Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS.
OBJECTIVE
To determine whether the severity in hyperandrogenemia determines, to a significant degree, the severity of hirsutism in patients with polycystic ovary syndrome (PCOS).


METHODS
Cross-sectional study.


METHODS
Tertiary care academic referral center.


METHODS
A total of 749 patients with PCOS.


METHODS
History and physical examination, blood sampling.


METHODS
Hirsutism defined by a value of >or=6 using the modified Ferriman-Gallwey (mFG) score, age, body mass index (BMI), calculated homeostatic assessment for insulin resistance (HOMA-IR) value, and levels of total (TT) and free (FT) testosterone, dehydroepiandrosterone sulfate (DHEAS) 17-hydroxyprogesterone (17OH-P), and fasting insulin (INS) and glucose (GLC).


RESULTS
Univariate correlations revealed associations between the mFG score and INS, 17OH-P, HOMA-IR, and BMI. Multivariate classification and regression tree analysis indicated that INS had the most significant association with mFG score and that at higher INS levels T played an additional role whereas at lower INS levels 17OH-P had an effect; however, this model accounted for only 8.2% of total variation in mFG score.


CONCLUSIONS
Insulin appears to have a direct effect on the severity of hirsutism in PCOS and appears to have a synergistic interaction with TT. Notably, over 90% of the variation in the mFG score was not related to the factors studied and likely reflects intrinsic factors related to pilosebaceous unit function or sensitivity and to other factors not yet assessed.
Landay
Melanie
M
Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California 90048, USA.
Huang
Andy
A
Azziz
Ricardo
R
D000328:Adult; D000728:Androgens / Q000097:blood*; D015897:Comorbidity; D005260:Female; D006628:Hirsutism / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis* / Q000453:epidemiology*; D007328:Insulin / Q000097:blood*; D015141:Los Angeles / Q000453:epidemiology; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
D000728:Androgens; D007328:Insulin