شیوع اختلال تحمل گلـوکـز و دیابت نوع 2 در خانم های مبتلا به سندرم تخمدان پلی‌کیستیک و لزوم غربالگری کلیه خانم های با PCOS برای اختلال تحمل گلوکز

Background: Polycystic ovary syndrome (PCOS) which is characterized by menstrual irregularities (due to chronic anovulation) and hyperandrogenism is one of the most common endocrine disorders of women at reproductive age. The precise cause of PCOS is unknown, but it seems that several factors may have role in its pathogenesis. Insulin resistance and impaired insulin secretion are common findings in PCOS patients. Approximately 30 – 40 % of women with PCOS have impaired glucose tolerance or type 2 DM. According to my knowledge, there is no published study about prevalence of IGT and type 2 Diabetes Mellitus (type 2 DM) in Iranian women with PCOS. The aim of this prospective, controlled study was to determine the prevalence of abnormal glucose metabolism in women from north west part of the country. Methods: 302 PCOS women and 116 normal women as a control group were prospectively studied. The diagnosis of PCOS was made based upon the presence of chronic anovulation and hyperandrogenemia. Other causes of hyperandrogenism were excluded by appropriate clinical and laboratory evaluations. None of the patients were known diabetics prior to study. In all patients with PCOS and control women appropriate medical history was taken and physical examination was done. Blood pressure, body weight, height, BMI, waist / hip ratio, score of hirsutism and other signs of androgen excess were determined. Serum concentrations of total testosterone and DHEA–S were measured by RIA methods in both patients and control group. Standard Oral Glucose Tolerance Test (OGTT) with 75 grams oral glucose was performed between 8 -9 AM after an overnight fast of 10 – 12 hours. Fasting and 2 – hour post - glucose plasma sugars were measured by glucose oxidase method. Results: Results of OGTT were interpreted according to WHO criteria. Mean age and mean BMI were similar in both patients and controls. Serum levels of total testosterone and DHEA – S were significantly higher in PCOS women in comparison with controls. 65% of patients and 68% of controls had BMI of ≥ 25 kg / m2. 55% of PCOS women and 51.6% of control women were obese (BMI ≥ 27kg/m2). 96 (31.7%) of PCOS women had impaired glucose tolerance (IGT) and 27 (8.9%) were diabetics. The prevalence of IGT and diabetes in controls were 14.6% and 5.1% respectively. In non-obese PCOS women the prevalence of IGT and DM were 17.2% and 3.6% respectively, while only 8.9% of control women had IGT and 1.7% were diabetics. Finally, 44.1% of obese PCOS women were glucose intolerant and 13.5% had diabetes mellitus in comparison with 20% and 10% of controls. Conclusion: It is concluded that the prevalence of IGT and DM in both obese and non–obese PCOS women were significantly higher than in control women. Screening of all PCOS women for IGT and DM is highly recommended.