title: Sex steroids, insulin sensitivity and sympathetic nerve activity in relation to affective symptoms in women with polycystic ovary syndrome.
abstract: BACKGROUND
  Affective symptoms are poorly understood in polycystic ovary syndrome (PCOS). Clinical signs of hyperandrogenism and high serum androgens are key features in PCOS, and women with PCOS are more likely to be overweight or obese, as well as insulin resistant. Further, PCOS is associated with high sympathetic nerve activity.
  
  
  OBJECTIVE
  To elucidate if self-reported hirsutism, body mass index (BMI) and waistline, circulating sex steroids, sex hormone-binding globulin (SHBG), insulin sensitivity and sympathetic nerve activity are associated with depression and anxiety-related symptoms in women with PCOS.
  
  
  METHODS
  Seventy-two women with PCOS, aged 21-37 years, were recruited from the community. Hirsutism was self-reported using the Ferriman-Gallway score. Serum estrogens, sex steroid precursors, androgens and glucuronidated androgen metabolites were analyzed by gas and liquid chromatography/mass spectroscopy (GC-MS/LC-MS/MS) and SHBG by chemiluminiscent microparticle immunoassay (CMIA). Insulin sensitivity was measured with euglycemic hyperinsulinemic clamp. Sympathetic nerve activity was measured with microneurography. Symptoms of depression and anxiety were self-reported using the Montgomery Åsberg Depression Rating Scale (MADRS-S) and the Brief Scale for Anxiety (BSA-S).
  
  
  RESULTS
  Circulating concentrations of testosterone (T) (P=0.026), free T (FT) (P=0.025), and androstane-3α 17β-diol-3glucuronide (3G) (P=0.029) were lower in women with depression symptoms of potential clinical relevance (MADR-S≥11). The odds of having a MADRS-S score ≥11 were higher with lower FT and 3G. No associations with BSA-S were noted.
  
  
  CONCLUSIONS
  Lower circulating FT and 3G were associated with worse self-reported depression symptoms. The relationship between mental health, sex steroids and corresponding metabolites in PCOS requires further investigation.
authors.affiliation: Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jedel
authors.forename: Deborah
authors.initials: D
authors.lastname: Gustafson
authors.forename: Margda
authors.initials: M
authors.lastname: Waern
authors.forename: Yrsa Bergmann
authors.initials: YB
authors.lastname: Sverrisdottir
authors.forename: Mikael
authors.initials: M
authors.lastname: Landén
authors.forename: Per Olof
authors.initials: PO
authors.lastname: Janson
authors.forename: Fernand
authors.initials: F
authors.lastname: Labrie
authors.forename: Claes
authors.initials: C
authors.lastname: Ohlsson
authors.forename: Elisabet
authors.initials: E
authors.lastname: Stener-Victorin
mesh_terms: D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000097:blood / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D001007:Anxiety / Q000097:blood / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D012739:Gonadal Steroid Hormones / Q000032:analysis / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007118:Immunoassay; D007333:Insulin Resistance / Q000502:physiology*; D013058:Mass Spectrometry; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications / Q000378:metabolism* / Q000523:psychology*; D011594:Psychometrics; D013564:Sympathetic Nervous System / Q000378:metabolism / Q000502:physiology*; D055815:Young Adult
chemical_list: D012739:Gonadal Steroid Hormones