title: Absence of profound hyperinsulinism in polycystic ovary syndrome is associated with subtle elevations in the plasminogen activator inhibitor system.
abstract: In order to describe potential hypofibrinolytic tendencies in young (< 35 years) polycystic ovary syndrome (PCOS) patients, we studied plasminogen activator inhibitor (PAI-1) system components in women without laboratory evidence of hyperinsulinism or hyperandrogenism. The study was a prospective, observational comparison and took place in a major urban infertility referral center. Age, body mass index, ovulatory status, selected androgen levels, fasting insulin and plasma lipids were measured in subjects with PCOS (n = 39) and normal control subjects (n = 20). Women with PCOS had higher mean serum total testosterone and androstenedione levels compared with controls (56.4 versus 40.3 ng/dl, p = 0.03, and 179 versus 133 microg/ml, p = 0.03, respectively). Mean fasting insulin levels were higher among PCOS women (p < 0.01) and were strongly correlated with PAI-1 antigen (Ag) (r = 0.46), PAI-1 activity (r = 0.43), and tissue plasminogen activator (t-PA) (r = 0.5). Correlations were evident in both PCOS and control subjects. Mean PAI-1 Ag, PAI-1 activity, and t-PA levels were significantly elevated (p = 0.003, 0.001, and 0.001, respectively) in PCOS. ANOVA was performed to control for insulin effect; a trend toward elevated PAI-1 in PCOS persisted but was no longer statistically significant (p = 0.24). PAI-1 activity elevation remained in PCOS women with mean fasting insulin levels < 10 mIU/ml (p = 0.02), yet the difference became less significant when insulin was controlled (p = 0.38). Although these data confirm known associations between insulin and PAI-1 derangements, this is the first study to quantify discrete PAI-1 elevations that persist in the setting of PCOS even with normal or low ambient insulin levels. Additional prospective studies are needed to determine whether this altered PAI-1 state is associated with a clinically important hypofibrinolytic condition and subsequent poor reproductive outcome.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Atlanta Medical Center, Atlanta, Georgia, USA.
authors.forename: E Scott
authors.initials: ES
authors.lastname: Sills
authors.forename: C D
authors.initials: CD
authors.lastname: Drews
authors.forename: M
authors.initials: M
authors.lastname: Perloe
authors.forename: M J
authors.initials: MJ
authors.lastname: Tucker
authors.forename: C R
authors.initials: CR
authors.lastname: Kaplan
authors.forename: G D
authors.initials: GD
authors.lastname: Palermo
mesh_terms: D000328:Adult; D000735:Androstenedione / Q000097:blood; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D005215:Fasting; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D011085:Polycystic Ovary Syndrome / Q000097:blood*; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood; D010959:Tissue Plasminogen Activator / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D007328:Insulin; D017395:Plasminogen Activator Inhibitor 1; D013739:Testosterone; D000735:Androstenedione; D010959:Tissue Plasminogen Activator