PCOS and Hyperinsulinemia

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PCOS and Hyperinsulinemia
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Metabolic Syndrome

• Constellation of metabolic abnormalities
• Excess weight
• High blood pressure
• Dyslipidemia
• Hyperglycemia
• Also considered
• Insulin resistance
• Inflammation
• Thrombosis
• Hyperuricemia
• Renal function

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NCEP/ATP III Criteria -Metabolic Syndrome

• (1) Abdominal obesity
• Men waist circumference gt 40 inches
• Women waist circumference gt 35 inches
• (2) Fasting glucose 110 lt 126 mg/dL
• (3) Blood pressure 130/85 mm Hg
• (4) Triglycerides 150 mg/dL
• (5) HDL-C
• Men lt 40 mg/dL
• Women lt 50 mg/dL
• Syndrome is present when three or more criteria
  are met.
• G. Reaven, Endocrinol Metab Clin N. Am 33
  (2004) 283-303

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Obesity Augmenting Risk

• Products of adipose tissue include
• Non-esterified fatty acids (NEFA) influx of NEFA
  into liver resulting in increase influx of
  apB-containing lipoproteins into circulation
• Inflammatory cytokines
• PAI-1

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Prevalence Metabolic Syndrome

• National Health and Nutrition Examination Survey
  III (NHANES III) 1988-1994
• Men Women
• 24.8 whites 22.8
• 25.7 African Americans 25.7
• 35.6 Mexican Americans 35.6
• 19.9 Other 19/9

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Insulin Resistance and Hyperinsulinemia

• Associated with PCO
• Worsens with obesity
• Increased
• Triglycerides
• Atherogenic lipid profile
• Cardiovascular disease