Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective
Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective
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多囊卵巢综合征女性高雄激素血症的定义：一个具有挑战性的观点
DOI：
10.1210/jc.2015-4009
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发表时间：
2016-05-01
影响因子：
5.8
通讯作者：
Gambineri, Alessandra
中科院分区：
文献类型：
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作者：
Pasquali, Renato;Zanotti, Laura;Gambineri, Alessandra
目的：本研究旨在应用高效液相色谱-串联质谱仪对不同表型的多囊卵巢综合征患者进行类固醇分析。设计：横断面研究。研究地点：意大利博洛尼亚大学医院。患者和方法：共调查156名多囊卵巢综合征患者和141名年龄相当的对照。所有患者均接受了用液相色谱与串联质谱仪联用的类固醇分析。结果：根据多毛症(MF-G>；=8)和/或高睾酮(T)(HA)、少闭经(OA)和多囊卵巢形态(PCOM)的组合，初步定义了三种不同的表型：OA+PCOM(n=43)、HA+OA+PCOM(n=65)和HA+OA+PCOM(n=45)。与对照组相比，T、雄烯二酮(A)和游离雄激素指数(FAI)在3种PCOS表型中逐渐升高，其中HA+OA+PCOM表型的水平最高。多毛症、高T、高A和高FAI的不同组合使我们可以将这3个原始表型分为8个高雄激素型亚组，其特征是不同的附加类固醇和代谢模式。因此，总共90%的多囊卵巢综合征患者被证明是高雄激素性。有趣的是，最初被归类为具有OA-PCOM表型的多囊卵巢综合征妇女中，有一半被归类为高雄激素亚组。T、A和MF-G评分之间没有明显的相关性。相反，A与T和FAI之间存在显著的相关性。结论：本研究提供的证据表明，尽管存在临床和生化异质性，但通过在高雄激素血症的定义中包括类固醇，大多数患有PCOS的妇女都是高雄激素血症。此外，这些数据表明，多毛症和高雄激素水平不能被无关紧要地用来定义高雄激素血症。
Objective:This study was designed to assessthesteroid profiling by liquid chromatography coupled with tandem mass spectrometry in PCOS women with different phenotypes.Design: Cross-sectional study.Setting: University hospital of Bologna, Italy.Patients and Methods: A total of 156 PCOS women and 141 controls comparable for age were investigated. All underwent a steroid profiling by liquid chromatography coupled with tandem mass spectrometry. Metabolic parameters were also investigated and hirsutism was measured by the modified Ferriman-Gallwey (mF-G) score.Results:Three distinct phenotypes were initially defined according to the combination of hirsutism (mF-G >= 8) and/or high testosterone (T) (HA), oligo-amenorrhea (OA), and polycystic ovarian morphology (PCOm); OA + PCOm (n = 43), HA + OA (n = 65), and HA + OA + PCOm (n = 45). T, androstenedione (A), and free androgen index (FAI) levels progressively increased in the 3 PCOS phenotypes with respect to the controls, with the highest values in the HA + OA + PCOm phenotype. The various combinations of hirsutism, high T, high A, and high FAI made it possible to categorize the 3 original phenotypes into 8 hyperandrogenic subgroups, characterized by divergent additional steroid profile and metabolic pattern. A total of 90% of patients with PCOS thus proved hyperandrogenic. Interestingly, half the PCOS women originally classified as having the OA-PCOm phenotype were categorized in a hyperandrogenic subgroup. No significant correlation was found between T, A, and the mF-G score. In contrast, significant correlation was found between A and both T and FAI.Conclusions: This study provides evidence that, by including a steroid profile in the definition of hyperandrogenemia, the majority of women with PCOS are hyperandrogenic, although a clinical and biochemical heterogeneity exists. In addition, these data demonstrate that hirsutism and high androgen levels cannot be used indifferently to define hyperandrogenism.