Human Reproduction, Vol 12, 1897-1901, Copyright © 1997 by Oxford University Press
M Ciampelli, AM Fulghesu, F Cucinelli, V Pavone, A Caruso, S Mancuso and A Lanzone
The aim of this study was to evaluate the impact of reduced peripheral
insulin sensitivity, beta cell hypersecretion and reduced hepatic insulin
clearance in the hyper-insulinaemia of lean and obese PCOS patients. A
total of 35 women with polycystic ovary syndrome (PCOS) and 10 lean
normo-ovulatory controls underwent an oral glucose tolerance test and an
euglycaemic-hyper-insulinaemic clamp study. PCOS patients were classified
into four groups according to their BMI and insulin secretion (normo-lean;
normo-obese; hyper-lean; hyper-obese), and results were compared between
groups and with the controls. All the PCOS groups showed significantly
higher insulin secretion than controls; there were no differences in
insulin response to glucose load between lean and obese normo- and
hyper-insulinaemic patients. Secretion of c-peptide was greater in PCOS
groups than controls. All the hyper-insulinaemic PCOS patients had lower
values of hepatic insulin clearance, independent of BMI, when compared
either with controls (P < 0.001) or with PCOS normo-insulinaemic women
(P < 0.01). Normo- and hyper-insulinaemic obese patients had similar
total body glucose utilization (M value), which was lower than in lean PCOS
subjects and controls. Our results suggest that evaluation of insulin
resistance alone does not fully characterize the PCOS population;
differences in liver metabolism of insulin are present in obese insulin
resistant subjects and in lean patients with normal insulin sensitivity
when divided into normo- and hyper-insulinaemic subgroups. Insulin
resistance and hyper-insulinaemia may represent two distinct features of
the insulin disorder in PCOS: the former appear to reflect the presence of
obesity, while the latter may be a primary feature of PCOS.
ARTICLES
Heterogeneity in beta cell activity, hepatic insulin clearance and peripheral insulin sensitivity in women with polycystic ovary syndrome
Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy.
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