The Androgenic Profile of Women with Type I and Type II Diabetes Mellitus Devrim ERTUNÇ 1 , Ekrem C. TOK 2 , Özlem PATA 2 , Umut DİLEK 2 , Mustafa KAPLANOĞLU 2 , Saffet DİLEK 3 Mersin-Turkey OBJECTIVE: Some evidence suggests that the diabetic patients share some of the features of women with polycystic ovary syndrome. To address this issue, we attempted to evaluate the androgenic profile of women with type I and type II diabetes mellitus. STUDY DESIGN: We evaluated the clinical, hormonal and ultrasonographic variables in women with type I and type II diabetes mellitus at reproductive age, and compared with age- and weight matched controls. The prevalence of polycystic ovary syndrome, hirsutismus, acne and temporal balding were investigated. Serum levels of total testosterone, estradiol, DHEAS, androstenedione, SHBG, LH and FSH were evaluated. Ovarian appearance and volume were assessed by transvaginal or transabdominal ultrasonography. RESULTS: The prevalence of polycystic ovary syndrome was found higher in diabetic patients than the prevalence in general population that reported earlier. Hirsutismus was also more prevalent in diabetic patients (p<0,05). The levels of FSH, LH, estradiol, total testosterone and androstenedione were significantly higher in diabetic patients than in control group (p<0,05), but, they did not differ among diabetes mellitus subtype. The levels of DHEAS and SHBG were comparable among the study groups. Although the rates of ultrasonographically polycystic ovary appearance and ovarian volumes were higher than in control group, the difference did not reach statistical significance (p>0,05). CONCLUSION: The results of this study suggest that women with diabetes mellitus have biochemical and clinical hyperandrogenism when compared with non-diabetic controls. To confirm this issue, large population-based studies with both types of diabetes mellitus should be performed. (Gynecol Obstet Reprod Med 2004; 10:109-113) Key Words: Polycystic ovary syndrome, Diabetes mellitus, Androgenic profile Polycystic ovary syndrome (PCOS) is a common endoc- rine disorder associated with anovulation and subfertility in women. 1,2 It is also characterized by hyperandrogenemia, i.e., elevated serum levels of testosterone and of the adrenal androgens dehydroepiandrosterone (DHEA) and its sulpha- ted derivative DHEAS. This hyperandrogenism manifests itself clinically as hirsutismus and menstrual irregularity. PCOS is well recognized to be associated with insulin resis- tance and hyperinsulinemia. 3 Consequently; women with this disorder are at increased risk of developing type II dia- betes mellitus (DM), hypertension and dyslipidemia. 4,5 Women with PCOS appear to share some of the features as women with type II DM. A large number of obese PCOS patients and a significant number of lean ones have periphe- ric insulin resistance. 6,7 Insulin resistance is characterized by an increased circulating insulin concentration, a condition known as compensatory hyperinsulinism. Insulin has been demonstrated to have stimulatory effects on ovarian and ad- renal androgens, both in vitro and in vivo. 8,9 When insulin sensitivity is assessed by the euglycemic hyperinsulinemic clamp technique, women with PCOS have profound periphe- ral insulin resistance of a magnitude similar to that seen in individuals with type II diabetes. 10,11 Similarly, there is also evidence that women with polycystic ovaries only, without clinical symptoms of PCOS, may be prone to develop vari- ous features of the insulin resistance syndrome. 12 The pati- ents with type II DM have peripheric insulin resistance. Compensatory hyperinsulinism ensues to overcome this re- sistance. The patients with type I DM have also higher circu- lating insulin concentrations, but, the mechanism is some- what different. As known, the problem in type I DM is the i- nability of pancreatic B-cells to secrete insulin. However, the patients are frequently treated with supraphysiologic do- ses of insulin to maintain acceptable glucose levels. Hence, both patients are in a hyperinsulinemic state. Only a few studies 13-15 have examined the association of PCOS with diabetes from the opposite perspective: how does diabetes mellitus of any type, affects the androgen le- vels and the prevalence of PCOS in premenopausal women? Furthermore, these studies searched only the patients with type I DM or only with type II DM. For this reason, we at- tempted to conduct a study about the androgen levels and the prevalence of PCOS in women with both type I and II DM at reproductive age. 1 Mustafa Kemal University Faculty of Medicine, Department of Obstetrics and Gynecology, Hatay, 2 Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, 3 Zekai Tahir Burak Maternity Hospital, Ankara-Turkey Address of Correspondence Ekrem Tok Mersin Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum ABD Mersin-Turkey Submitted for Publication: 05.11.2003 Accepted for Publication: 27.12.2003