A study on clinical correlation with Hyperinsulinemia in polycystic ovary Syndrome

INTRODUCTION: Polycystic Ovary Syndrome is one of the most common endocrine disorder of women in reproductive age group and constitutes approximately 4 to 12%. The clinical manifestation of this disorder includes menstrual disturbances, infertility and hirsutism. World Health Organisation has classified PCOS as the class II anovulatory disorder. The hallmark endocrine disorders of this syndrome are hyperinsulinemia and hyperandrogenism. In 1921 Archard and Thiers gave the description of bearded women with diabetes and found that there was significant association between hyperandrogenism and insulin. In 1935 Stein and Leventhal coined the term polycystic ovary syndrome in those women having polycystic ovaries and the triad of hirsutism, amenorrhoea and obesity. The syndrome has major metabolic and reproductive morbidities since that PCOS was associated with hyperinsulinemia. Insulin receptor gene mutation leading to hyperglycemia and hyperinsulinemia has been identified in majority of PCOS. There also appears to have defect in HPO axis in patients presenting with PCOS. AIM OF THE STUDY: 1. To correlate the abnormal carbohydrate metabolism due to increased serum fasting insulin levels with symptomatology of PCOS. 2. To find out the sensitivity of estimation of serum fasting insulin levels in predicting abnormal carbohydrate metabolism in PCOS. 3. Early identification of insulin resistance among PCOS and to prevent future metabolic disorders in women. MATERIALS AND METHODS: The study was undertaken among PCOS patients attending the Gynaecology Outpatient Department in Coimbatore Medical College Hospital. The study was done during a one year period from June 2011- June 2012. Inclusion Criteria: Those patients who were diagnosed to have PCOS using Rotterdam’s criteria given by (ASRM / ESRHRE) American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology were included in this study. ROTTERDAM’S CRITERIA (2/3) if any two of the three criteria are present patients were included in the study. 1. Oligomenorrhoea / anovulation, 2. Hyperandrogenism (clinical / biochemical), 3. Polycystic ovaries in ultrasound. More than 12 follicles each measuring 2 to 9 mm Volume of ovary more than 10cu.mm. Exclusion Criteria: Known diabetes, Adrenal disorder, Renal / Liver disease. Oligomenorrhoea denotes infrequent, irregular menses occuring at interval of more than 35 days.Amenorrhoea denotes absence of menses for 6 months or more. Clinical evidence of hyperandrogenism includes hirsuitism, acne, androgenic alopecia. Biochemical evidence of hyperandrogenism includes elevated androgen – testosterone, androstenedione, DHEA, DHEAS. Obesity was measured by calculating patient’s body mass index and waist/ hip ratio using standard methods. CONCLUSION: 1. Abnormal carbohydrate metabolism due to increased serum fasting insulin levels is associated with 20% of patients with PCOS. 2. All the symptoms of PCOS (Hirsutism, obesity, menstrual disturbances) were found to be more commonly associated with hyperinsulinemic than normoinsulinemic PCOS women. 3. Hyperinsulinemia is twice more common than abnormal glucose tolerance test ,thereby showing that estimation of fasting serum insulin levels is a more sensitive index of predicting abnormal carbohydrate metabolism than OGTT in PCOS women