Effects of laparoscopic ovarian drilling on adrenal steroids in polycystic ovary syndrome patients with and without hyperinsulinemia.
OBJECTIVE
To evaluate adrenal steroid responses to ACTH stimulation and insulin responses to oral glucose tolerance test (OGTT) in clomiphene-citrate-resistant anovulatory women with polycystic ovary syndrome (PCOS) before and after laparoscopic ovarian drilling.


METHODS
Prospective study.


METHODS
Healthy participants in a university teaching hospital.


METHODS
Twenty clomiphene-citrate-resistant anovulatory women with PCOS.


METHODS
Laparoscopic ovarian drilling.


METHODS
Adrenal steroid responses to ACTH stimulation and insulin responses to OGTT before and after ovarian drilling.


RESULTS
Fourteen of 20 women completed the study. There was a correlation between body mass index and basal insulin levels before ovarian drilling. This correlation was lost after surgery. Area-under-the-curve glucose and insulin values before surgery in women with hyperinsulinemia (1,033.3 +/- 112.7 mmol/L and 141,919 +/- 26,177 pmol/L, respectively) were significantly higher than in those with normoinsulinemia (777.1 +/- 77.2 mmol/L and 69,867 +/- 19,390 pmol/L respectively, P<.05). There was a significant difference in insulin and glucose responses before and after ovarian drilling in women with hyperinsulinemia. No difference was found in women with normoinsulinemia. There was no significant difference in adrenal steroid responses to ACTH stimulation before and after ovarian drilling.


CONCLUSIONS
PCOS women with hyperinsulinemia respond differently to laparoscopic ovarian drilling than do those with normoinsulinemia. Among women with hyperinsulinemia, surgery decreases glucose and insulin responses to OGTT. Regardless of the insulin level, laparoscopic ovarian drilling does not influence adrenal steroid dynamics.
Saleh
A
A
Division of Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montreal, Canada.
Morris
D
D
Tan
S L
SL
Tulandi
T
T
D000324:Adrenocorticotropic Hormone; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002996:Clomiphene; D004351:Drug Resistance; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications*; D007328:Insulin / Q000097:blood; D007700:Kinetics; D010535:Laparoscopy; D010053:Ovary / Q000601:surgery*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood
D001786:Blood Glucose; D007328:Insulin; D002996:Clomiphene; D013739:Testosterone; D000324:Adrenocorticotropic Hormone