interseting article with average/obese, PCOS/Non-Pcos

Amby1 · 10-28-2009, 07:35 PM

I can't get the whole article to cut and paste. Dr's did comparison of normal weight women with pcos, without PCOS, obese women with PCOS and with out PCOS. http://jcem.endojournals.org/cgi/con...l/93/9/3365/F3
http://jcem.endojournals.org/cgi/content/full/93/9/3365

Obese PCOS women were more resistant than obese controls (P = 0.02). In contrast, normal-weight women with PCOS had similar insulin sensitivity, compared with normal-weight women without PCOS. Baseline responses to ACh showed no difference in the four groups. ACh responses during insulin infusion were significantly greater in normal-weight PCOS and controls than in obese PCOS and controls. PCOS per se had no significant influence on ACh responses during insulin infusion. During hyperinsulinemia, SNP-dependent vasodilatation did not significantly increase, compared with base

Polycystic ovary syndrome (PCOS) and obesity are associated with diabetes and cardiovascular disease, but it is unclear to what extent PCOS contributes independently of obesity. Objective: The objective of the study was to investigate whether insulin sensitivity and insulin’s effects on the microcirculation are impaired in normal-weight and obese women with PCOS.
Design and Population: Thirty-five women with PCOS (19 normal weight and 16 obese) and 27 age- and body mass index-matched controls (14 normal weight and 13 obese) were included. Metabolic Insulin sensitivity (isoglycemic-hyperinsulinemic clamp) and microvascular insulin sensitivity [endothelium dependent (acetylcholine [ACh])] and endothelium-independent [sodium nitroprusside (SNP)] vasodilation with laser Doppler flowmetry was assessed at baseline and during hyperinsulinemia.
Main Outcome Measures: Metabolic insulin sensitivity (M/I value) and the area under the response curves to ACh and SNP curves were measured to assess microcirculatory function at baseline and during insulin infusion (microvascular insulin sensitivity).
Results: Obese women were more insulin resistant than normal-weight women (P < 0.001), and obese PCOS women were more resistant than obese controls (P = 0.02). In contrast, normal-weight women with PCOS had similar insulin sensitivity, compared with normal-weight women without PCOS. Baseline responses to ACh showed no difference in the four groups. ACh responses during insulin infusion were significantly greater in normal-weight PCOS and controls than in obese PCOS and controls. PCOS per se had no significant influence on ACh responses during insulin infusion. During hyperinsulinemia, SNP-dependent vasodilatation did not significantly increase, compared with baseline in the four groups.
Conclusion: PCOS per se was not associated with impaired metabolic insulin sensitivity in normal-weight women but aggravates impairment of metabolic insulin sensitivity in obese women. In obese but not normal-weight women, microvascular and metabolic insulin sensitivity are decreased, independent of PCOS. Therefore, obese PCOS women in particular may be at increased risk of metabo
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Pink Nails · 10-29-2009, 03:45 PM

So thin women are not IR? It's something else causing the hormone imbalance?

Amby1 · 10-29-2009, 10:28 PM

Made me wonder too. Does anyone skinny have RI with PCOS? Is it to much male hormone?

Thermophile · 10-30-2009, 01:46 AM

I don't understand the endocrinology very well-why did they measure microvascular response?? However the statistics are not very convincing. The sample size is so small that it would have to be a huge difference between pcos vs normal for anything to be significant. They talk about another study with bigger sample size that found lean pcos were not significantly more IR but did exhibit hyperinsulimia. Again I don't understand the distinction that makes it possible to be hyperinsulimic but not insulin resistant. I think it may be that lean pcos have less pronounced IR but we're still likely to produce more insulin than we should which seems like will eventually lead to IR

here's the other paper
jcem.endojournals.org/cgi/content/abstract/89/6/2942?ijkey=9d23fb5d4548ef564e7bd22ac4e5170b0916d8a e&keytype2=tf_ipsecsha

entrepreneur513 · 10-30-2009, 11:02 AM

thanks for the article, it was an interesting read...

Pink Nails · 10-30-2009, 01:10 PM

Yes that is how I understood it too, more sensitive to the insulin. I think amby1 has a point and some of the laymans reasearch I have done seems to suggest this possibility as well.

This is the avenue where I am looking for answers for myself. I think in my case (this is purely my own hypothesis) the adrenal excess caused the pcos. However it did it I am not certin, maybe by making me more sensitive to insulin. What caused the adrenal excess I am not sure but I think stress played a very important part. Maybe combined with an inherited tendency towards adrenal excess (making me athletic) plus major life stressors at important markers in my life like puberty the whole thing dominoed and got out of contol. The American diet and daily dose of products fragrances ect I think adds another stressor to the body.

Ok so anyway this is all very amature musing but the research isn't real conclusive and pcos seems to be a very common problem but I think there is a definite difference between obese pcos and thin pocs.

Pink Nails · 10-30-2009, 01:30 PM

http://humrep.oxfordjournals.org/cgi...tract/8/8/1179

It says some us have a "deranged regulation of androgen secretion"

Thermophile · 10-30-2009, 02:14 PM

Ha deranged adrenals

since I've been diagnosed I'm really sad that I slept and slacked my way through the one physiology class I took in undergrad. Oh well. My little bro is in med school, I asked him to find the difference between hyperinsulimia and IR. I can explain the stats to him if he can explain the hormone stuff to me

pink nails how were you dignosed with adrenal source hormone excess? (sorry if that's not exactly how you explained it, I'm typing on my phone a can't see your post). I've looked at some of the info for late onset hyper adrenal whatever it's called. However I don't have any of the physical manifestations. I did have a u/s earlier this week and my adrenals weren't visable which the tech said was normal. I had some follow up bloodwork last week too, one was a version of testerone that has an adrenal source (I think). But won't see my dr for another 2 weeks to get the results of those tests.

Pink Nails · 11-02-2009, 01:40 PM

Hi Thermophile - My DHEA is high and that comes from the adrenals. I was diagnosed by that a long time ago. DHEA is a mild androgen, a precursor to androgens like it builds estrogen and testosterone. It has a sulfate version which is high in me too. Now I have some cycts on my ovaries 10 on one - that was never looked at before.

Thermophile · 11-03-2009, 01:28 PM

Alright I talked to little bro (med student) and he sent me copies of the uptodate service topics related to pcos or insulin resistance. It seems that the issue of high insulin but not resistant is mostly to do to the difficulty assessing IR. He also sent me something talking about pcos with normal insulin sensitivity in muscle tissues but hypersensitive ovaries. So even though most of the body reacts to insulin normally, increasing sensitivity is still desirable leads to a decrease in insulin (possibly below normal) improves the pcos symptoms by decreasing the insulin the ovaries are exposed to.

Pink Nails · 11-04-2009, 04:48 PM

OK thanks for the feedback. Had to read it twice but that makes sense. That must be why metformin works in some thin pcos women. I wonder if there is an easy way to see where the excess insulin is being secreted?

If it was in the muscles then it makes sense how regular exercise is so important if in the ovaries maybe it is the cycts themselves that cause it. How to get rid of those cycts? I hear that ovarian drilling works but only for about 6 months then they come back.

Thermophile · 11-05-2009, 12:46 AM

Whew sorry sometimes I don't write in actual English or anything that resembles a sentince. Anyway, the two studies that talked about different levels of insulin sensitivity in muscle vs ovaries were done in cell cultures (pmid 8530637) and homogenized ovary tissue (pmid 6382082). So not anything that can be assessed in us, I'm still a little too attached to my ovaries to cut them out and homogenize

. I didn't read the original papers because they're too far out of my knowledge area for me to get much out of them but you can google the pmids if you want them. This has convinced me to give met a try -to see if lowering my insulin levels will regulate my hormones.

I don't know very much about ovarian drilling, I'm hoping met or something else will be successful in regulating my hormones so I ovulate and stop getting stalled at the small follicule/cyst stage.