Case Report | DOI: https://doi.org/10.31579/2690-4861/900
1Department of Nursing, Faculty of Health Sciences, University of Gjirokastër “Eqrem Çabej”, Gjirokastër, Albania.
2Department of Obstetrics and Gynecology, Regional Hospital “Omer Nishani”, Gjirokastër, Albania.
3Department of Radiology, Regional Hospital “Omer Nishani”, Gjirokastër, Albania.
*Corresponding Author: Altin Goxharaj, Department of Nursing, Faculty of Health Sciences, University of Gjirokastër “Eqrem Çabej”, Gjirokastër, Albania.
Citation: Altin Goxharaj, Julinda Mijo, Dashamir Demiri, Migena Kuro, Maksim Logli, (2025), Laboratory Assessment of Insulin Resistance in Polycystic Ovary Syndrome (PCOS): Clinical Cases and Diagnostic Implications, International Journal of Clinical Case Reports and Reviews, 30(5); DOI:10.31579/2690-4861/900
Copyright: © 2025, Altin Goxharaj. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 26 June 2025 | Accepted: 30 September 2025 | Published: 08 October 2025
Keywords: PCOS; insulin resistance; HOMA-IR; hyperandrogenism; infertility, laboratory medicine
Background: Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age. Insulin resistance (IR) is a central metabolic feature of PCOS, often present even in non-obese individuals.
Objective: This article explores the role of laboratory markers in the diagnosis and management of IR in PCOS through clinical cases and discusses their implications in clinical practice.
Methods: A review of key biochemical markers associated with PCOS and IR was conducted, followed by the presentation of two clinical cases illustrating the utility of these parameters in diagnosis and treatment.
Results: Elevated fasting insulin, HOMA-IR >2.5, and altered androgenic and gonadotropin profiles were observed. Treatment with metformin and ovulation-induction agents proved effective in managing IR and reproductive dysfunction.
Conclusion: Laboratory testing is essential in the comprehensive evaluation of PCOS. Early identification of IR allows for timely interventions that can improve metabolic outcomes and fertility.
Polycystic Ovary Syndrome (PCOS) is a multifactorial endocrine disorder affecting 6–20% of women of reproductive age, depending on the diagnostic criteria used. The syndrome is characterized by reproductive, metabolic, and psychological components, with insulin resistance (IR) being a major underlying contributor to its pathophysiology.[1]
Despite being traditionally associated with obesity, IR in PCOS can occur independently of body mass index (BMI), emphasizing the importance of biochemical assessments even in lean women.[2] The Rotterdam criteria (2003) define PCOS based on the presence of at least two of the following: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound.[3]
2.1 Key Metabolic Markers
| Test | Normal Range | Findings in IR |
|---|---|---|
| Fasting Glucose | 70–99 mg/dL | >100 mg/dL (prediabetes) |
| Fasting Insulin | 2–20 μIU/mL | >10–15 μIU/mL |
| HOMA-IR = (Glucose × Insulin)/405 | <2> | >2.5 indicates IR |
| HbA1c | <5> | 5.7–6.4% (prediabetes) |
| OGTT (2h post-glucose) | <140> | 140–199 mg/dL (impaired tolerance) |
| C-peptide | 0.5–2.0 ng/mL | Often elevated in IR |
HOMA-IR is a widely used surrogate index for IR in clinical and research settings due to its simplicity and non-invasiveness.⁴
2.2 Hormonal and Endocrine Profile in PCOS
| Parameter | Normal Range | Alteration in PCOS |
|---|---|---|
| LH/FSH Ratio | ~1:1 | >2:1 suggests PCOS |
| Total Testosterone | <0> | Elevated |
| Free Testosterone | 0.3–1.9 pg/mL | Elevated – more specific |
| DHEA-S | 35–430 μg/dL | Elevated in 20–30% |
| Androstenedione | 0.3–3.5 ng/mL | Elevated |
| SHBG | 18–114 nmol/L | Decreased |
| Prolactin | 4.8–23.3 ng/mL | May be elevated |
| TSH | 0.4–4.5 mIU/L | To rule out hypothyroidism |
| 17-OH Progesterone | <200> | Elevated in adrenal hyperplasia |
Case 1: Young Woman with Metabolic and Reproductive Symptoms
Case 2: Infertility and Hyperandrogenism
Effective PCOS management must address both hormonal imbalance and metabolic dysfunction:
Effective PCOS management must address both hormonal imbalance and metabolic dysfunction:
PCOS is a heterogeneous disorder that significantly impacts women’s health across reproductive, metabolic, and emotional domains. Insulin resistance plays a critical role in its pathogenesis and should be systematically evaluated even in normoglycemic patients.
Laboratory assessment is vital for both diagnosis and personalized management. Early identification of IR allows for timely interventions that can reduce long-term complications, including infertility, type 2 diabetes, and cardiovascular disease.
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