Association of insulin, resistance with hyperandrogenia in women

In humans, the skin is a target tissue for androgen action; hair growth and sebum secretion are under active androgen control. An increased production or metabolism of testosterone, the main active androgen, shows up clinical ly in dermatological symptoms such as hirsutism, hyperseborrheic acne and a lopecia. Polycystic ovary syndrome (PCOS) is the most frequent androgen dis order of ovarian function. PCOS patients have amenorrhea or severe oligomen orrhea, increased testosterone levels and most often enlarged polycystic ov aries on ultrasound examination. In addition, many PCOS patients have a ten dency to accumulate abdominal fat and/or to develop obesity. Some also disp lay ai particular metabolic pattern including an atherogenic lipid profile, glucose intolerance and an increased fasting insulin level, which is known to be closely linked with: an insulin resistant state. Several studies hav e now reported that PCOS patients show increased incidence of type 2 diabet es and cardiovascular disease. In addition to being a target for androgens the skin has abundant insulin receptors on the keratinocyte surface membran e and acanthosis nigricans is a common symptom of severe insulin resistance among patients with insulin receptor disorders. How-ever, acanthosis nigri cans could also be present in PCOS women given evidence of the intensity of their insulin resistance. This presentation will review the mutual relatio nship between hyperandrogenia and insulin resistance, with particular atten tion paid to: (1) insulin secretion and insulin sensitivity in PCOS; (2) th e complexity of the molecular mechanisms involved in insulin resistance; (3 ) the paradoxical relationship between insulin resistance and hyperandrogen ia; (4) the current genetic studies; and (5) new avenues for long-term trea tment of PCOS women. Copyright (C) 2001 S. Karger AG, Basel.