Hyperandrogenism, Insulin Resistance and Hyperinsulinemia as Cardiovascular Risk Factors in Diabetes

摘要

The polycystic ovary syndrome (PCOS) and hyperandrogenism are some of the most common endocrinendisorders in women of fertile age. Insulin resistance is present in a significant proportion of hyperandrogenic patients, yetnalso, impaired ß-cell function, even in absence of clinically evident glucose intolerance, is a frequent finding, especially innpatients with familial history of type 2 diabetes mellitus.nTherefore, it is not surprising that hyperandrogenism, PCOS, and disorders of carbohydrate metabolism are associatednfrequently. This association was first reported 75 years ago and, although the mechanisms responsible are not preciselynunderstood, insulin resistance plays an important role in the development of both disorders. PCOS patients develop type 2ndiabetes mellitus more frequently than non-hyperandrogenic women and, conversely, women with type 2 diabetes have angreater risk of having PCOS compared with the normal population.nAlthough type 1 diabetes mellitus is a disease characterized by complete abolition of endogenous insulin secretion, ancertain degree of hyperinsulinism may exist, resulting from the relatively excessive insulin doses needed to maintain anstrict metabolic control. This exogenous hyperinsulinism may increase ovarian androgen secretion, and it has beennreported that there is an increased prevalence of hyperandrogenic disorders in type 1 diabetic women.nConsidering that insulin resistance, hyperinsulinemia and androgen excess may collaborate in increasing the risk for CVDnin these women, the identification of hyperandrogenic symptoms in diabetic women, and the identification of disorders ofnglucose tolerance in hyperandrogenic patients, may have important consequences for the correct management of thesenwomen.