Androgen excess contributes to altered growth hormone/insulin-like growth factor-1 axis in nonobese women with polycystic ovary syndrome

Objective: To investigate the relationship between ovarian androgen excess and impaired growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis in nonobese women with polycystic ovary syndrome (PCOS). Design: A prospective, controlled clinical study. Setting: Reproductive Endocrine Unit, Department of Obstetrics and Gynecolo gy, Jinling Hospital, Nanjing University School of Clinical Medicine. Patient(s): Six patients with PCOS with both clomiphene resistance and gona dotropin hyperreponsiveness and six controls with regular cycles, matched f ur age and body mass index (BMI). Intervention(s): Bilateral ovarian wedge resection (OWR) was performed to i nduce ovulation surgically for these refractory women with PCOS. A GH stimu lation test with oral L-dopa was arranged for controls and for patients wit h PCOS before and again 6 months later after OWR. Main Outcome Measure(s): Plasma CII, IGF-1, FSH, LII, testosterone, androst enedione, estradiol, progesterone, prolactin, insulin, and glucose. Result(s): Basal levels and areas under the response curve of GH and GH-IGF -1 ratio to L-dopa were significantly lower in patients with PCOS before su rgery than those of controls. The OWR in patients with PCOS obviously reduc ed their androstenedione and testosterone levels and insulin-glucose ratios , and increased the GH and GH-IGF-1 responses to L-dopa. Conclusion(s): Impaired somatotrophic axis caused by a defect in central do paminergic activity may be responsible for seven anovulation in these women with PCOS, which could be reversed by removing excessive androgens with OW R.