Abstract
Although insulin resistance plays an important pathogenetic role in polycystic ovary syndrome (PCOS), no correlation between ultrasound PCOS pattern and insulin resistance has yet been reported. The aim of this retrospective observational study was to assess whether the ovarian ultrasonographic parameter differed between PCOS women with insulin resistance and those with a hyperandrogenic profile. Women who fulfilled the Rotterdam criteria for PCOS were retrospectively studied. Anthropometric, biochemical, and clinical data were recorded. Women were divided into two groups based on specific transvaginal ultrasound parameters: subjects with more than half of the follicles measuring between 5 and 9 mm in diameter, an ultrasonographic determined stroma/total area (S/A) > 0.34 and a "necklace" sign of antral follicles (Group A); and subjects with more than half of the antral follicles measuring between 2 and 4 mm in diameter, an S/A ≤ 0.34; no "necklace" sign but ubiquitously distributed follicles determined by ultrasound (Group B). The association between these ultrasound patterns and the presence of insulin resistance was also evaluated. Seventy-eight patients were enrolled: 33 with ultrasound sound pattern A and 45 with pattern B. The latter pattern had a sensitivity of 88% and a specificity of 78% in predicting PCOS women with insulin resistance. There were no differences in age, Ferriman-Gallwey score, and serum gonadotropin or androgen levels between the two groups. Body mass index, the waist-to-hip ratio, and homeostasis model assessment were significantly higher in group B than in group A (p < 0.05). Conversely, sex hormone binding globulin levels and ovarian volume were significantly higher in group A (p < 0.05). Insulin resistance was more frequent in group B than in group A (36/41, 87.8% versus 7/32, 21.8%; p < 0.05). These results suggest that insulin resistance could be associated with a specific ultrasound pattern in PCOS patients.
Highlights
Polycystic ovary syndrome (PCOS) is a common endocrine disease affecting approximately 5–10% of women of reproductive age [1]
Women affected by insulin resistance were more likely to have a type B ultrasound pattern than women without insulin resistance (87.8 versus 21.8%, p < 0.01)
We have identified an association between metabolic parameters and ultrasound pattern in patients affected by PCOS
Summary
Polycystic ovary syndrome (PCOS) is a common endocrine disease affecting approximately 5–10% of women of reproductive age [1]. It is clinically characterized by anovulation, oligomenorrhea and hyperandrogenism, and polycystic ovary on ultrasound imaging [2]. PCOS women with insulin resistance are usually overweight and can be distinguished from PCOS women with androgenic features, slim appearance, and absence of insulin resistance. These two different “PCOS profiles” are consistent with Rotterdam criteria, their physiological and clinical phenotypes are macroscopically different
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