In polycystic ovary syndrome, adrenal steroids are regulated differently in the morning versus in response to nutrient intake

ObjectiveTo investigate adrenal steroid regulation in polycystic ovary syndrome.DesignFive-hour oral glucose tolerance test (OGTT) and frequently sampled-intravenous gluclose tolerance test.SettingUniversity research center.Patient(s)Thirty patients.Intervention(s)None.Main Outcome Measure(s)Anthropometrics, leptin, cortisol, DHEAS, glucose, insulin.Result(s)Morning cortisol correlated with sensitivity index (SI, r = .540), DHEAS correlated inversely with age (r = −.6359), body mass index (BMI, r = −.6199), fat mass (r = −0.630), and leptin (r = −0.5676). Between the second and fourth hour of OGTT, cortisol changes (Δ) exhibited three patterns: I, responders (n = 9, Δ: 10.7 ± 1.0 μg/dL); II, nonresponders (n = 10, Δ: −3.5 ± 0.6 μg/dL); III, intermediates (n = 11, Δ: 4.3 ± 1.0 μg/dL). Compared with nonresponders, responders were more obese (BMI: 37.0 ± 1.6 vs. 31.7 ± 1.8 kg/m2); had higher leptin (28.9 ± 1.7 vs. 24.1 ± 1.1 ng/mL), and lower DHEAS (133 ± 12 vs. 236 ± 32 ng/mL), higher glucose at 1 h of OGTT (195 ± 13 vs. 131 ± 12 mg/dL), higher area under the curve (AUC)Glucose (332 ± 20 vs. 265 ± 17 mg/dL), higher AUCInsulin (244 ± 50 vs. 125 ± 30 μU/mL), and lower nadir glucose (61 ± 2 vs. 70 ± 2 mg/dL).Conclusion(s)Obesity and insulin resistance are associated with lower morning cortisol and DHEAS but increased cortisol and DHEA responses after glucose ingestion. Morning steroid levels may not reflect the day-long exposure.