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Association between the serum estrone-to-estradiol ratio and parameters related to glucose metabolism and insulin resistance in women with polycystic ovary syndrome

  • Kim, Nayoung (Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital) ;
  • Chun, Sungwook (Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Inje University College of Medicine)
  • Received : 2021.04.28
  • Accepted : 2021.08.27
  • Published : 2021.12.31

Abstract

Objective: We aimed to evaluate associations between the ratio of serum estrone (E1) to estradiol (E2) and parameters related to serum glucose metabolism and insulin resistance in women with polycystic ovary syndrome (PCOS). Methods: In total, 133 women between the ages of 18 and 35 diagnosed with PCOS were enrolled in this study. All participants with PCOS underwent blood tests to determine hormonal and biochemical metabolic parameters and a standard 2-hour 75-g oral glucose tolerance test. They were divided into two groups according to the serum E1-to-E2 ratio: group 1 (E1/E2 ratio <2.0) and group 2 (E1/E2 ratio ≥2.0). Results: In the comparative analysis, the waist-to-hip ratio (WHR) was the only clinical variable that was significantly different between the two groups. Patients with a higher E1/E2 ratio showed higher fasting insulin levels, homeostasis model for insulin resistance, and postprandial glucose level at 2 hours (PPG2). In a correlation analysis, only PPG2 was significantly related to the serum E1/E2 ratio. However, after controlling for the confounding effects of body mass index (BMI) and WHR, fasting glucose was also significantly correlated with the serum E1/E2 ratio. Conclusion: Women with PCOS with a higher serum E1/E2 ratio were found to be more likely to show higher fasting insulin and postprandial glucose levels. Significant correlations were found between the serum E1/E2 ratio and both fasting and postprandial serum glucose levels after adjusting for BMI and WHR in women with PCOS.

Keywords

References

  1. Kuzbari O, Doralis J, Peterson CM. Endocrine disorders. In: Berek JS. editor. Berek & Novak's gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 1075-80.
  2. Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 501-18.
  3. Broekmans FJ, Knauff EA, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BC. PCOS according to the Rotterdam consensus criteria: Change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 2006;113:1210-7. https://doi.org/10.1111/j.1471-0528.2006.01008.x
  4. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012;33:981-1030. https://doi.org/10.1210/er.2011-1034
  5. Yildizhan B, Anik Ilhan G, Pekin T. The impact of insulin resistance on clinical, hormonal and metabolic parameters in lean women with polycystic ovary syndrome. J Obstet Gynaecol 2016;36:893-6. https://doi.org/10.3109/01443615.2016.1168376
  6. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005;352:1223-36. https://doi.org/10.1056/NEJMra041536
  7. Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN, et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91:48-53. https://doi.org/10.1210/jc.2005-1329
  8. Essah PA, Nestler JE. The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Invest 2006;29:270-80. https://doi.org/10.1007/BF03345554
  9. Carmina E, Lobo RA. Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Fertil Steril 2004;82:661-5. https://doi.org/10.1016/j.fertnstert.2004.01.041
  10. Lin JF, Li X, Zhu MW. Exploration of the classification of polycystic ovarian syndrome. Zhonghua Fu Chan Ke Za Zhi 2006;41:684-8.
  11. Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, Ku SY, et al. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod 2008;23:1924-31. https://doi.org/10.1093/humrep/den239
  12. Kumar AN, Naidu JN, Satyanarayana U, Ramalingam K, Anitha M. Metabolic and endocrine characteristics of indian women with polycystic ovary syndrome. Int J Fertil Steril 2016;10:22-8.
  13. Celik C, Abali R, Bastu E, Tasdemir N, Tasdemir UG, Gul A. Assessment of impaired glucose tolerance prevalence with hemoglobin A1c and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study. Hum Reprod 2013;28:1062-8. https://doi.org/10.1093/humrep/det002
  14. Zahiri Z, Sharami SH, Milani F, Mohammadi F, Kazemnejad E, Ebrahimi H, et al. Metabolic syndrome in patients with polycystic ovary syndrome in Iran. Int J Fertil Steril 2016;9:490-6.
  15. Ketel IJ, Stehouwer CD, Serne EH, Korsen TJ, Hompes PG, Smulders YM, et al. Obese but not normal-weight women with polycystic ovary syndrome are characterized by metabolic and microvascular insulin resistance. J Clin Endocrinol Metab 2008;93:3365-72. https://doi.org/10.1210/jc.2008-0626
  16. Acien P, Quereda F, Matallin P, Villarroya E, Lopez-Fernandez JA, Acien M, et al. Insulin, androgens, and obesity in women with and without polycystic ovary syndrome: a heterogeneous group of disorders. Fertil Steril 1999;72:32-40. https://doi.org/10.1016/S0015-0282(99)00184-3
  17. Morciano A, Romani F, Sagnella F, Scarinci E, Palla C, Moro F, et al. Assessment of insulin resistance in lean women with polycystic ovary syndrome. Fertil Steril 2014;102:250-6.e3. https://doi.org/10.1016/j.fertnstert.2014.04.004
  18. Arduc A, Saricam O, Dogan BA, Tuna MM, Tutuncu YA, Isik S, et al. Should insulin resistance be screened in lean hirsute women? Gynecol Endocrinol 2015;31:291-5. https://doi.org/10.3109/09513590.2014.994598
  19. Shah D, Rasool S. Polycystic ovary syndrome and metabolic syndrome: the worrisome twosome? Climacteric 2016;19:7-16. https://doi.org/10.3109/13697137.2015.1116505
  20. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997;18:774-800. https://doi.org/10.1210/er.18.6.774
  21. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013;98:4565-92. https://doi.org/10.1210/jc.2013-2350
  22. Lee S, Choi S, Kim HJ, Chung YS, Lee KW, Lee HC, et al. Cutoff values of surrogate measures of insulin resistance for metabolic syndrome in Korean non-diabetic adults. J Korean Med Sci 2006;21:695-700. https://doi.org/10.3346/jkms.2006.21.4.695
  23. Chun S. Relationship between early follicular serum estrone level and other hormonal or ultrasonographic parameters in women with polycystic ovary syndrome. Gynecol Endocrinol 2020;36:143-7. https://doi.org/10.1080/09513590.2019.1633296
  24. DeVane GW, Czekala NM, Judd HL, Yen SS. Circulating gonadotropins, estrogens, and androgens in polycystic ovarian disease. Am J Obstet Gynecol 1975;121:496-500. https://doi.org/10.1016/0002-9378(75)90081-2
  25. Baird DT, Corker CS, Davidson DW, Hunter WM, Michie EA, Van Look PF. Pituitary-ovarian relationships in polycystic ovary syndrome. J Clin Endocrinol Metab 1977;45:798-801. https://doi.org/10.1210/jcem-45-4-798
  26. MacDonald PC, Rombaut RP, Siiteri PK. Plasma precursors of estrogen. I. Extent of conversion of plasma delta-4-androstenedione to estrone in normal males and nonpregnant normal, castrate and adrenalectomized females. J Clin Endocrinol Metab 1967;27:1103-11. https://doi.org/10.1210/jcem-27-8-1103
  27. de Kat AC, Broekmans FJ, Laven JS, van der Schouw YT. Anti-Mullerian Hormone as a marker of ovarian reserve in relation to cardio-metabolic health: a narrative review. Maturitas 2015;80:251-7. https://doi.org/10.1016/j.maturitas.2014.12.010
  28. La Marca A, Orvieto R, Giulini S, Jasonni VM, Volpe A, De Leo V. Mullerian-inhibiting substance in women with polycystic ovary syndrome: relationship with hormonal and metabolic characteristics. Fertil Steril 2004;82:970-2. https://doi.org/10.1016/j.fertnstert.2004.06.001
  29. Nardo LG, Yates AP, Roberts SA, Pemberton P, Laing I. The relationships between AMH, androgens, insulin resistance and basal ovarian follicular status in non-obese subfertile women with and without polycystic ovary syndrome. Hum Reprod 2009;24:2917-23. https://doi.org/10.1093/humrep/dep225
  30. Chun S. 1-h Postprandial glucose level is related to the serum anti-Mullerian hormone level in women with polycystic ovary syndrome. Gynecol Endocrinol 2015;31:815-8. https://doi.org/10.3109/09513590.2015.1056143
  31. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
  32. Kim JJ, Chae SJ, Choi YM, Hwang SS, Hwang KR, Kim SM, et al. Assessment of hirsutism among Korean women: results of a randomly selected sample of women seeking pre-employment physical check-up. Hum Reprod 2011;26:214-20. https://doi.org/10.1093/humrep/deq303
  33. Kim JJ, Hwang KR, Oh SH, Chae SJ, Yoon SH, Choi YM. Prevalence of insulin resistance in Korean women with polycystic ovary syndrome according to various homeostasis model assessment for insulin resistance cutoff values. Fertil Steril 2019;112:959-66.e1. https://doi.org/10.1016/j.fertnstert.2019.06.035
  34. Abdul-Ghani MA, Tripathy D, DeFronzo RA. Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose. Diabetes Care 2006;29:1130-9. https://doi.org/10.2337/dc05-2179
  35. Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, et al. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007;30:753-9. https://doi.org/10.2337/dc07-9920
  36. Qiao Q, Jousilahti P, Eriksson J, Tuomilehto J. Predictive properties of impaired glucose tolerance for cardiovascular risk are not explained by the development of overt diabetes during follow-up. Diabetes Care 2003;20:2910-4.
  37. Powers AC, Niswender KD, Evans-Molina C. Diabetes mellitus: diagnosis, classification, and pathophysiology [Internet]. New York: McGraw-Hill; 2018 [cited 2021 Oct 1]. Available from: http://accessmedicine.mhmedical.com/content.aspx?bookid=2129§ionid=192288322.