cohort that appears to be at the highest metabolic risk. The analysis of 2543 pre- and perimenopausal women in their 40s originally included in the SWAN study indicated that hyperandrogenemia but not oligomenorrrhoea was independently associated with the risk of prevalent metabolic syndrome. High prevalence of cardiovascular risk factors in PCOS is assumed to be associated with accelerated cardiovascular disease (CVD). However, clear data from large end point trials about cardiovascular morbidity and mortality in PCOS is currently lacking. Though, there is plenty of data on early occurrence of subclinical, potentially reversible atherosclerosis in women with PCOS. Endothelial dysfunction is associated with higher levels of androgens and with insulin resistance. This was observed even at very early ages, and with a trend of deterioration of endothelial function from lean to overweight and obese PCOS women. Recent systematic review has confirmed that carotid intima-media thickness was thicker in women with PCOS in comparison to controls. PCOS women have a greater prevalence and extent of coronary artery calcification, and that is independent of age and BMI.