Tetrad of Hormonal and Biochemical Manifestations in Phenotypes of Polycystic Ovary Syndrome

Abstract

A prospective observational case- control study was conducted to evaluate the relationship and prevalence of subclinical hypothyroidism, hyperprolactenemia, impaired glucose metabolism and hyperhomocysteinemia as components of hormonal/biochemical manifestation tetrad amongst four phenotypes of polycystic ovary syndrome (PCOS) with respect to controls. 200 women diagnosed as PCOS as per the ESHRE/ASRM Rotterdam criteria were taken as cases (group I) and 200 as controls (group II).All women recruited came for subfertility treatment to assure homogeneity in study population. Group I was further divided into four phenotypes. Records of demographic (age, BMI, duration of infertility), biochemical(homocysteine,fasting blood sugar,HBA1C)and hormonal (thyroid profile and prolactin)parameters of patients were taken. Both groups were comparable in age, ethnicity and marital status. Percentages of phenotypes A, B, C and D in our Indian population were 25.5%,16%,35.5% and 23 % respectively. BMI was significantly more in PCOS as compared to non-PCOS with highest mean in phenotype B subgroup. All parameters measured were significantly increased in PCOS group compared with non-PCOS group with prolactin levels similar in all phenotypes. Impaired glucose tolerance and diabetes incidence was more in phenotype C and D. Hypothyroidism and hyperhomocystenemia were higher in phenotypes B and C. Phenotypes are affected by hormonal and biochemical manifestations and if followed for long term may be associated with metabolic syndrome in future. Thus non classical phenotypes should also be properly monitored and treated as this hormonal imbalance and biochemical derangements add to the brunt of management of PCOS.