title: A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome.
abstract: To determine whether hyperinsulinemia can directly reduce serum sex hormone-binding globulin (SHBG) levels in obese women with the polycystic ovary syndrome, six obese women with this disorder were studied. Before study, ovarian steroid production was suppressed in each woman by the administration of 7.5 mg of a long-acting GnRH agonist, leuprolide depot, im, on days -56, -28, and 0. This resulted in substantial reductions in serum concentrations of testosterone (from 1.72 +/- 0.29 nmol/L on day -56 to 0.32 +/- 0.09 nmol/L on day 0), non-SHBG-bound testosterone (from 104 +/- 16 pmol/L on day -56 to 19 +/- 5 pmol/L on day 0), androstenedione (from 7.25 +/- 1.65 nmol/L on day -56 to 2.78 +/- 0.94 nmol/L on day 0), estrone (from 371 +/- 71 pmol/L on day -56 to 156 +/- 29 pmol/L on day 0), estradiol (from 235 +/- 26 pmol/L on day -56 to 90 +/- 24 pmol/L on day 0), and progesterone (from 0.28 +/- 0.12 nmol/L on day -56 to 0.08 +/- 0.02 nmol/L on day 0). Serum SHBG levels, however, did not change (18.8 +/- 2.8 nmol/L on day -56 vs. 17.8 +/- 2.6 nmol/L on day 0). While continuing leuprolide treatment, the women were administered oral diazoxide (300 mg/day) for 10 days to suppress serum insulin levels. Diazoxide treatment resulted in suppressed insulin release during a 100-g oral glucose tolerance test (insulin area under the curve, 262 +/- 55 nmol/min.L on day 0 vs. 102 +/- 33 nmol/min.L on day 10; P less than 0.05) and deterioration of glucose tolerance. Serum testosterone, androstenedione, estrone, estradiol, and progesterone levels did not change during combined diazoxide and leuprolide treatment. In contrast, serum SHBG levels rose by 32% from 17.8 +/- 2.6 nmol/L on day 0 to 23.5 +/- 2.0 nmol/L on day 10 (P less than 0.003). Due primarily to the rise in serum SHBG levels, serum non-SHBG-bound testosterone levels fell by 43% from 19 +/- 5 pmol/L on day 0 to 11 +/- 4 pmol/L on day 10 (P = 0.05). These observations suggest that hyperinsulinemia directly reduces serum SHBG levels in obese women with the polycystic ovary syndrome independently of any effect on serum sex steroids.
authors.affiliation: Department of Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298.
authors.forename: J E
authors.initials: JE
authors.lastname: Nestler
authors.forename: L P
authors.initials: LP
authors.lastname: Powers
authors.forename: D W
authors.initials: DW
authors.lastname: Matt
authors.forename: K A
authors.initials: KA
authors.lastname: Steingold
authors.forename: S R
authors.initials: SR
authors.lastname: Plymate
authors.forename: R S
authors.initials: RS
authors.lastname: Rittmaster
authors.forename: J N
authors.initials: JN
authors.lastname: Clore
authors.forename: W G
authors.initials: WG
authors.lastname: Blackard
mesh_terms: D000328:Adult; D015113:Androstane-3,17-diol / Q000031:analogs & derivatives / Q000097:blood; D000735:Androstenedione / Q000097:blood; D003981:Diazoxide; D004958:Estradiol / Q000097:blood; D004970:Estrone / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D016729:Leuprolide; D009765:Obesity / Q000097:blood / Q000150:complications*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications*; D011374:Progesterone / Q000097:blood; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D013739:Testosterone / Q000097:blood
chemical_list: D007328:Insulin; D012738:Sex Hormone-Binding Globulin; D015113:Androstane-3,17-diol; C028895:androstane-3,17-diol glucuronide; D004970:Estrone; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D000735:Androstenedione; D011374:Progesterone; D004958:Estradiol; D016729:Leuprolide; D003981:Diazoxide