PREVALANCE OF ADRENAL ANDROGEN EXCESS IN PATIENTS WITH THE POLYCYSTIC OVARY SYNDROME
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Keywords
PCOS, Adrenal androgen excess, Androgens, DHEAS, Metabolic disturbances, Hyperandrogenemia
Abstract
Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. Adrenal androgen excess, a significant yet underexplored aspect of hyperandrogenism in PCOS, contributes to its clinical presentation and metabolic abnormalities.
Objective: To determine the prevalence of adrenal androgen excess in women with PCOS and explore its relation with clinical and biochemical parameters.
Material & Method: This cross-sectional study was conducted at Gynae Department, Hayatabad Medical Complex & Khyber Teaching Hospital Peshawar, from March 2021 to February 2023. The study included 233 females aged between 20-55 years diagnosed as cases of PCOS according to Rotterdam criteria. Data were collected through structured questionnaire, clinical examination, biochemical analysis and pelvic ultrasonography. Serum levels of dehydroepiandrosterone sulfate (DHEAS), testosterone and androstenedione were determined. Prevalence of adrenal androgen excess was calculated while associations between it with clinical parameters as well as with biochemical parameters were assessed.
Results: Biochemical analysis indicated that 125 (53.6%) women had elevated DHEAS levels and 105 women (45.1%) demonstrated elevated values of testosterone Ninety-eight (42.1 %) participants had elevated androstenedione levels. All fasting glucose levels were 5.4 ± 0.9 mmol/L at baseline, and all mean insulin levels after a night of fasting were found to be higher than the upper limit (12.8±6 μU/mL ). Lipid profile showed that 89 (38.2%) participants had high total cholesterol, and in addition to this, the percentage of those who has elevated LDL were 65 (27.9%), while it was found that 71 (30.5%) participants had reduced high-density lipoprotein (HDL) levels.
Conclusions: There is a high prevalence of adrenal but not ovarian androgen excess in PCOS, especially among the most hyperandrogenic women who are also insulin resistant. These results emphasize the importance of including adrenal contributions in PCOS treatment, and suggest an individualized medicine strategy that encompasses ovarian as well as adrenal excess androgen production.
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Dr. Naheed Akhter
Assistant Professor Gynae “A” Unit, Gynaecoly & Obs Deptt Khyber Teaching Hospital Peshawar
Dr. Madiha Iqbal
Assistant Professor Gynae “B” Unit, Gynae & Obs Department Hayatabad Medical Complex Peshawar