ORIGINAL ARTICLE Biochemical hyperandrogenism is associated with metabolic syndrome independently of adiposity and insulin resistance in Romanian polycystic ovary syndrome patients Alice Albu • Serban Radian • Simona Fica • Carmen Gabriela Barbu Received: 23 December 2013 / Accepted: 12 June 2014 Ó Springer Science+Business Media New York 2014 Abstract The aim of the study was to determine whether Romanian polycystic ovary syndrome (PCOS) patients have an increased prevalence of metabolic syndrome (MetS) and to study the involvement of adiposity, insulin resistance and hyperandrogenism in the pathogenesis of MetS in PCOS. A total of 398 PCOS patients and 126 controls were evaluated between January 2006 and December 2012. MetS was defined by National Cholesterol Education Program, Adult Treatment Panel III criteria. Principal component analysis (PCA) was used to analyze the correlations among variables of interest by grouping them in few components, and principal component (PCs) scores were saved and used as independent variables in logistic regression. The prevalence of MetS was higher among patients with PCOS (20.4 %) than in controls (11.1 %, p \ 0.05). In PCOS patients, PCA extracted three PCs from the analyzed variables. First PC aggregated variables related to adiposity and insulin resistance, with factor loadings showing strong relationship between these parameters. The second PC included markers of hyperan- drogenemia and was best represented by free androgen index (FAI) which correlated strongly and exclusively with this PC. The third component was best represented by hirsutism. Logistic regression analysis revealed that in PCOS patients, the first and the second PCs were inde- pendently associated with MetS, whereas the third com- ponent was not. Romanian PCOS patients have an increased risk for MetS; adiposity, insulin resistance and hyperandrogenemia, but not hirsutism, are independent predictors of MetS presence. Our data also suggest that insulin resistance is only secondary to increased adiposity and FAI is a good marker of biochemical hyperandroge- nism with little influences from the metabolic component. Keywords Polycystic ovary syndrome Á Insulin resistance Á Hyperinsulinemia Á Hyperandrogenemia Á Metabolic syndrome Introduction More than 75 years have passed from the first description by Stein and Leventhal of the disease known today as polycystic ovary syndrome (PCOS) [1]. Although at the beginning PCOS was considered mainly a reproductive disorder, studies of the last two decades showed that PCOS also implies a predisposition to metabolic complications and an association with cardiovascular and metabolic risk factors [2, 3]. Metabolic syndrome (MetS) is among the most studied cardio-metabolic risk factors in PCOS patients, and a recent meta-analysis reported an increased risk for MetS of PCOS patients [3]. Nevertheless, not all studies of PCOS patients found an association with MetS [4]. This could be due to heterogeneity of the study pop- ulations with regard to various confounding factors such as age, adiposity and ethnicity. For example, the prevalence of obesity ranges from 25.9 % in Italian PCOS patients [5] to 61 and 76 %, respectively, in the USA [6] and Australia A. Albu Á S. Radian Á S. Fica Á C. G. Barbu ‘‘Carol Davila’’ University of Medicine and Pharmacy, Dionisie Lupu Street 37, Bucharest, Romania A. Albu Á S. Fica (&) Á C. G. Barbu Endocrinology and Diabetes Department, Elias University Hospital, Marasti Street 17, Bucharest, Romania e-mail: simonafica@yahoo.com S. Radian ‘‘CI Parhon’’ National Institute of Endocrinology, Aviatorilor Blvd 34-36, Bucharest, Romania 123 Endocrine DOI 10.1007/s12020-014-0340-9