Evaluation of the relationship between dehydroepiandrosterone sulfate-total testosterone ratio and metabolic parameters in patients with polycystic ovary syndrome

Abstract

Objective: In this study we aimed to evaluate the correlations between dehydroepiandrosterone sulfate-total testosterone (DHEAS/TT) ratio and insulin resistance, glycemic and lipid parameters. Methods: A total of 35 patients with polycystic ovary syndrome (PCOS) and 34 healthy volunteers were included in the study. Anthropometric, clinical, biochemical, lipid and glycemic measurements were performed according to routine standards. Patients’ demographic, clinical, anthropometric, biochemical, glycemic, lipid and hormonal parameters were measured and recorded. DHEAS/TT ratio was calculated in all patients. DHEAS/TT ratio and metabolic parameters were compared between the PCOS and control groups. Results: There were significant differences between the PCOS and control groups in terms of fasting blood glucose, total cholesterol, high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), triglycerides, insulin and homeostatic model assessment-Insulin resistance (HOMA-IR) values (for all, p<0.05). Androstenedione and DHEAS/TT values were statistically significantly higher in the PCOS group. Pearson’s correlation analysis revealed no statistically significant correlation between DHEAS/TT ratio and body mass index (BMI), HOMA-IR and lipid profile. Conclusion: In PCOS patients, glycemic and lipid parameters, HOMA-IR and DHEAS levels were significantly higher compared to the control subjects. In addition, the DHEAS/TT ratio was also significantly higher at limit in the PCOS group. However, no correlations were observed between DHEAS/TT ratio, BMI, glycemic and lipid parameters, suggesting that DHEAS/TT ratio is not an appropriate method to be used in prediction of metabolic status in patients with PCOS.

Keywords

• Polycystic ovary syndrome
• lipid profile
• dehydroepiandrosterone sulfate testosterone
• insulin resistance
• body mass index

References

1. Goodarzi MO, Carmina E, Azziz R. DHEA, DHEAS and PCOS. J Steroid Biochem Mol Biol. 2015 Jan;145:213-25. doi: 10.1016/j.jsbmb.2014.06.003.
2. Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006 Mar;91(3):781-5. doi: 10.1210/jc.2005-2153.
3. Mehrabian F, Khani B, Kelishadi R, Ghanbari E. The prevalence of polycystic ovary syndrome in Iranian women based on different diagnostic criteria. Endokrynol Pol. 2011;62(3):238- 42.
4. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod. 2012 Oct;27(10):3067-73. doi: 10.1093/humrep/des232.
5. Rashidi H, Ramezani Tehrani F, Bahri Khomami M, Tohidi M, Azizi F. To what extent does the use of the Rotterdam criteria affect the prevalence of polycystic ovary syndrome? A community-based study from the Southwest of Iran. Eur J Obstet Gynecol Reprod Biol. 2014 Mar;174:100-5. doi: 10.1016/j. ejogrb.2013.12.018.
6. Christodoulaki C, Trakakis E, Pergialiotis V, Panagopoulos P, Chrelias C, Kassanos D, Sioutis D, Papantoniou N, Xirofotos D. Dehydroepiandrosterone-sulfate, insulin resistance and ovarian volume estimation in patients with polycystic ovarian syndrome. J Family Reprod Health. 2017 Mar;11(1):24-9.
7. Rosenfield RL, Ehrmann DA. The Pathogenesis of polycystic ovary syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev. 2016;37(5):467-520. doi:10.1210/er.2015-1104.
8. Yang Y, Ouyang N, Ye Y, Hu Q, Du T, Di N, Xu W, Azziz R, Yang D, Zhao X. The predictive value of total testosterone alone for clinical hyperandrogenism in polycystic ovary syndrome. Reprod Biomed Online. 2020 Oct;41(4):734-42. doi: 10.1016/j. rbmo.2020.07.013.

9. Khan SH, Rizvi SA, Shahid R, Manzoor R. Dehydroepiandrosterone sulfate (DHEAS) levels in polycystic ovarian syndrome (PCOS). J Coll Physicians Surg Pak. 2021 Mar;31(3):253-7. doi: 10.29271/jcpsp.2021.03.253.
10. Abbott DH, Zhou R, Bird IM, Dumesic DA, Conley AJ. Fetal programming of adrenal androgen excess: Lessons from a nonhuman primate model of polycystic ovary syndrome. Endocr Dev 2008;13:145-58. doi: 10.1159/000134831
11. Ersoy AO, Tokmak A, Ozler S, Oztas E, Ersoy E, Celik HT, Erdamar H, Yilmaz N. Are progranulin levels associated with polycystic ovary syndrome and its possible metabolic effects in adolescents and young women? Arch Gynecol Obstet 2016;294:403-9.
12. Lerchbaum E, Schwetz V, Giuliani A, Pieber TR, Obermayer- Pietsch B. Opposing effects of dehydroepiandrosterone sulfate and free testosterone on metabolic phenotype in women with polycystic ovary syndrome. Fertil Steril 2012;98:1318-25.
13. Köşüş N, Köşüş A, Kamalak Z, Hızlı D, Turhan NÖ. Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome. Gynecol Endocrinol. 2012 Aug;28(8):611-4. doi: 10.3109/09513590.2011.650770.
14. Güdücü N, Kutay SS, Görmüş U, Kavak ZN, Dünder İ. High DHEAS/free testosterone ratio is related to better metabolic parameters in women with PCOS. Gynecol Endocrinol. 2015 Jun;31(6):495-500. doi: 10.3109/09513590.2015.1022862.
15. The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus working group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-7.
16. Azziz R, Adashi EY. Stein and Leventhal: 80 years on. Am J Obstet Gynecol. 2016 Feb;214(2):247.e1-247.e11. doi: 10.1016/j. ajog.2015.12.013.
17. Bizoń A, Płaczkowska S, Niepsuj J, Czwojdzińska M, Leśniewski M, Nowak A, Pluta D, Madej P, Piwowar A, Franik G. Body Composition and Its Impact on the Hormonal Disturbances in Women with Polycystic Ovary Syndrome. Nutrients. 2021 Nov 24;13(12):4217. doi: 10.3390/nu13124217.
18. Neubronner SA, Indran IR, Chan YH, Thu AWP, Yong EL. Effect of body mass index (BMI) on phenotypic features of polycystic ovary syndrome (PCOS) in Singapore women: a prospective cross-sectional study. BMC Womens Health. 2021 Apr 1;21(1):135. doi: 10.1186/s12905-021-01277-6.
19. Majid H, Masood Q, Khan AH. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR): A Better Marker for Evaluating Insulin Resistance Than Fasting Insulin in Women with Polycystic Ovarian Syndrome. J Coll Physicians Surg Pak. 2017 Mar;27(3):123-6.
20. Alebić MŠ, Bulum T, Stojanović N, Duvnjak L. Definition of insulin resistance using the homeostasis model assessment (HOMA-IR) in IVF patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria. Endocrine. 2014 Nov;47(2):625-30. doi: 10.1007/s12020-014- 0182-5.
21. Swetha N, Vyshnavi R, Modagan P, Rajagopalan B. A correlative study of biochemical parameters in polycystic ovarian syndrome. Int J Biol Med Res 2013;4:3148-54.
22. Ibrahim TAE, Ali AE, Radwan ME. Lipid Profile in Women with Polycystic Ovary Syndrome. EJHM 2020;78(2):272-7.
23. Manjunatha S, Bennal AS, Hiremath S, Veena HC. Effect of PCOS on lipid profile. Sch J App Med Sci. 2014;2(3D):1153-5.