Korean J Obstet Gynecol.  2011 Nov;54(11):659-665. 10.5468/KJOG.2011.54.11.659.

Inappropriate gonadotropin secretion in polycystic ovary syndrome: The relationship with clinical, hormonal and metabolic characteristics

• Shim AR
• Hwang YI
• Lim KJ
• Choi YM
• Jeon YE
• Seo SK
• Cho SH
• Choi YS
• Lee BS

• KMID: 2274104
• DOI: http://doi.org/10.5468/KJOG.2011.54.11.659

Abstract

OBJECTIVE
To evaluate the clinical, hormonal and metabolic characteristics according to luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio in women with polycystic ovary syndrome (PCOS).
METHODS
A total of 225 women with PCOS were included in this study. They were divided into two groups according to LH/FSH ratio; group A (LH/FSH < 2, n=160) and group B (LH/FSH > 2, n=65). We compared clinical, hormonal and metabolic characteristics including age at menarche, body mass index (BMI), blood pressures, ovarian volume, and serum androgen levels between the two groups. Serum glucose and insulin levels, fasting glucose/insulin ratio, homeostatic model assessment of insulin resistance (HOMA-IR), and lipid profiles were also compared between the two groups. Pearson correlation coefficients were used to evaluate correlation between the LH/FSH ratio and various parameters.
RESULTS
Age of menarche in the group B was significantly later than that in the group A. BMI, waist-hip ratio and blood pressures were significantly lower in the group B compared to those of the group A. Ovarian volume and serum levels of LH, estradiol, total testosterone, sex-hormone binding globulin, 17-hydroxyprogesterone (OHP), and high density lipoprotein were significantly higher in the group B. Postprandial 2 hours glucose, insulin and HOMA-IR were significantly higher in the group A. After adjustment of BMI, the LH/FSH ratio was significantly positively correlated with age at menarche, ovarian volume, total testosterone levels, and 17-OHP levels.
CONCLUSION
The inappropriate gonadotropin secretion may be negatively correlated with BMI, and positively with age of menarche and increased ovarian androgen production irrespective of BMI in women with PCOS. However, it may not be associated with metabolic characteristics.

Keyword

Polycystic ovary syndrome; Luteinizing hormone (LH); Follicle stimulating hormone (FSH); LH/FSH ratio

MeSH Terms

17-alpha-Hydroxyprogesterone
Body Mass Index
Estradiol
Fasting
Female
Glucose
Gonadotropins
Humans
Insulin
Insulin Resistance
Lipoproteins
Luteinizing Hormone
Menarche
Ovary
Polycystic Ovary Syndrome
Testosterone
Waist-Hip Ratio
17-alpha-Hydroxyprogesterone
Estradiol
Glucose
Gonadotropins
Insulin
Lipoproteins
Luteinizing Hormone
Testosterone

Reference

1. Park HR, Choi Y, Lee HJ, Oh JY, Hong YS, Sung YA. The metabolic syndrome in young Korean women with polycystic ovary syndrome. Diabetes Res Clin Pract. 2007. 77:Suppl 1. S243–S246.

2. Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metab. 1999. 84:1897–1899.

3. Hirshfeld-Cytron J, Barnes RB, Ehrmann DA, Caruso A, Mortensen MM, Rosenfield RL. Characterization of functionally typical and atypical types of polycystic ovary syndrome. J Clin Endocrinol Metab. 2009. 94:1587–1594.

4. Rebar R, Judd HL, Yen SS, Rakoff J, Vandenberg G, Naftolin F. Characterization of the inappropriate gonadotropin secretion in polycystic ovary syndrome. J Clin Invest. 1976. 57:1320–1329.

5. Cho LW, Jayagopal V, Kilpatrick ES, Holding S, Atkin SL. The LH/FSH ratio has little use in diagnosing polycystic ovarian syndrome. Ann Clin Biochem. 2006. 43:217–219.

6. Franks S. Polycystic ovary syndrome: a changing perspective. Clin Endocrinol (Oxf). 1989. 31:87–120.

7. Grulet H, Hecart AC, Delemer B, Gross A, Sulmont V, Leutenegger M, et al. Roles of LH and insulin resistance in lean and obese polycystic ovary syndrome. Clin Endocrinol (Oxf). 1993. 38:621–626.

8. Zawadeski JK, Dunaif A. Dunaif A, Givens J, Haseltine F, Merriam G, editors. Diagnostic criteria for PCOS: towards a more rational approach. PCOS. 1992. Cambridge: Blackwell Scientific Publications;377–384.

9. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004. 81:19–25.

10. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009. 91:456–488.

11. Hsu MI, Liou TH, Liang SJ, Su HW, Wu CH, Hsu CS. Inappropriate gonadotropin secretion in polycystic ovary syndrome. Fertil Steril. 2009. 91:1168–1174.

12. Arroyo A, Laughlin GA, Morales AJ, Yen SS. Inappropriate gonadotropin secretion in polycystic ovary syndrome: infl uence of adiposity. J Clin Endocrinol Metab. 1997. 82:3728–3733.

13. Taylor AE, McCourt B, Martin KA, Anderson EJ, Adams JM, Schoenfeld D, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1997. 82:2248–2256.

14. Moran C, Garcia-Hernandez E, Barahona E, Gonzalez S, Bermudez JA. Relationship between insulin resistance and gonadotropin dissociation in obese and nonobese women with polycystic ovary syndrome. Fertil Steril. 2003. 80:1466–1472.

15. Roh JS, Ji IW, Son BR, Kim HS. High correlation of serum inhibin A and B with gonadotropin levels in oligo-amenorrheic women with polycystic ovary syndrome. Korean J Obstet Gynecol. 1999. 42:1550–1555.

16. Rosenfield RL, Ghai K, Ehrmann DA, Barnes RB. Diagnosis of the polycystic ovary syndrome in adolescence: comparison of adolescent and adult hyperandrogenism. J Pediatr Endocrinol Metab. 2000. 13:Suppl 5. 1285–1289.

17. Ibáñez L, Potau N, Marcos MV, De Zegher F. Adrenal hyperandrogenism in adolescent girls with a history of low birthweight and precocious pubarche. Clin Endocrinol (Oxf). 2000. 53:523–527.

18. Sadrzadeh S, Klip WA, Broekmans FJ, Schats R, Willemsen WN, Burger CW, et al. Birth weight and age at menarche in patients with polycystic ovary syndrome or diminished ovarian reserve, in a retrospective cohort. Hum Reprod. 2003. 18:2225–2230.

19. Silfen ME, Denburg MR, Manibo AM, Lobo RA, Jaffe R, Ferin M, et al. Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents. J Clin Endocrinol Metab. 2003. 88:4682–4688.

20. Pagán YL, Srouji SS, Jimenez Y, Emerson A, Gill S, Hall JE. Inverse relationship between luteinizing hormone and body mass index in polycystic ovarian syndrome: investigation of hypothalamic and pituitary contributions. J Clin Endocrinol Metab. 2006. 91:1309–1316.

21. Katsikis I, Karkanaki A, Misichronis G, Delkos D, Kandaraki EA, Panidis D. Phenotypic expression, body mass index and insulin resistance in relation to LH levels in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2011. 156:181–185.

22. Sikka P, Gainder S, Dhaliwal LK, Bagga R, Sialy R, Sahdev S. Ultrasonography of the ovaries and its correlation with clinical and endocrine parameters in infertile women with PCOS. Int J Fertil Womens Med. 2007. 52:41–47.

23. Kumar A, Woods KS, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf). 2005. 62:644–649.

24. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005. 90:1929–1935.

25. Lee H, Oh JY, Hong Y, Sung YA, Chung H. Prevalence of metabolic syndrome in young Korean women with polycystic ovary syndrome. J Korean Diabetes Assoc. 2006. 30:285–291.

26. Nofer JR, van der Giet M, Tölle M, Wolinska I, von Wnuck Lipinski K, Baba HA, et al. HDL induces NO-dependent vasorelaxation via the lysophospholipid receptor S1P3. J Clin Invest. 2004. 113:569–581.

27. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999. 22:141–146.

28. Patel K, Coffler MS, Dahan MH, Yoo RY, Lawson MA, Malcom PJ, et al. Increased luteinizing hormone secretion in women with polycystic ovary syndrome is unaltered by prolonged insulin infusion. J Clin Endocrinol Metab. 2003. 88:5456–5461.

29. Mehta RV, Patel KS, Coffler MS, Dahan MH, Yoo RY, Archer JS, et al. Luteinizing hormone secretion is not infl uenced by insulin infusion in women with polycystic ovary syndrome despite improved insulin sensitivity during pioglitazone treatment. J Clin Endocrinol Metab. 2005. 90:2136–2141.

30. Park HR, Oh JY, Hong YS, Sung YA, Lee H, Cheong HW. The clinical characteristics of Korean women with polycystic ovary syndrome. Korean J Med. 2007. 73:169–175.

31. Yang HI, Lee KE, Seo SK, Kim HY, Cho SH, Choi YS, et al. The influence of BMI on clinical and metabolic characteristics in patients with polycystic ovary syndrome. Korean J Gynecol Endocrinol. 2009. 1:143–152.