Assessment of Insulin Resistance (IR) by Oral Glucose Tolerance Test (OGTT) in Adolescents with PCOS

FREIRE AV; BALLERINI MG; ARCARI AJ; BERGADÁ I; BOERO L; GRYNGARTEN MG; RUBINO C; RODRIGUEZ ME; BENGOLEA SV; ROPELATO MG

Buenos Aires

Congreso; XXVI Annual Meeting SLEP; 2016

Sociedad Latinoamericana de Endocrinología Pediátrica

Background: Prevalence rates of IR in adults PCOS womenhave been reported from 44?70%, mostly in obese patients and usingsurrogate markers of fasting insulin concentration instead ofdynamic tests. Information about the frequency of IR in adolescentcohorts measured by OGTT is limited.Objectives: To evaluate IR frequency in adolescents withPCOS by OGTT. To determine differences in androgenic and metabolicprofiles in the presence or absence of IR and obesity. Todetermine diagnostic efficiency (DE) of HOMA-IR and fastingglucose/insulin index (G/I) in comparison to OGTT to diagnoseIR.Patients and Methods: Prospective cross-sectional study.PCOS adolescents diagnosed according to AES criteria underwenta standard 75-g OGTT where glucose and insulin were measuredevery 30 min during 2 hs. At baseline, androgens (total and freetestosterone, androstenedione, SHBG), lipids (TC, HDL, LDL, tryglicerides)and high sensitive CRP (hs-CRP) were measured. IRwas defined as a peak insulin >150 μU/mL and/or 2-hour insulinlevel of >75 μU/mL. Normal cutoffs of HOMA-IR 7were obtained from 20 normal cycling adolescents. ANOVA analyseswas used to compare the results between groups. Data are expressedby mean±SEM.Results: Twenty three PCOS, chronological age (CA): 16.8 ±0.40 years with gynaecological age >2.5 years were included. IRdiagnosed by OGTT was found in 74% of patients (6/12, 50% withnormal BMI and 100% with higher BMI). PCOS were subdividedaccording to IR and BMI into 3 groups: GA: n = 6, normal BMIwithout IR; GB: n = 6, normal BMI with IR and GC: n = 11, highBMI with IR. There were no differences in CA, hirsutism, menstrualcycle abnormalities and in the grade of hyperandrogenemia.As expected, GC showed the highest proportion of abnormal valuesin lipid profiles. GC showed higher hs-CRP (2.1 ± 0.68 mg/L,p < 0.005) than GA: 0.56 ± 0.10 and GB: 0.44 ± 0.03 mg/L. HOMAIRpresented DE of 83% and G/I of 82% to diagnose IR defined byOGTT.Conclusion: High frequency of IR was observed in PCOS adolescentsincluding in 50% of patients with normal BMI. Insulinsurrogate cutoffs used could efficiently demonstrate IR. The coexistenceof IR and obesity substantially modifies metabolic and inflammatoryprofiles.