P-891: Clinical profile of insulin resistant PCOS subjects. Characterization of a Latin American population

Abstract

To determine the clinical and laboratory profile of those subjects having the more elevated levels of insulin resistance according to the homeostasis model assessment (HOMA) in a population of Latin American PCOS subjects. Prospective descriptive clinical trial. Thirty three (33) consecutive subjects with diagnosis of PCOS were prospectively recruited. All patients had, at least, 12 weeks without any hormonal treatment and normal levels of thyroid-stimulating hormone, and prolactin before entering the study protocol. The diagnosis of PCOS was established by the exclusion of other conditions chronic anovulation with associated hyperandrogenism: 21-OH-deficient-non classic adrenal hyperplasia, ovarian-adrenal tumors, and Cushing’s syndrome. A detailed physical examination was performed and registered. We measured Body Mass Index (BMI), Ferriman Galwey score (FG), Waist to Hip ratio (W/H), ovarian volume (OV) by ultrasound and menstrual cycle length. Additional laboratory assessment was obtained including fasting glucose and insulin, and plasminogen activator inhibitor 1 (PAI-1). Serum samples for measuring androgens at the end of recuitment period were also collected and were frozen at -20 °C. Statistical analysis was performed using KwikStat-4 Statistical Data Analysis Program (TexaSoft, Cedar Hill, TX). We did obtain a mean HOMA value for entire study population; we then classified those subjects having HOMA values above the mean as insulin resistant and those with HOMA values below the mean as non insulin resistant. A total of 24 subjects completed the clinical and laboratory protocol. The mean HOMA value for the entire study population was 2.43. Ten from 24 (41.6%) subjects had values higher than the general mean, and constituted the insulin resistant group. Mean age of insulin resistant group was higher compared to non insulin resistant subjects (28.8 vs 24.62) but without reaching statistical significance. Overall, the insulin resistant group had a more severe clinical condition as it is suggested by the fact that they had statistically significant higher values of BMI (30.52 Kg/m2 vs 24.40 Kg/m2), W/H ratio (0.84 vs 0.78), menstrual cycle length (72.50 days vs 49.64 days), PAI (18.13 ng/mL vs 10.39 ng/mL), and A4 (4.11 ng/mL vs 3.33 ng/mL). Of note insulin resistant women had significantly lower values of DHEAS (154 ug/dL vs 208 ug/dL) In this population of Latin American PCOS women, we have demonstrated that PCOS subjects with higher insulin resistant state have a more severe disease, being older, with a major degree of obesity, elevated levels of PAI-1 and poorer menstrual function. Unexpectedly, adrenal androgens were lower in the insulin resistant group.