Abstract
A bi‑directional relationship exists between obesity and polycystic ovary syndrome (PCOS). Although most of the patients with PCOS are obese, normal-weight patients still account for a certain proportion of PCOS who have lesser degrees of insulin resistance and fewer metabolic risk factors. This study was conducted to compare the clinical, metabolic, and endocrine parameters of the two categories of PCOS: lean and obese PCOS. We evaluated 523 women with PCOS attending the Endocrinology outpatient department of a tertiary hospital in Bangladesh. PCOS patients with body mass index (BMI) <23 kg/m2 were categorized as lean PCOS and those with BMI ≥23 kg/m2 as obese PCOS. Out of 523 women with PCOS studied, the frequencies of lean- and obese PCOS were 23.3% and 76.7%, respectively. Age, systolic blood pressure (BP), diastolic BP, fasting plasma glucose, plasma glucose 2-hour after oral glucose tolerance test, serum triglyceride, total cholesterol, low-density lipoprotein cholesterol, total testosterone, and thyroid-stimulating hormone were higher in obese PCOS group; serum prolactin was higher in the lean PCOS group; modified Ferriman-Gallwey score and high-density lipoprotein cholesterol were similar in the two groups. Acanthosis nigricans (89.3% vs. 45.9%), prediabetes (24.4% vs. 13.1%), diabetes (6.7% vs. 1.6%), pre-hypertension (22.2% vs. 9.8%), hypertension (8.7% vs. 0.8%), metabolic syndrome (61.3% vs. 14.8%), and biochemical hyperandrogenism (27.7% vs. 11.5%) were more frequent in the obese group than the lean group. The two groups had similar frequencies of menstrual irregularity, hirsutism, a family member with type 2 diabetes, and dyslipidemia. Though metabolic abnormalities are more frequently observed when obesity is associated with PCOS, both lean and obese have adverse metabolic consequences. All patients with PCOS should be screened for metabolic abnormalities irrespective of BMI category.
Highlights
Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age
Patients with PCOS are classified into two broad categories based on their body mass index (BMI), obese PCOS with BMI ≥23 kg/m2, and lean PCOS with BMI
BMI, Waist circumference (WC), systolic blood pressure (BP), diastolic BP, fasting plasma glucose (FPG), PG 2H-Oral glucose tolerance test (OGTT), serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), TT, and thyroidstimulating hormone (TSH) were higher in obese PCOS group; serum prolactin was higher in the lean PCOS group; modified F-G score and high-density lipoprotein cholesterol (HDL-C) levels were similar in the two groups
Summary
Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age. The prevalence of PCOS varies from country to country, which is as low as 6-10% in the western world and as high as 22.5% in the Indian subcontinent[1,2]. This heterogeneous androgen-excess disorder presents with different degrees of reproductive and metabolic dysfunctions. [6,7] Lean patients with PCOS have lesser degrees of insulin resistance and fewer metabolic risk factors, which suggests that the pathogenesis of this group may be different from that of obese PCOS patients[4,5]. In addition to the metabolic features, differences in the reproductive and endocrine parameters between the two groups are observed[611]
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