Relationship Between Insulin Resistance and Adrenal Steroids Pattern in Women During Menopausal Transition

Abstract

Recognition of rise of adrenal androgens experienced by majority of women during Menopause transition (MT) can explain diversity of female phenotypes at postmenopausal ages. Adrenal androgens may mitigate imminent future fallouts of estradiol decline. Perhaps pattern of adrenal androgens predetermines alterations in female organism after menopause including growing insulin resistance in some of them. Objectives. Our study made an attempt to collate insulin resistance index (HOMA--IR) with status of adrenal steroids in women during MT. Methods. Cross-sectional associations were examined between body mass index (BMI), hip- waist ratio (HWR), HOMA-IR and Serum content of insulin, testosterone (T), sex hormone binding globulin (SHBG), free androgen index (FAI), dehydroepiandrosterone sulfate (DHEAS), androstenedione (Adione), delta-5-androstenediol (Adiol) measured in 315 women of perimenopausal age (age range from 45 to 55 years) with amenorrhea less than 2 years. Results. It turned out that women who fell into two different subsets according to HOMA-IR (either raised HOMA-IR – 1st group, or within physiological range – 2nd group) showed androgen profile distinctive to each group. The main significant difference was fivefold higher level of Adiol in the 2nd group, when the 1st group shows preponderance of Adione (p<0.05). Also patients of the 2nd group proved to have lower FAI, less fasting insulin, a bit higher DHEAS, lower BMI and HWR. Conclusion. High Adiol (evidence of activated delta-5 steroidogenic pathway, ethnicity-specific or inherited) provides the ground for physiological course of MT. Excessive androgen activity (Adione – probably ensued from overactivated delta 4/5 isomerase pushing delta-5 hormones to turn into delta-4 ones; T, low SHBG, higher FAI) may incur insulin resistance, android obesity. Stressful excessive cortisol production devastates resources for DHEAS rise and adrenal androgens.