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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 194-198

Clinical, biochemical, and phenotype profile of the patients newly diagnosed with polycystic ovarian syndrome


1 Department of Endocrinology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
2 Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
3 Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
4 Department of Endocrinology, Gauhati Medical College, Guwahati, Assam, India

Date of Submission27-Nov-2020
Date of Decision01-Dec-2020
Date of Acceptance02-Dec-2020
Date of Web Publication11-Aug-2021

Correspondence Address:
Dr. Harpreet Kour
Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_124_20

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  Abstract 


OBJECTIVES: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. This study was aimed to assess the clinical, biochemical, and phenotypic profile of patients newly diagnosed to have PCOS.
SUBJECTS AND METHODOLOGY: A cross-sectional study was conducted for a period of 1 year in the Department of Endocrinology, Guwahati Medical College and Hospital. A total of 50 female patients newly diagnosed to have PCOS by the Rotterdam criteria 2003 were enrolled for the study. Clinical Characteristics, thyroid profile, other hormonal tests, oral glucose tolerance test, and phenotypic assessment were done.
RESULTS: Twenty-four percent of patients had dysglycemia, while the rest 76% had normal glucose levels. Glucose abnormalities were noted in 13.7% of lean PCOS and 32.2% of overweight PCOS. There was no difference in insulin resistance among the three phenotypes of PCOS.
CONCLUSION: Women with PCOS are at increased risk of developing glucose intolerance and diabetes. Dysglycemia in PCOS women was mainly evident in postglucose challenge glucose levels. Since there is no difference in insulin resistance among various phenotypes, all the phenotypes equally merit screening for glucose abnormalities.

Keywords: Glucose profile, hormonal, polycystic ovary syndrome


How to cite this article:
Ghatnatti V, Patil S, Kour H, Bhuyan AK, Choudhary BK, Saikia UK, Sharma D. Clinical, biochemical, and phenotype profile of the patients newly diagnosed with polycystic ovarian syndrome. BLDE Univ J Health Sci 2021;6:194-8

How to cite this URL:
Ghatnatti V, Patil S, Kour H, Bhuyan AK, Choudhary BK, Saikia UK, Sharma D. Clinical, biochemical, and phenotype profile of the patients newly diagnosed with polycystic ovarian syndrome. BLDE Univ J Health Sci [serial online] 2021 [cited 2022 Jul 2];6:194-8. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/2/194/323710



Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age with a prevalence of approximately 6%–10% worldwide.[1] PCOS reflects multiple potential etiologies and variable clinical manifestations. PCOS can be viewed as a heterogeneous androgen excess disorder with varying degrees of reproductive and metabolic abnormalities determined by the interaction of multiple genetic and environmental factors. PCOS has significant implications for the health and quality of life of these patients.[2],[3] The prevalence of PCOS is increased in women with increased abdominal adiposity, dyslipidemia, hypertension, insulin resistance, and glucose intolerance.[4],[5] The prevalence of impaired glucose metabolism in women with PCOS has been reported as high as 20%–35% compared with the general population.[6],[7] Type 2 diabetes mellitus (T2DM) is more common in women with PCOS as compared to age-matched normal females. There are various reports of differing insulin resistance among different phenotypes of PCOS.[8],[9] Therefore, this study aimed to assess the clinical, biochemical, and phenotypic profile of patients newly diagnosed to have PCOS.


  Subjects and Methodology Top


This cross-sectional study was conducted for a period of 1 year in the Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati. A total of 78 patients were enrolled for the period of 1 year. After screening, 23 patients were excluded after primary evaluation as per exclusion criteria, and five patients refused to participate in the study. Hence, a total of 50 female patients newly diagnosed to have PCOS by the Rotterdam criteria 2003 were enrolled for the study. The written informed consent was obtained from all patients involved in the study, and institutional ethical clearance was obtained before the conduct of the study.

Diagnostic criteria

PCOS was diagnosed using the Rotterdam 2003 criteria, which defines PCOS as having two of the following:

(1) Oligoovulation or anovulation, (2) clinical and or biochemical signs of hyperandrogenism, or (3). Polycystic ovaries by ultrasonography.

Exclusion criteria

  1. Patients with known medical illnesses such as diabetes, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or active thyroid disorder
  2. Patients on medications such as corticosteroids, oral contraceptives, or metformin-like drugs which could alter the endocrine and metabolic parameters under investigation
  3. Patients with disorders, namely, 21-hydroxylase-deficient nonclassic adrenal hyperplasia, thyroid dysfunction, hyperprolactinemia, neoplastic androgen secretion, drug-induced androgen excess, the syndromes of severe insulin resistance, Cushing's syndrome, and glucocorticoid resistance.


Primary study outcome

  1. Clinical characteristics were evaluated by through physical examination and detailed menstrual History, measurements of anthropometric variables, and calculating modified Ferriman–Gallwey (FG) score
  2. Hormonal assessment included thyroid profile, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, prolactin, dehydroepiandrosterone sulfate (DHEAS), 17 OH progesterone, and fasting serum insulin
  3. Biochemical assessment included 75 g oral glucose tolerance test (OGTT)
  4. Phenotypic assessment was done with the help of diagnostic features
  5. Transabdominal ultrasonography in all cases to demonstrate the presence of more than 12 peripheral ovarian follicles, each between 2 and 9 mm and/or ovarian volume >10 cm3 suggestive of PCOS.


The physical examination included recording of blood pressure, weight in kg using a digital weighing scale, and height in cm using stadiometer. The body mass index was calculated using the formula: weight (kg)/height2 (cm). Waist circumference (WC) was measured with the patient standing, at a point midway between the lower costal margin, and the iliac crest at the mid axillary line. Overweight (body mass index [BMI] >23 kg/m2) and central obesity (WC >80 cm) were defined by the Asian criteria.[10] Modified FG scoring was used to assess hirsutism. A score of ≥8 is considered hirsutism.[11]

Venous blood samples were taken from patients in a fasting state for hormonal and biochemical analysis including basal tetraiodothyronine, thyroid-stimulating hormone, 17-hydroxy progesterone, serum insulin, and prolactin. The samples for LH, FSH, total testosterone, and DHEAS were collected on days 3rd–7th (early follicular phase) of spontaneous menstrual cycle or anytime in amenorrheic patients.[12] The OGTT was performed after an overnight fast of 10–12 h.[13]

Statistical analysis

Data are presented as mean + standard deviation; the clinical hormonal, biochemical, and phenotype characteristics were tabulated into two groups and compared using two-sample t-test. A P < 0.05 was considered statistically significant. All data were analyzed with commercial software IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp. IBM Corp. Released 2010.


  Results Top


The mean age of fifty newly diagnosed PCOS patients was 24.04 ± 4.1 years, with mean-BMI of 23.96 ± 3.36 kg/m2. With a cutoff BMI of 23 kg/m2, 28 females (56%) were overweight PCOS and 22 females (44%) were lean PCOS. Average WC was 84.26 ± 9.53 cm. Hirsutism score as calculated by modified FG mean score was 8.12 ± 5.78. Hirsutism was seen in 40% of the PCOS patients and 26% (13/50) had acne vulgaris. Acanthosis nigricans was seen in 42% of PCOS women. A positive family history of Type 2 diabetes mellitus in first- and second-degree relatives was noted in 26 women (52%) [Table 1].
Table 1: Clinical characteristics of polycystic ovary syndrome patients

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About 31 (62%) patients had elevated testosterone levels, 8 (16%) patients had elevated DHEAS level, and 3 (6%) had isolated elevation of DHEAS. LH: FSH ratio more than 2 in almost 33 (66%) females among the study population. The observed values are shown in [Table 2].
Table 2: Hormonal profile of polycystic ovary syndrome patients

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IFG was noted in 2 (4%) patients, IGT in 8 (16%) patients, and overt diabetes mellitus in 2 (4%) patients. The remaining 38 (76%) patients had normal glucose levels [Table 3].
Table 3: Categorization of glucose abnormalities in polycystic ovary syndrome women

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About 39 patients (78%) had hyperandrogenism, 46 (92%) had oligomenorrhea, and 45 (90%) had polycystic ovaries. According to the individual combinations of these features, 70% (35/50) had classic phenotype, 8% (4/50) had ovulatory phenotype, and 22% (11/50) had the normoandrogenic phenotype [Table 4].
Table 4: Diagnostic features and phenotypic classification of polycystic ovary syndrome

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Glucose abnormalities were noted in 13.7% of lean PCOS and 32.2% of overweight PCOS. IGT was significantly more common in overweight compared to lean PCOS women (21.4% vs. 9.0%). Significantly more number of lean PCOS women had normal glucose levels compared to the obese (86.3% vs. 67.8%) [Table 5].
Table 5: Distribution of glucose abnormalities in lean and overweight polycystic ovary syndrome

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BMI and WC were significantly less in the normoandrogenic group compared to the classic group. As expected, FG score and serum testosterone levels were significantly lower in the normoandrogenic group compared to the other two groups. Serum fasting insulin levels and homeostatic model assessment for insulin resistance (HOMA IR) were higher in the classic compared to the other two groups though it did not achieve statistical significance [Table 6].
Table 6: Characteristics of polycystic ovary syndrome women subdivided according to the polycystic ovary syndroame phenotype

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  Discussion Top


The women with PCOS in our study were relatively young, with a mean age of 24.04 ± 4.17. The mean BMI of PCOS patients in our study was 23.95 ± 3.36. Batteries of papers have reported a highly variable range of prevalence of 2.2% to 24% and also an alarming high 22.85% of prevalence of PCOS in the younger population with a lower mean age.[14],[15],[16],[17],[18],[19] Higher BMI and obesity further lead to hormonal imbalances, resulting in hyperandrogenism. This supports the higher Ferryman–Gallwey score, elevated testosterone levels, and increased FSH: LH ratio in patients diagnosed newly with PCOS.[20],[21]

The prevalence of dysglycemia in our study was less compared to most other studies. This is probably because we had recruited newly diagnosed cases of PCOS in our study unlike other studies which had included already diagnosed cases of PCOS. Furthermore, the mean age of our patients was less compared to the other studies where most women were in the third or fourth decade. We had also excluded newly diagnosed PCOS cases who had a previous history of diabetes. The low prevalence of dysglycemia in our study could be also due to the fact that we used Rotterdam criteria, unlike other studies. The majority of the studies assessing glucose tolerance and insulin resistance have used the NICHD criteria for the diagnosis of PCOS.[20],[21]

In our study, dysglycemia (fasting glucose >100 mg/dl, and/or 2-h postchallenge glucose >140 mg/dl) was mainly evident in postglucose challenge glucose levels. Women with PCOS most commonly have postprandial dysglycemia, which reflects peripheral, primarily skeletal muscle, and insulin resistance, rather than fasting dysglycemia, which reflects increased endogenous glucose production. Therefore, 2-h postchallenge glucose values are optimal for the diagnosis of IGT and T2DM in PCOS.[23],[24]

In our study, although the classic group had higher HOMA IR values compared to the ovulatory and normoandrogenic groups, we did not find any significant difference in the insulin resistance between the three PCOS phenotypes. This could be due to the lesser number of patients in ovulatory and normoandrogenic group. With regard to PCOS phenotypes, most previous studies reported that women with the classic phenotype were more insulin resistant than those with either the ovulatory or the normoandrogenic phenotype. However, several studies did not confirm these findings.[20],[21],[25]


  Conclusion Top


Women with PCOS are at increased risk of developing glucose intolerance and diabetes. This has been attributed to the increased insulin resistance, which is present in most patients. Dysglycemia in PCOS women was mainly evident in postglucose challenge glucose levels. Hence, OGTT seems necessary to diagnose glucose abnormalities in women with PCOS. Since in our study, there was no difference in insulin resistance among various phenotypes, all the phenotypes equally merit screening for glucose abnormalities.

Acknowledgment

We are thankful to the Department of Endocrinology, Gauhati Medical College, Guwahati, for all the support in conduct of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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