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Polycystic Ovarian Syndrome [keywords]
- Reproductive neuroendocrine dysfunction in polycystic ovary syndrome: insight from animal models. [REVIEW]
- Front Neuroendocrinol 2014 Apr 17.
Polycystic ovary syndrome (PCOS) is a common endocrinopathy with elusive origins. A clinically heterogeneous disorder, PCOS is likely to have multiple etiologies comprised of both genetic and environmental factors. Reproductive neuroendocrine dysfunction involving increased frequency and amplitude of gonadotropin-releasing hormone (GnRH) release, as reflected by pulsatile luteinizing hormone (LH) secretion, is an important pathophysiologic component in PCOS. Whether this defect is primary or secondary to other changes in PCOS is unclear, but it contributes significantly to ongoing reproductive dysfunction. This review highlights recent work in animal models, with a particular emphasis on the mouse, demonstrating the ability of pre- and postnatal steroidal and metabolic factors to drive changes in GnRH/LH pulsatility and GnRH neuron function consistent with the observed abnormalities in PCOS. This work has begun to elucidate how a complex interplay of ovarian, metabolic, and neuroendocrine factors culminates in this syndrome.
- Age-specific serum antimüllerian hormone levels in women with and without polycystic ovary syndrome. [JOURNAL ARTICLE]
- Fertil Steril 2014 Apr 17.
To determine the serum antimüllerian hormone (AMH) reference values in Chinese women with and without polycystic ovary syndrome (PCOS), and the associations of AMH with clinical or biochemical characteristics.Retrospective study.Academic institutions.Totals of 1,896 infertile control women and 304 women with PCOS.None.Serum basal AMH levels and clinical, endocrine, and metabolic parameters.In the same age group, serum AMH levels were higher in PCOS women than those without PCOS. AMH levels were not significantly related to indices of insulin resistance or metabolic-related variables in both groups. In the infertile control group, AMH increased with antral follicle count (AFC) and LH and decreased with age, body mass index (BMI), and FSH. In the PCOS group, AMH levels showed positive correlations with LH, AFC, and T and negative correlations with BMI. The median AMH levels were 2.35 ng/mL for ages 20-31 years, 1.58 ng/mL for ages 32-34 years, 1.30 ng/mL for ages 35-37 years, 0.96 ng/mL for ages 38-40 years, 1.05 ng/mL for ages 41-43 years, and 0.67 ng/mL for ages >43 years in the control group and 4.38 ng/mL for ages 20-31 years, 3.47 ng/mL for ages 32-34 years, and 3.30 ng/mL for ages 35-37 years in the PCOS group.This study determined reference values of serum AMH in Chinese women with and without PCOS. Elevated serum AMH levels do not affect the risk of insulin resistance or metabolic syndrome.
- A retrospective survey of quality of reporting on randomized controlled trials of metformin for polycystic ovary syndrome. [JOURNAL ARTICLE]
- Trials 2014 Apr 17; 15(1):128.
From previous reviews, there still have been controversies over the effect of metformin (MET) on reproductive function in PCOS patients. The reasons for the inconsistent findings especially lie in the transparency and accuracy of randomized controlled trials (RCTs) reports. However, we could find no data about the quality of RCTs reporting in MET for PCOS. Thus, a retrospective survey related to the quality of reporting in MET for PCOS was conducted.A retrospective survey was conducted by two investigators. Two investigators assessed the quality of overall reporting and key methodological factors reporting using items from the CONSORT 2010 statement.A total of 39 RCTs were included in full text. The median overall quality score was 9, with a minimum of 2 and a maximum of 13. Good or general reporting existed in 11 items with positive rate of more than or equal to 50%. The median score of key methodological items was 4 with a minimum of 0 and a maximum of 5. Randomization, allocation concealment, blinding, baseline characteristics and intention-to-treat (ITT) analysis were reported in 26 (67%), 19 (49%), 20 (51%), 38 (97%) and 17 (44%) of the 39 RCTs, respectively. After adjustment, the mean overall score increased by about 1.71 for manuscripts with funding source (95% CI, 0.18 to 3.24), while it increased by about 3.51 for manuscripts published in one year increment (95% CI, 1.82 to 5.19). There was a relatively close, significant correlation (r = 0.589, P < 0.001) between the score of overall reporting quality and year of publication.Although the overall reporting quality of RCTs in MET for PCOS has improved over time, reporting of key methodological items remains poor. Reporting of RCTs on MET for PCOS should keep up with the standards of the CONSORT statement.
- [Diagnosing polycystic ovary syndrome in adolescent girls]. [English Abstract, Journal Article]
- Ginekol Pol 2014 Feb; 85(2):145-8.
Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies and it manifests itself in about 4-12% women of reproductive age. The Rotterdam, AES and NIH criteria can be used to diagnose PCOS in adults but there are no specific criteria to diagnose PCOS in adolescent girls. Most authors agree that applying criteria for adult to teenagers leads to overdiagnosis because of similarity in physiological changes during puberty and common PCOS symptoms. Tightening of the current criteria and including new, not widely accepted yet, was proposed. Currently it seems justifiable to diagnose PCOS in adolescent girls using the Rotterdam criteria, on condition that all three symptoms are present, hyperandrogenism is established in laboratory tests and pelvic ultrasound reveals an increased ovarian volume (> 10 ml). Nevertheless, the necessity of more research and establishing specific criteria for adolescent girls is emphasized.
- Characteristics of harmonic indexes of the arterial blood pressure waveform in polycystic ovary syndrome. [JOURNAL ARTICLE]
- Blood Press Monit 2014 Apr 16.
Patients with polycystic ovary syndrome (PCOS; which is often associated with increased cardiovascular risk factors) may present hemodynamic changes in the cardiovascular system. The aim of the present study was to verify whether harmonic indexes of the arterial blood pressure waveform (BPWs) can be used to discriminate between PCOS patients and healthy individuals.Twenty-minute bilateral radial BPW signals were obtained in 20 PCOS patients and 20 healthy individuals. Amplitude proportions (Cn values) and their coefficients of variation (CVn values) were calculated for harmonics 1-10 of the BPW.C1 was significantly larger whereas C4, CV2, and CV6 were significantly smaller in PCOS patients compared with healthy individuals.The results of the present study suggest that harmonic-analysis indexes of the BPWs could provide information about the arterial pulse transmission (by monitoring Cn) and cardiovascular regulatory activities (by monitoring CVn). These findings could aid the development of an easy-to-perform, noninvasive, and continuous monitoring technique to improve the detection of PCOS-induced hemodynamic changes.
- Tissue-specific dysregulation of 11ss-hydroxysteroid dehydrogenase type 1 in overweight/obese women with Polycystic Ovary Syndrome compared with weight-matched controls. [JOURNAL ARTICLE]
- Eur J Endocrinol 2014 Apr 17.
Context. Abnormal cortisol metabolism in Polycystic Ovary Syndrome (PCOS) has been invoked as a cause of secondary activation of the hypothalamic-pituitary-adrenal axis and hence androgen excess. However, this is based on urinary excretion of cortisol metabolites, which cannot detect tissue-specific changes in metabolism and may be confounded by obesity.Objective. To assess cortisol clearance and whole-body and tissue-specific activities of 11ß-HSD1 in PCOS.Design. Case-control study.Setting. Medical center.Patients. 20 overweight-obese unmedicated Caucasian women with PCOS, aged 18-45 yr, and 20 Caucasian controls matched for age, body mass index, body fat distribution, and HSD11B1 genotypes (rs846910 and rs12086634).Main Outcome Measures. Cortisol metabolites were measured in 24 h urine. During steady-state 9,11,12,12-2H4-cortisol infusion, cortisol clearance was calculated and whole-body 11ß-HSD1 activity assessed as rate of appearance of 9,12,12-2H3-cortisol (d3-cortisol). Hepatic 11ß-HSD1 activity was quantified as the generation of plasma cortisol following an oral dose of cortisone. Subcutaneous adipose 11ß-HSD1 activity and mRNA were measured, ex vivo, in biopsies.Results. Urinary cortisol metabolite excretion, deuterated-cortisol clearance and the rate of appearance of d3-cortisol did not differ between PCOS and controls. However, hepatic 11ß-HSD1 conversion of oral cortisone to cortisol was impaired (P< 0.05), whereas subcutaneous abdominal adipose tissue 11ß-HSD1 mRNA levels and activity were increased (P< 0.05) in PCOS women with respect to controls.Conclusions. Tissue-specific dysregulation of 11ß-HSD1 is a feature of PCOS, over and above obesity, whereas increased clearance of cortisol may result from obesity rather than PCOS.
- Body composition is improved during 12 months treatment with metformin alone or combined with oral contraceptives compared to treatment with oral contraceptives in polycystic ovary syndrome. [JOURNAL ARTICLE]
- J Clin Endocrinol Metab 2014 Apr 17.:jc20141135.
Context: Central obesity in polycystic ovary syndrome (PCOS) is associated with increased inflammatory markers and increased risk for type 2 diabetes. Objective: To evaluate if treatment with metformin (M) or M combined with oral contraceptive pills (OCP) resulted in a more advantageous body composition than treatment with OCP alone. Setting: Outpatient clinic. Patients and interventions: Randomized, controlled clinical trial. 90 patients with PCOS were randomized to 12 months treatment with M (2 g/day), M + OCP (150 mg desogestrel+30 microgram ethinylestradiol) or OCP. Whole body DXA-scans, clinical and hormonal evaluations were performed before and after the intervention period. A total of 65/90 patients completed the study. Main outcome measures: Changes in weight at 6 and 12 months and changes in regional fat mass estimates at 12 months. Results: Dropout rates between intervention groups were not significantly different. Treatment with M and M+OCP were superior to OCP regarding weight and regional fat mass. The median (quartiles) weight changes during 12 months M, M+OCP, and OCP treatment were -3.0 (-10.3; 0.6), -1.9 (-4.9; 0.1), and 1.2 (-0.8; 3.0) kg, respectively, p<0.05. Upper/lower fat mass ratio was unchanged. Changes in body composition were predicted by type of medical intervention (M, M+OCP or OCP) and not by BMI at study inclusion. OCP and M+OCP were superior to M regarding reduction in free testosterone levels. Conclusions: M treatment alone or in combination with OCP was associated with weight loss and improved body composition compared to OCP, whereas free testosterone levels decreased during M+OCP or OCP. Combined treatment with M+OCP should be considered as an alternative to treatment with OCP alone to avoid weight gain in PCOS.
- Correlation between serum adiponectin and clinical characteristics, biochemical parameters in Indian women with polycystic ovary syndrome. [Journal Article]
- Indian J Endocrinol Metab 2014 Mar; 18(2):221-5.
Polycystic ovary syndrome (PCOS) is a common disorder. PCOS women are at a high risk for insulin resistance and metabolic syndrome (MS). Adiponectin is positively related to insulin sensitivity. It has a preventive role in atherogenesis and MS. The present work was conducted to study the correlation between serum adiponectin levels and clinical characteristics and biochemical parameters in PCOS patients.A prospective study in 49 newly diagnosed (as per Rotterdam criteria) Indian PCOS women was conducted. PCOS women were clinically examined and investigated for biochemical parameters.The mean serum adiponectin was 12 ± 9.4 μg/mL (range 0.47-45). Hypoadiponectinemia (serum adiponectin <4 μg/mL) was present in 22% patients. Age and adiponectin correlated significantly and inversely (r = -0.42, P = 0.027). Overweight/obese patients had lower mean adiponectin levels than normal weight (11.62 ± 9.5 vs 13.58 ± 9.5, P = 0.56). It was significantly lower in patients with acanthosis nigricans (AN) as compared with those without AN (8.4 ± 5.9 vs 15 ± 11, P = 0.038). Hirsute patients showed lower mean adiponectin levels than nonhirsute (10 ± 7.3 vs 13 ± 10, P = 0.57). A positive, insignificant correlation was observed between serum adiponectin and cholesterol, low-density lipoprotein, follicle stimulating hormone (FSH), thyroid stimulating hormone, levels. A negative insignificant correlation existed between serum adiponectin and luteinizing hormone (LH), LH: FSH ratio, prolactin, dehydroepiandrosterone, testosterone, triglyceride, high-density lipoprotein, fasting blood glucose, fasting insulin, and Homeostasis Model Assessment.Hypoadiponectinemia is present in one-fifth of women with PCOS. Adiponectin levels decrease as age advances. Low levels of adiponectin possibly contributes to the development of dermal manifestation (AN) of insulin resistance.
- Comparative evaluation of sonographic ovarian morphology of Indian women with polycystic ovary syndrome versus those of normal women. [Journal Article]
- Indian J Endocrinol Metab 2014 Mar; 18(2):180-4.
To study ovarian morphology by ultrasound in women with or without polycystic ovary syndrome (PCOS) and to establish cut-off values of these parameters in Indian women with PCOS.A total of 119 consecutive women diagnosed PCOS and 77 apparently healthy women were enrolled. Transabdominal ultrasound examination was carried out to assess ovarian volume, stromal echogenecity, follicle number and size. Cut-off values of the above ovarian parameters with sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated.Sensitivity of 79.49% and specificity of 90.67% was achieved with a cut-off of 8 mL as ovarian volume. A cut-off value of 9 follicles to distinguish between PCOS and control women yielded a sensitivity of 82.35% and specificity of 92.0% while as a follicular size of 5 mm yielded sensitivity and specificity of 74.67% and 78.15% respectively. With all the three parameters sensitivity was 87.39% and specificity 87.84% with 92.04% PPV and 81.25% NPV.Using two or three sonographic criteria in combination improves sensitivity and helps diagnose additional patients with PCOS. Our results are at variance with the established cut-off values highlighting the fact that American Society for Reproductive Medicine consensus cut-off values are not reproducible in Indian context.