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Adipose tissue has aberrant morphology and function in PCOS: enlarged adipocytes and low serum adiponectin, but not circulating sex steroids, are strongly associated with insulin resistance.

Journal article
Authors Louise Mannerås Holm
Henrik Leonhardt
Joel Kullberg
Eva Jennische
Anders Odén
Göran Holm
Mikael Hellström
Lars Lönn
Gunilla Olivecrona
Elisabet Stener-Victorin
Malin Lönn
Published in The Journal of clinical endocrinology and metabolism
Volume 96
Issue 2
Pages E304-11
ISSN 1945-7197
Publication year 2011
Published at Institute of Neuroscience and Physiology
Institute of Neuroscience and Physiology, Department of Physiology
Department of Mathematical Sciences, Mathematical Statistics
Institute of Biomedicine, Department of Clinical Chemistry and Transfusion Medicine
Institute of Medicine, Department of Emergeny and Cardiovascular Medicine
Institute of Clinical Sciences, Department of Radiology
Institute of Biomedicine, Department of Medical Biochemistry and Cell Biology
Pages E304-11
Language en
Keywords Adipocytes, pathology, Adiponectin, blood, Adipose Tissue, pathology, Adult, Amyloid, blood, Body Height, physiology, Body Mass Index, Body Weight, physiology, Cell Size, Female, Glycerol, blood, Gonadal Steroid Hormones, blood, Humans, Immunohistochemistry, Insulin Resistance, physiology, Lipoprotein Lipase, metabolism, Macrophages, pathology, Polycystic Ovary Syndrome, pathology, Sex Hormone-Binding Globulin, metabolism, Waist Circumference, Waist-Hip Ratio
Subject categories Endocrinology


Context: Comprehensive characterization of the adipose tissue in women with polycystic ovary syndrome (PCOS), over a wide range of body mass indices (BMIs), is lacking. Mechanisms behind insulin resistance in PCOS are unclear. Objective: To characterize the adipose tissue of women with PCOS and controls matched pair-wise for age and BMI, and to identify factors, among adipose tissue characteristics and serum sex steroids, that are associated with insulin sensitivity in PCOS. Design/Outcome Measures: Seventy-four PCOS women and 31 controls were included. BMI was 18-47 (PCOS) and 19-41 kg/m2 (controls). Anthropometric variables, volumes of subcutaneous/visceral adipose tissue (magnetic resonance imaging; MRI), and insulin sensitivity (clamp) were investigated. Adipose tissue biopsies were obtained to determine adipocyte size, lipoprotein lipase (LPL) activity, and macrophage density. Circulating testosterone, free testosterone, free 17β-estradiol, SHBG, glycerol, adiponectin, and serum amyloid A were measured/calculated. Results: Comparison of 31 pairs revealed lower insulin sensitivity, hyperandrogenemia, and higher free 17β-estradiol in PCOS. Abdominal adipose tissue volumes/distribution did not differ in the groups, but PCOS women had higher waist-to-hip ratio, enlarged adipocytes, reduced adiponectin, and lower LPL activity. In regression analysis, adipocyte size, adiponectin, and waist circumference were the factors most strongly associated with insulin sensitivity in PCOS (R2=0.681, P < 0.001). Conclusions: In PCOS, adipose tissue has aberrant morphology/function. Increased waist-to-hip ratio indicates abdominal/visceral fat accumulation, but this is not supported by MRI. Enlarged adipocytes and reduced serum adiponectin, together with a large waistline, rather than androgen excess, may be central factors in the pathogenesis/maintenance of insulin resistance in PCOS.

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