Serum androgen changes during meal-induced hyperinsulinemia and after acute sequential blockade and hyperstimulation of insulin release in women with polycystic ovary syndrome.

To investigate if acute changes in endogenous insulin release are associated with similar changes in serum androgen, 13 healthy ovulatory women (group 1) and six women with polycystic ovary syndrome (PCOS) and hyperinsulinemia, three with acanthosis nigricans (group 2) were studied. On day 1 all women ingested a 725 kilocalories breakfast between 7:30 and 8:00 A.M. The next day (day 2) only PCOS women had the breakfast and a simultaneous 90-min intravenous infusion of epinephrine (E, 6 micrograms/min) and propranolol (P, 80 micrograms/min). On both days serum glucose, insulin, cortisol, 17 alpha hydroxyprogesterone (17 OHP), dehydroepiandrosterone sulfate (DHEAS), free testosterone (free T), and androstenedione (A) were determined every 30 min for a period of 3 h. In group 1, glucose, insulin, free T, and DHEAS simultaneously rose (p < or = 0.026) while cortisol and 17 OHP fell (p < or = 0.020). Group 2 on day 1 had fasting and meal-stimulated hyperinsulinemia but all serum steroids progressively decreased. In only one woman free T rose. On day 2 during the E + P infusion, glucose increased yet fasting insulin remained constant and serum steroids decreased again. During the 90 min post-infusion, insulin sharply increased but no acute elevation in any steroid occurred. In conclusion, in PCOS women no parallel changes in serum androgen concentrations were seen in association with acute truly physiologic endogenous hyperinsulinemia or during the acute pharmacologically induced hypoinsulinemia and subsequent hyperinsulinemia.