Elevated serum androstenedione is associated with a more severe phenotype in women with polycystic ovary syndrome (PCOS)

Objective: To evaluate the impact of elevated serum.4A levels on the hormonal and metabolic features of the different phenotypes of PCOS. Design: 1276 women with PCOS according to the Rotterdam criteria were included, in whom serum hormonal levels were determined. Results: In PCOS women as a whole, as well as in patients presenting clinical and/or biochemical hyperandrogenemia (phenotypes I and II), Delta(4)A levels >3.8 ng/ml were positively related to LH, LH/FSH ratio, T, DHEAS, 17 OH progesterone and FAI and negatively related to T/Delta(4)A ratio. In the milder phenotype III, a positive correlation between Delta(4)A levels > 3.8 ng/ml and T, DHEAS, 17 OH progesterone and FAI and a negative one between increased Delta(4)A and T/Delta(4)A ratio were reported. In the whole PCOS group with androstenedione > 3.8 ng/ml, an increased ovarian volume was observed, while a greater mean follicular number was found only in phenotypes I and II. Conclusions: Increased serum Delta(4)A levels, which are associated with more severe PCOS phenotypes, possibly contribute to the worsening of PCOS features and therefore could be a valuable marker of biochemical hyperandrogenemia.