BACKGROUND: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterised by chronic anovulation, hyperandrogenism and polycystic ovaries on ultrasound. Patients commonly show features of the metabolic syndrome and insulin resistance. It has been shown that treatment with the insulin sensitising agent metformin can lead to improvements in symptoms in some but not all patients. The aim of the study was to assess whether sex hormone binding globulin (SHBG) (a surrogate marker of insulin resistance) could predict a positive response to metformin treatment in women with PCOS. METHODS: Medical notes of patients who presented to the gynaecology clinic at Southmead Hospital, Bristol with suspected PCOS were reviewed. Data collected included clinical symptoms and signs of hyperandrogenism, markers of PCOS in the family and obstetric history, biochemical markers and outcome of any treatment. RESULTS: A total of 66 patients were included in the study; 45 were classified as PCOS positive. In this group, patients who responded to metformin treatment had significantly lower SHBG levels compared to those who did not (median SHBG 37.5 nmol/L compared to 56.0 nmol/L) (p = 0.016, Mann-Whitney U-test). Patients with lower SHBG tended to have a better treatment outcome than those with higher values (odds ratio 0.983, 95% confidence interval 0.963-1.002, p = 0.079). CONCLUSIONS: Patients with a positive response to metformin treatment had significantly lower pre-treatment SHBG levels. For every unit increase in SHBG, the odds of a patient having a positive outcome to metformin treatment fell by a factor of 0.983.
BACKGROUND:Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterised by chronic anovulation, hyperandrogenism and polycystic ovaries on ultrasound. Patients commonly show features of the metabolic syndrome and insulin resistance. It has been shown that treatment with the insulin sensitising agent metformin can lead to improvements in symptoms in some but not all patients. The aim of the study was to assess whether sex hormone binding globulin (SHBG) (a surrogate marker of insulin resistance) could predict a positive response to metformin treatment in women with PCOS. METHODS: Medical notes of patients who presented to the gynaecology clinic at Southmead Hospital, Bristol with suspected PCOS were reviewed. Data collected included clinical symptoms and signs of hyperandrogenism, markers of PCOS in the family and obstetric history, biochemical markers and outcome of any treatment. RESULTS: A total of 66 patients were included in the study; 45 were classified as PCOS positive. In this group, patients who responded to metformin treatment had significantly lower SHBG levels compared to those who did not (median SHBG 37.5 nmol/L compared to 56.0 nmol/L) (p = 0.016, Mann-Whitney U-test). Patients with lower SHBG tended to have a better treatment outcome than those with higher values (odds ratio 0.983, 95% confidence interval 0.963-1.002, p = 0.079). CONCLUSIONS:Patients with a positive response to metformin treatment had significantly lower pre-treatment SHBG levels. For every unit increase in SHBG, the odds of a patient having a positive outcome to metformin treatment fell by a factor of 0.983.
Authors: Andrea D Coviello; Robin Haring; Melissa Wellons; Dhananjay Vaidya; Terho Lehtimäki; Sarah Keildson; Kathryn L Lunetta; Chunyan He; Myriam Fornage; Vasiliki Lagou; Massimo Mangino; N Charlotte Onland-Moret; Brian Chen; Joel Eriksson; Melissa Garcia; Yong Mei Liu; Annemarie Koster; Kurt Lohman; Leo-Pekka Lyytikäinen; Ann-Kristin Petersen; Jennifer Prescott; Lisette Stolk; Liesbeth Vandenput; Andrew R Wood; Wei Vivian Zhuang; Aimo Ruokonen; Anna-Liisa Hartikainen; Anneli Pouta; Stefania Bandinelli; Reiner Biffar; Georg Brabant; David G Cox; Yuhui Chen; Steven Cummings; Luigi Ferrucci; Marc J Gunter; Susan E Hankinson; Hannu Martikainen; Albert Hofman; Georg Homuth; Thomas Illig; John-Olov Jansson; Andrew D Johnson; David Karasik; Magnus Karlsson; Johannes Kettunen; Douglas P Kiel; Peter Kraft; Jingmin Liu; Östen Ljunggren; Mattias Lorentzon; Marcello Maggio; Marcello R P Markus; Dan Mellström; Iva Miljkovic; Daniel Mirel; Sarah Nelson; Laure Morin Papunen; Petra H M Peeters; Inga Prokopenko; Leslie Raffel; Martin Reincke; Alex P Reiner; Kathryn Rexrode; Fernando Rivadeneira; Stephen M Schwartz; David Siscovick; Nicole Soranzo; Doris Stöckl; Shelley Tworoger; André G Uitterlinden; Carla H van Gils; Ramachandran S Vasan; H-Erich Wichmann; Guangju Zhai; Shalender Bhasin; Martin Bidlingmaier; Stephen J Chanock; Immaculata De Vivo; Tamara B Harris; David J Hunter; Mika Kähönen; Simin Liu; Pamela Ouyang; Tim D Spector; Yvonne T van der Schouw; Jorma Viikari; Henri Wallaschofski; Mark I McCarthy; Timothy M Frayling; Anna Murray; Steve Franks; Marjo-Riitta Järvelin; Frank H de Jong; Olli Raitakari; Alexander Teumer; Claes Ohlsson; Joanne M Murabito; John R B Perry Journal: PLoS Genet Date: 2012-07-19 Impact factor: 5.917