Endocrine Insulin Resistance Screening

Resistance to the effects of insulin produces an increase in insulin production and circulating levels (known as hyperinsulinemia). Too much insulin can lead to skin disorders and elevated androgens (known as hyperandogenism).

The elevated androgens like dehydroepiandrostenendione sulfate (DHEAS) and testosterone can lead to male pattern hair growth and acne. The androgens cause an increase in free estrogen (by reducing sex hormone-binding globulin, which binds both estrogens and androgens), which results in a decrease in follicle stimulating hormone (FSH).

Because of decreased FSH, the follicles are initially stimulated to grow but do not have enough FSH to continue growth. This results in the polycystic appearance of the ovaries. Because follicles are not developing normally, women will not ovulate normally and will not have normal menses.

Other names that have been used to refer to this syndrome include insulin resistance syndrome and hyperestrogenic anovulation. It is most likely this syndrome does not represent one disease process but several disease processes that result in a similar clinical presentation.

What to Expect

Current testing includes a 12-hour fast followed by a 75 g glucola challenge (sugar solution commonly used to test for gestational diabetes in pregnancy). Blood work is drawn before the glucola (fasting) and at one and two hours after the glucola.