Hyperandrogenism in polyendocrine metabolic ovarian syndrome is associated with increase of urinary inositol

Abstract Background Hyperandrogenemia, insulin resistance (IR), and metabolic disorders are cardinal features of polycystic ovary syndrome, also referred to here as Polyendocrine Metabolic Ovarian Syndrome (PMOS). Inositol supplementation can restore ovulation in women with PCOS, but the relationship between inositol and the clinical features of PMOS remains unclear. This study explored the associations of serum and urinary inositol with sex hormone abnormalities, IR, hyperandrogenemia, and metabolic disturbances in women with PMOS. Methods In this cross-sectional cohort study, 278 women with PMOS and 93 healthy controls were recruited between 2018 and 2020. Serum and urinary inositol levels were measured by enzyme-linked immunosorbent assay in 109 (54 PMOS, 55 controls) and 167 (100 PMOS, 67 controls) participants, respectively. Women with PMOS were further stratified according to the presence of hyperandrogenemia (87 with vs. 145 without), IR, and hyperlipidemia. Results Compared with controls, women with PMOS had lower serum inositol (347.82 ± 61.044 vs. 380.90 ± 47.573 ng/ml, P < 0.01) and higher urinary inositol (197.3630 ± 32.83196 vs. 157.9955 ± 32.07824 ng/ml, P < 0.01). Among women with PMOS, urinary inositol was higher in those with hyperandrogenemia than in those without (224.3879 ± 12.64750 vs. 194.0597 ± 35.21394 ng/ml, P < 0.01) and higher in those with IR than in those without (205.6333 ± 30.10527 vs. 190.7538 ± 34.63573 ng/ml, P < 0.05), whereas serum inositol did not differ significantly between these subgroups. Receiver operating characteristic analysis of urinary inositol for discriminating PMOS from controls yielded an area under the curve of 0.8066 (P < 0.0001). Conclusions An inositol imbalance characterized by decreased serum and increased urinary inositol was associated with PMOS, and higher urinary inositol was associated with hyperandrogenemia and IR among women with PMOS. These cross-sectional findings are exploratory and hypothesis-generating; longitudinal and interventional studies are needed to establish causality and any diagnostic or therapeutic utility.