This article is more than 5 years old. Information may no longer be current.
Greater risks for metabolic syndrome, dysglycemia present for women with hyperandrogenemia
Click Here to Manage Email Alerts
Women with hyperandrogenemia are at greater risk for metabolic syndrome, dysglycemia than women without hyperandrogenemia, and this heightened risk may be predicted by sex hormone-binding globulin levels, according to findings published in Obesity.
“Our study found that asymptomatic hyperandrogenemia is very common in women and is associated with obesity. Further, women with asymptomatic hyperandrogenemia have increased risk for adverse metabolic outcomes, such as metabolic syndrome and dysglycemia, when compared with women with normal androgen levels,” Laura C. Torchen, MD, assistant professor of pediatrics in the division of endocrinology at Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, told Endocrine Today. “This association was independent of PCOS diagnosis. Therefore, hyperandrogenemia may be a marker of metabolic risk for women, even in reproductively normal women.”
Torchen and colleagues examined data from 198 women to determine whether they had hyperandrogenemia. The researchers took measurements of blood pressure, waist circumference, weight, height, total testosterone, unbound testosterone, SHBG, dehydroepiandrosterone, anti-Müllerian hormone (AMH) and lipids, and participants also underwent a 75-g oral glucose tolerance test. Participants with testosterone levels greater than 2.08 nmol/L, unbound testosterone greater than 0.62 nmol/L or DHEA sulfate greater than 8.23 µmol/L were considered to have hyperandrogenemia. The researchers also analyzed data from 110 women with polycystic ovary syndrome (mean age, 27 years), which was confirmed by 36.4 pmol/L or more AMH.
Differences based on hyperandrogenemia status
The researchers identified hyperandrogenemia in 22% of the women (mean age, 28 years) tested for the condition and found that 68% of these women had high unbound testosterone, 43% had high total testosterone and 30% had high DHEA sulfate. In addition, a higher percentage of women with a BMI greater than 30 kg/m2 had hyperandrogenemia (31%) vs. those with a BMI of 25 kg/m2 to 30 kg/m2 (22%) and those with a BMI of less than 25 kg/m2 (12%; P = .01).
Women with hyperandrogenemia had an average total testosterone level of 1.98 nmol/L vs. 1.01 nmol/L for women without the condition (P < .0001). Women with hyperandrogenemia had higher mean levels of bioavailable testosterone (0.73 nmol/L vs. 0.28 nmol/L; P < .0001), DHEA sulfate (6.76 µmol/L vs. 3.67 µmol/L; P < .0001), AMH (44.8 pmol/L vs. 24.4 pmol/L; P = .003) and triglycerides (1.28 mmol/L vs. 0.93 mmol/L; P = .009) and lower average levels of SHBG via immunoradiometric assay (62 nmol/L vs. 93 nmol/L ; P = .02) and SHBG via Immulite (40 nmol/L vs. 60 nmol/L; P = .008) vs. women without the condition.
As for glycemic markers, women with hyperandrogenemia had higher average levels of 2-hour glucose (6.44 mmol/L vs. 5.94 mmol/L; P = .05), fasting insulin (111.1 pmol/L vs. 90.3 pmol/L; P = .05) and 2-hour insulin (576.4 pmol/L vs. 382 pmol/L; P = .002) vs. women without the condition.
Effect of SHBG and PCOS
There were also differences between the group with hyperandrogenemia and the group with PCOS (n = 110). Women in the PCOS group had an average total testosterone level of 2.81 nmol/L (P < .0001), an average bioavailable testosterone level of 0.9 nmol/L (P = .01), an average AMH level of 82.5 pmol/L (P = .0002) and an average fasting insulin level of 187.5 pmol/L (P = .0008), which the researchers noted were all greater those of the women with hyperandrogenemia. In addition, women in the PCOS group had an average DHEA sulfate level of 5.15 µmol/L, which the researchers noted was less than that of the women with hyperandrogenemia (P = .003).
According to the researchers, women with hyperandrogenemia had 2.9 times greater risk for developing metabolic syndrome (adjusted OR = 2.9; 95% CI, 1.2-6.9) and 2.7 times greater risk for developing dysglycemia than women without the condition (aOR = 2.7; 95% CI, 1.2-5.8). There was a negative association between SHBG and metabolic syndrome (P < .0001) and dysglycemia (P = .001).
“Our study suggests that androgen levels, and especially SHBG levels, could be measured clinically as a marker of metabolic risk,” Torchen said. “More research is needed to better understand the nature of this relationship and whether these hormone differences are a contributor to metabolic disease or rather a result of insulin resistance and metabolic syndrome.”
However, the researchers identified PCOS among 16 women with hyperandrogenemia and noted that there was no change in the metabolic syndrome results when looking at only women with hyperandrogenemia and no PCOS. – by Phil Neuffer
For more information:
Laura C. Torchen, MD, can be reached at LTorchen@luriechildrens.org.
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts