Improvement of hyperandrogenism and insulin resistance in females with severe obesity after weight loss through bariatric surgery
M Monteiro1, H Cardoso1, G Vargas1, F Pichel1, IA Pereira1, A Sergio2, MJ Santos3, F Bravo3, C Santos3 & H Ramos1
The association of hyperandrogenism and insulin resistance is common in several syndromes. The proposed mechanism is the stimulation of ovarian theca cells by insulin to produce testosterone. Weight loss, improves insulin resistance, reduces insulin levels and consequently decreases circulating androgens.
Material and methods:
Ten female subjects with severe obesity and hyperandrogenism were evaluated before and after weight loss attained by bariatric surgery. All had functional ovarian hyperandrogenism and three complained of infertility. In all patients other causes of hyperandrogenism were excluded. Their mean age was 30.82 years old (22-46). Before surgery their mean weight and BMI were, 149.3 kg (91-239) and IMC 44.9 kg/m2 (41-77), respectively. Mean serum levels of testosterone, insulin and C-Peptide were: 5.71 ng/dl, 18.45 uU/ml and 4.10 ng/ml, respectively. The degree of insulin resistance assessed by HOMA-RI was 3.78. They were submitted to bariatric surgery (Swedish Adjustable Gastric Band) by laparoscopy for treatment of their obesity.
After surgery, with a mean follow-up of 19.2 months (9-36), weight and BMI reduced significantly (p < 0.001) to 100.1 kg (61-167) and 40.9 kg/m2 (26-63), respectively.
There was regression of hyperandrogenism signs, restoration of regular menstrual cycles and restoration of fertility in all the cases previously infertile.
Serum levels of testosterone, insulin and C-peptide decreased, significantly (p<0.05), to 0.68 ng/dl, 9.42 uU/ml and 2.27 ng/ml, respectively. As did the degree of insulin resistance assessed by HOMA-IR 1.97. Insulin resistance and testosterone levels correlated positively(r = 0.51, p= 0.0006).
Sustained weight loss in severe obesity attained by bariatric surgery, reversed signs of hyperandrogenism, and decreased significantly testosterone levels and the degree of insulin resistance.