Dr. Cobin explains if a woman who is diagnosed with polycystic ovarian syndrome (PCOS) should be evaluated for insulin resistance.
If a woman has suggestive signs or symptoms that she might have polycystic ovary syndrome, whether that be signs on her skin: acanthosis, acne, hirsutism, hair loss. She has menstrual irregularity, and we have shown that it isn’t due to some of these other disorders if she is having difficulty with fertility.
If she has a family history of polycystic ovary syndrome or type 2 diabetes, hypertension, heart attack, or stroke, in any one of those situations it is not only advisable, we believe it is mandatory to look for the components of the insulin resistance syndrome because it occurs in a very high percentage of these women.
So how do we look for insulin resistance syndrome? Again, there isn’t one single marker. Reduced sensitivity to insulin can be shown by abnormalities of glucose, blood sugar, can be shown by blood pressure. Some people believe that a part of the insulin resistance syndrome is measuring the waist circumference or the Body Mass Index which is the height and weight put it into an equation, looking for high blood pressure, looking for abnormalities in lipids and looking for abnormalities and in some other markers or cardiovascular risk that occur frequently in this syndrome.
One of the tightest correlations between insulin resistance syndrome and something that you can measure easily in the blood is measuring the triglycerides which are a form of fat that circulates in the blood and actually, the high density lipoprotein, not the low density, which we think of as a cardiac risk and should be measured, but a low HDL cholesterol combined with high triglyceride is a very strong marker of insulin resistance syndrome and correlates better with some of the complicated scientific tests that have to be done to prove insulin resistance.
Whether you should measure insulin itself is a matter of discussion at this moment. Measures of insulin are difficult in laboratories out in the world, not in research laboratories, and may not correlate as well with resistance to insulin as some of the other markers that I just told you about.
About Dr. Cobin, M.D., M.A.C.E.:
Dr. Rhoda Cobin is Past-President of the American College of Endocrinology, a Past-President of the American Association of Clinical Endocrinologists (AACE), and a Master of the American College of Endocrinology (ACE). Dr. Cobin has been in private practice in northern New Jersey for 31 years. She is a Clinical Professor of Medicine at Mount Sinai School of Medicine in New York City and is Co-Chief of the Mount Sinai's Thyroid/Endocrinology Clinic.