to determine the proportion of polycystic ovarian syndrome ( pcos ) patients who have normal body mass index ( bmi ) and to compare the clinical , hormonal , and metabolic profile between lean and overweight patients of pcos . one hundred consecutive infertile women with pcos were studied and divided into lean ( bmi between 18.5 and 23 ) and overweight ( bmi  23 ) . metabolic and hormonal profile ( serum fsh , lh , testosterone , prolactin , tsh on days 23 of menstrual cycle ; serum progesterone premenstrually ; serum insulin  fasting and 2 hours postglucose , glucose tolerance test , and fasting serum lipid profile ) was performed along with pelvic sonogropahy ; and clinical features , viz . waist hip ratio , hirsutism , acne , acanthosis nigricans , and clitoromegaly were recorded . average age , hirsutism ( 80.9% vs. 89.7% ) , irregular cycles ( 92.8% vs. 96.6% ) , acne ( 9.5% vs. 15.5% ) , clitoromegaly ( 2.3% vs. 3.4% ) , endometrial thickness > 4 mm ( 9.5% vs. 15.5% ) , and hormonal profile were similar in the lean and overweight pcos groups . family history of diabetes ( 9.5% vs. 24.1% ) , abnormal glucose tolerance test ( gtt ) ( 4.7% vs. 10.3% ) , deranged lipid profile ( 14.2% vs. 31% ) , and 2-hour postprandial insulin levels were higher in the overweight pcos ( p < 0.05 ) . insulin resistance was observed in 83.3% of lean pcos but was still lower than 93.1% seen in overweight pcos ( p < 0.05 ) . 42% of the pcos had normal bmi , but clinical and hormonal profile was similar to pcos patients with elevated bmi ( overweight / obese ) . family history of diabetes , impaired gtt , deranged lipid profile , and insulin resistance were more prevalent in overweight pcos . it is a conglomeration of symptoms with varied presentations such as hirsutism , acne , alopecia , anovulatory cycles , and obesity . according to eshre / asrm consensus workshop at rotterdam in 2003 , the diagnosis of pcos is based on the presence of any two of ( 1 ) chronic anovulation , ( 2 ) clinical/ biochemical parameters for hyperandrogenism , and ( 3 ) polycystic ovaries on ultrasonography . according to the ae pcos ( androgen excess and pcos society ) criteria , pcos should be defined by the presence of hyperandrogenism ( clinical and/or biochemical ) , ovarian dysfunction ( oligo- anovulation and/or polycystic ovaries ) , and the exclusion of related disorders . overweight or obesity is not an essential criterion , although menstrual irregularities , obesity , and hypertension are considered as clinical indicators of pcos . recent studies have shown that insulin resistance is a key feature in the evolution of pcos and predisposes to type 2 diabetes mellitus in the long run . although a major proportion of pcos patients are overweight or obese , some of them may be having normal or lower body mass index . this study aimed to determine the proportion of pcos subjects who are not overweight / obese and to compare the clinical , hormonal , and metabolic profile of lean [ normal body mass index ( bmi ) ] and overweight / obese pcos women . one hundred consecutive women with age range 20- 38 years presenting with infertility over a 3-year period and diagnosed to have pcos according to eshre / asrm criteria were included in the study after obtaining an informed written consent . patients with bmi < 23 kg/ m were included in the lean pcos and those with bmi 23 kg/ m were considered as overweight pcos . a detailed history including menstrual pattern , personal , past , family , obstetric , and treatment history was recorded . a complete physical examination including general , systemic , breast , and pelvic examination was also performed , and subjects were screened for signs of hyperandrogenism such as hirsutism , acne , acanthosis nigricans , clitoromegaly , and alopecia . hirsutism scoring was done according to ferriman gallwey score and women with a score > 7 were considered hirsute . waist circumference was measured at the level of the umbilicus without clothing and in standing position . subjects with known thyroid disorder ( including those with subclinical hypothyroidism ) , hypothalamic , pituitary or adrenal disease , neoplastic disease , hepatic/ renal / cardiovascular disorders , and tuberculosis were not included for the study . a set of blood investigations was performed for each subject which comprised complete blood count with esr ( erythrocyte sedimentation rate ) , fasting lipid profile , hormonal profile ( day 2 or 3 of menstruation ) including lh , fsh , total testosterone , prolactin , and tsh . blood sugar values and serum insulin values were determined during a 75 g oral glucose tolerance test ( gtt ) . presence of insulin resistance was defined by fasting or postload insulin levels > 25 and > 41 u/ ml , respectively ( drg diagnostic instrument , gmbh , germany ) . lipid profile was estimated by using enzymatic colorimetric technique and criteria adopted were in consonance with ncep - atp iii guidelines . deranged lipid profile was considered if any of the cholesterol , triglycerides , and hdl - cholesterol fractions were abnormal , the individual cutoffs taken were 200 , 150 , and < 50 mg/ dl , respectively . sonography of the pelvis with transvaginal probe ( 7 mhz ) was done on day 2 of menstrual cycle or withdrawal bleed to evaluate day 2 endometrial thickness . polycystic ovaries were defined as an ovary with 12 or more follicles measuring 29 mm in diameter and/or increased ovarian volume more than 10 cm along with stromal hyperplasia . data are presented as mean  sd . the various clinical , metabolic , and hormonal characteristics were tabulated in the two groups and compared using unpaired , two - tailed student 's t - test . the study group had 58 subjects with bmi 23 , i.e. , 58% were overweight or obese pcos with infertility , the rest had normal weight . average age was 28.4  4.2 years in the lean pcos group ( n = 42 ) and 29  5.2 years in the overweight pcos group ( n = 58 ) . presence of hirsutism , hirsutism score , irregular menstrual cycles , endometrial thickness of > 4 mm , and acanthosis nigricans were comparable in both the groups . the hormonal profile was similar in both the groups , with serum lh , lh / fsh ratio and testosterone levels higher and serum progesterone levels lower denoting anovulation in both the groups . the average systolic as well as diastolic blood pressures were significantly higher in the overweight or obese subjects [ table 1 ] . clinical and hormonal profi le in the lean and overweight polycystic ovarian syndrome subjects metabolic parameters in both the groups are shown in table 2 . the bmi and waist - to - hip ratio were significantly higher in the overweight group denoting the prevalence of android obesity . number of patients with impaired gtt and higher postprandial insulin were more in the overweight pcos group . family history of diabetes , deranged lipid profile , 2-hour postprandial insulin , and insulin resistance were significantly more in overweight patients . however , fasting and the postprandial glucose levels were comparable . insulin resistance was present in a large number of the study subjects irrespective of whether they were lean or obese . 83.3% of lean subjects and 93.1% of overweight subjects had insulin resistance [ table 2 ] . women with pcos are generally overweight or obese ; however , 42% in the present study had a normal bmi . this study outlines the fact that patients with pcos , irrespective of their weight , demonstrate clinical manifestations such as irregular cycles , acne , hirsutism ; hormonal abnormalities such as higher lh , lh / fsh , and testosterone levels . impaired gtt , abnormal lipid profile , higher fasting/2-hour insulin levels , and higher insulin resistance , are also witnessed in the pcos patients , but were markedly higher in pcos with elevated bmi . this study indicates that irrespective of weight , pcos patients ( lean as well as overweight or obese ) , are inherently insulin resistant with compensatory hyperinsulinemia and this plays a central role in the pathogenesis of pcos.[911 ] hyperinsulinemia probably acts at the level of hypothalamic  pituitary axis and stimulates lh secretion which leads to anovulation with irregular cycles . in the liver , it decreases production of sex hormone - binding protein and igf-1-binding protein which results in an increase in free androgen in the blood and an increase in free igf-1 in the ovary . within the ovary , it promotes formation of androstenedione and testosterone which is seen clinically as hirsutism and acne . increased androgens are converted to estrones and are responsible for causing endometrial hyperplasia and potentiates lh secretion . insulin resistance and hyperinsulinemia are presently considered risk factors in the development of atherosclerosis raising serum triglycerides and lowering the level of high - density lipoprotein cholesterol , and this may play an etiological role in the development of hypertension . it also elevates the level of plasminogen activator inhibitor , the major inhibitor of fibrinolysis , which is an independent risk factor for atherosclerosis . thus , the metabolic disorders associated with pcos along with their long - term sequelae have to be closely evaluated in both lean and obese pcos patients . presence of obesity makes these patients susceptible to deranged lipid profile , impaired gtt and a greater degree of insulin resistance . recently , obesity has been reported to be a significant predictor for development of metabolic syndrome within the pcos subjects . two - hour postprandial insulin levels and insulin resistance and acanthosis nigricans ( marker of insulin resistance ) were much higher in the overweight group as compared to the lean pcos patients in this study . family history of diabetes was also more common in overweight as compared to lean , and this may indicate a genetic predisposition . glucose tolerance test is considered better than simply the fasting and postprandial values in the evaluation of pcos patients . to conclude , insulin resistance is inherent to pcos , irrespective of whether the subject is lean or obese . it is suggested that all pcos subjects should be considered at risk of atherosclerosis and its manifestations in view of the insulin resistant state ; periodic monitoring of blood pressure , lipids , and an annual ogtt specially for obese pcos patients should be performed .
objective : to determine the proportion of polycystic ovarian syndrome ( pcos ) patients who have normal body mass index ( bmi ) and to compare the clinical , hormonal , and metabolic profile between lean and overweight patients of pcos.materials and methods : one hundred consecutive infertile women with pcos were studied and divided into lean ( bmi between 18.5 and 23 ) and overweight ( bmi  23 ) . 
 metabolic and hormonal profile ( serum fsh , lh , testosterone , prolactin , tsh on days 23 of menstrual cycle ; serum progesterone premenstrually ; serum insulin  fasting and 2 hours postglucose , glucose tolerance test , and fasting serum lipid profile ) was performed along with pelvic sonogropahy ; and clinical features , viz . 
 waist hip ratio , hirsutism , acne , acanthosis nigricans , and clitoromegaly were recorded.results:42% of the pcos subjects had normal bmi . 
 average age , hirsutism ( 80.9% vs. 89.7% ) , irregular cycles ( 92.8% vs. 96.6% ) , acne ( 9.5% vs. 15.5% ) , clitoromegaly ( 2.3% vs. 3.4% ) , endometrial thickness > 4 mm ( 9.5% vs. 15.5% ) , and hormonal profile were similar in the lean and overweight pcos groups . 
 family history of diabetes ( 9.5% vs. 24.1% ) , abnormal glucose tolerance test ( gtt ) ( 4.7% vs. 10.3% ) , deranged lipid profile ( 14.2% vs. 31% ) , and 2-hour postprandial insulin levels were higher in the overweight pcos ( p < 0.05 ) . 
 insulin resistance was observed in 83.3% of lean pcos but was still lower than 93.1% seen in overweight pcos ( p < 0.05).conclusion:42% of the pcos had normal bmi , but clinical and hormonal profile was similar to pcos patients with elevated bmi ( overweight / obese ) . 
 however , insulin resistance is observed in 83.3% of lean pcos . 
 family history of diabetes , impaired gtt , deranged lipid profile , and insulin resistance were more prevalent in overweight pcos .