title: Hyperinsulinemia and ovarian hyperandrogenism. Cause and effect.
abstract: The evidence that supports the hypothesis that hyperinsulinemia causes ovarian hyperandrogenism was reviewed. The most dramatic clinical expression of the association between hyperinsulinemia and hyperandrogenism is the HAIR-AN syndrome. In the HAIR-AN syndrome, severe insulin resistance results in a compensatory hyperinsulinemia that stimulates ovarian androgen production. Acanthosis nigricans, a dermatologic manifestation of severe insulin resistance, is an epiphenomenon of the disease. Hyperandrogenic (HA) women can be divided into two major groups: insulin-resistant (HA-IR) and non-insulin-resistant (HA-nIR). HA-nIR women have markedly elevated LH, often have minimally elevated serum prolactin, and have polycystic ovaries. HA-IR women have minimally elevated LH, markedly elevated plasma insulin, and stromal hyperthecosis. Women with HA-nIR probably have a primary hypothalamic-pituitary abnormality as the cause of their hyperandrogenism. Women with HA-IR probably have a primary metabolic abnormality as the cause of their hyperandrogenism. The relationship between hyperinsulinemia and hyperandrogenism is one example of the complex interrelationships that exist between central metabolism and reproduction.
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: R L
authors.initials: RL
authors.lastname: Barbieri
authors.forename: M D
authors.initials: MD
authors.lastname: Hornstein
mesh_terms: D000052:Acanthosis Nigricans / Q000150:complications; D000728:Androgens / Q000096:biosynthesis*; D000818:Animals; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood* / Q000494:pharmacology; D007333:Insulin Resistance; D010049:Ovarian Diseases / Q000209:etiology / Q000503:physiopathology*; D010053:Ovary / Q000187:drug effects / Q000503:physiopathology; D011085:Polycystic Ovary Syndrome / Q000209:etiology / Q000503:physiopathology; D013002:Somatomedins / Q000494:pharmacology
chemical_list: D000728:Androgens; D007328:Insulin; D013002:Somatomedins