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Polycystic Ovarian Syndrome [keywords]
- Small for gestational age babies are not related to changes in markers of adipose tissue dysfunction during reproductive age. [JOURNAL ARTICLE]
- Early Hum Dev 2014 Mar 3.
Small for gestational age (SGA) birth has been associated with adipocyte dysfunction during later phases of life. Because SGA women are at a higher risk of developing polycystic ovary syndrome (PCOS), adipocyte dysfunction detected in patients with PCOS may be associated with SGA birth.To determine whether SGA birth is related to altered serum markers of adipose tissue dysfunction during the third decade of life in Brazilian women. A secondary objective was to relate the presence of PCOS with serum markers of adipose tissue dysfunction.Prospective cohort observational study.A total of 384 women born at 37 to 42weeks of gestation from June 1, 1978 to May 31, 1979 in Ribeirão Preto, State of São Paulo, Brazil. After exclusion, 165 women participated in the study. Of these women, 43 were in the SGA group and 122 were in the adequate for gestational age group based on birth weight determined from cohort files.Body mass index (BMI), arterial systolic and diastolic pressures, abdominal circumference and serum concentrations of total testosterone, fasting glucose and insulin, lipid profile, adiponectin, leptin and necrosis factor alpha tumor (TNFα).BMI was an independent predictor of lower adiponectin (adjusted coefficient=-0.02, p=0.01) and higher leptin (adjusted coefficient=0.06, p=0.01) concentrations. The serum insulin concentration was associated with higher leptin (adjusted coefficient=0.03, p=0.02) and TNF-α (adjusted coefficient=0.01, p=0.03) concentrations. Having PCOS or being born SGA did not predict any markers of adipocyte dysfunction.
- Body Satisfaction and Eating Attitudes among Girls and Young Women with and without Polycystic Ovary Syndrome. [Journal Article]
- J Pediatr Adolesc Gynecol 2014 Apr; 27(2):72-7.
The main goal of the current study was to examine the associations between polycystic ovary syndrome (PCOS) and body dissatisfaction and eating attitudes in a sample of adolescent girls and young women. Body dissatisfaction is 1 of the strongest predictors of the development of negative outcomes such as low self-esteem, and eating disorders. In adolescent age group of patients, both hirsutism and increased body mass index, appearing with PCOS, may be the leading symptoms also resulting or contributing to body dissatisfaction and eating disorder.The sample of 94 Turkish adolescent girls and young women [PCOS (n = 42) vs non-PCOS (n = 52)] completed measures of figure rating scale, the socio-cultural attitudes toward appearance questionnaire, body esteem scale, eating attitude test, and demographics.The results revealed that body esteem was important for predicting eating attitudes in both groups and sociocultural internalization of thinness ideal and body dissatisfaction were also significant factors in PCOS group. However, scores for major study variables (BMI, sociocultural attitudes toward awareness and internalized appearance ideals, body esteem subscales, body dissatisfaction and eating attitudes) in the PCOS group were not significantly higher than those for girls without PCOS.
- Visceral adiposity index (VAI) is related to the severity of anovulation and other clinical features in women with polycystic ovary syndrome. [JOURNAL ARTICLE]
- Clin Endocrinol (Oxf) 2014 Mar 7.
The clinical phenotype of PCOS includes reproductive and hormonal aberrations. Visceral adiposity index (VAI) is an indicator which could connect hyperandrogenism and anovulation. The objective was to evaluate the relationship between VAI, menstrual disorders and hormonal, biochemical and ultrasound parameters in women with PCOS.193 women with PCOS diagnosed with Rotterdam criteria.We correlated VAI with metabolic and clinical features of the syndrome and with indices of inflammation and insulin sensitivity. In addition, we classified the patients into 4 groups according to the severity of menstrual disorders: Group A (n = 42), with severe menstrual disorders, Group B (n = 83), with mild menstrual disorders, Group C (n = 58), without menstrual disorders and Group D (n = 10) with women with sychnominorroia.In women with PCOS studied, VAI significantly positively correlated with body weight, fasting glucose, insulin, HOMA score, white blood cells, platelets, uric acid, free testosterone, estradiol, total cholesterol, γ-GT, SGPT. Furthermore a significant inverse correlation between VAI and SHBG, Matsuda Index and menstrual cycles per year was documented. From the comparison of the four groups, PCOS women with menstrual disorders had significantly higher VAI and HOMA indices when compared to PCOS without menstrual disorders.VAI is increased in patients with PCOS in concordance with the severity of anovulation, insulin resistance and inflammation. This index could be a very easy and helpful clinical tool in daily practice to predict insulin resistance in women with PCOS. This article is protected by copyright. All rights reserved.
- Modulatory role of D-chiro-inositol (DCI) on LH and insulin secretion in obese PCOS patients. [JOURNAL ARTICLE]
- Gynecol Endocrinol 2014 Mar 7.
Abstract Polycystic ovary syndrome (PCOS) is a common endocrine condition that affects fertility through oligo-ovulation, hyperandrogenism and polycystic morphology of the ovaries. Since it has been demonstrated a high incidence of insulin resistance in PCOS patients, our study aimed to evaluate the efficacy of the integrative treatment with D-chiro-inositol (DCI) (500 mg die, per os, for 12 weeks) on hormonal parameters and insulin sensitivity in a group of overweight/obese PCOS patients (body mass index; BMI > 26). After the treatment, interval several endocrine parameters improved (luteinizing hormone [LH], LH/follicle stimulating hormone [FSH], androstenedione and insulin), insulin response to oral glucose tolerance test reported the significant improvement of insulin sensitivity as well as the gonadotropin-releasing hormone (GnRH)-induced (10 µg, in bolus) LH response. BMI decreased, though no lifestyle modification was requested. When data were analyzed according to the presence or absence of first-grade diabetic relatives, PCOS patients with diabetic relatives showed greater improvement after DCI administration. In conclusion DCI administration is effective in restoring better insulin sensitivity and an improved hormonal pattern in obese hyperinsulinemic PCOS patients, in particular, in hyperinsulinemic PCOS patients who have diabetic relatives.
- Comparing letrozole with medroxyprogesterone acetate (MPA) as hormonal therapy for simple endometrial hyperplasia without atypia in adult and middle-aged women. [Journal Article]
- Eur J Gynaecol Oncol 2013; 34(6):552-5.
The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate (MPA) in treatment of simple endometrial hyperplasia to preserve fertility in young women.Forty-five patients referred to Shahid Sadoughi gynecology clinics from 2009 until 2011 who suffered from abnormal vaginal bleeding or endometrial thickness, that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled. The patients were divided randomly into two groups. First group including 22 women receive ten mg MPA, for ten days during a month for three months. All cases were followed by interview, endometrial curetage, and vaginal sonography. Serum level of estradiol was checked before and after treatment. At the end of the study, biopsy was retaken in 41 patients. All the patients were under observation by two gynecologists.Age range of patients was 20 to 42 years. Mean body mass index (BMI) in the MPA and letrozole groups was 29.13 +/- 4.8 and 25.42 +/- 4.2, respectively. Fifty and 34.8 percent of cases had history of obesity or polycystic ovarian syndrome (PCOS) in MPA and letrozole groups, respectively. Forty-one selected cases (20 of the MPA and 21 of the letrozole groups) continued the treatment for three months. The endometrial thicknesses decreased in both groups. Serum estradiol level also decreased in both groups. The most common complication in the MPA and letrozole groups was headache (27.3%) and flashing and dizziness, respectively. The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing.In women suffering from simple endometrial hyperplasia without atypia, letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA. In both groups, there was no simple hyperplasia report in curettage report following treatment. It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type.Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia: cases candidate for medical treatment. To confirm the effect and safety of letrozole, more studies with larger samples are recommended.
- Effect of underlying infertility factors on second trimester serum screening results. [Journal Article]
- J Reprod Med 2014 Jan-Feb; 59(1-2):76-80.
To determine whether assisted reproductive technologies (ART) alone or an underlying cause of infertility has any effect on second trimester serum screening results.Second trimester serum screening results of ART pregnancies of women with polycystic ovary syndrome (IVF-P group) were compared with those of women who underwent ART due to malefactor infertility (IVF-M group) and of women who conceived spontaneously.Comparison of the groups for a-fetoprotein, beta-hCG, and beta-hCG multiples of the median (MoM) revealed a significant difference between the IVF-M and control groups. Comparison of groups for unconjugated estriol (uE3) and uE3 MoM levels revealed a statistically significant difference between the IVF-P versus the control groups.It seems advisable to use a population of ART pregnancies, preferably divided by type of treatment and the etiology of the infertility, when establishing median curves for second trimester serum screening markers.
- Role of luteal phase support on gonadotropin ovulation induction cycles in patients with polycystic ovary syndrome. [Journal Article]
- J Reprod Med 2014 Jan-Feb; 59(1-2):25-30.
To evaluate the effect of luteal phase progesterone support on pregnancy rates in women with polycystic ovary syndrome (PCOS) who were treated for clomiphene citrate-resistant anovulatory infertility with ovulation induction and intrauterine insemination (OI/ IUI).This randomized study included 110 clomiphene citrate-resistant PCOS patients. All patients underwent ovulation induction with recombinant follicle-stimulating hormone and intrauterine insemination, up to 3 cycles, and were randomized into 2 groups: (1) luteal support with progesterone or (2) a control group. The main outcomes were clinical pregnancy rates and live birth rates per cycle.Demographic data were not different between the study and control groups. Cycle characteristics were found to be homogeneous between groups. A total of 38 pregnancies were achieved (15.5% pregnancy rate per cycle). The clinical pregnancy rate and live birth rate per cycle in progesterone supported cycles were 18.9% and 16.8%, respectively.There might be a clinical benefit of luteal progesterone supplementation on OI/IUI cycles for women with PCOS. Although we did not reach a statistically significant difference between the 2 groups, luteal-supported cycles demonstrated a 6.7% higher clinical pregnancy rate and 6.1% higher live birth rate.
- Ovarian torsion associated with cessation of hormonal treatment for polycystic ovarian syndrome: a case report. [Journal Article]
- Clin Exp Obstet Gynecol 2013; 40(4):609-11.
Torsion of an ovary or fallopian tube (adnexal torsion) usually occurs in ovaries with tumors or functional cysts. In polycystic ovarian syndrome (PCOS), the ovaries are bilaterally enlarged, but these enlarged ovaries rarely twist. Recently, the authors encountered a PCOS patient with ovarian torsion after the cessation of Kaufmann treatment. The etiological factors were unclear, but the authors suggest that the increase in ovarian volume was due to transient hypergonadotropic feedback. Thus, more attention should be paid to adnexal torsion that may arise subsequent to transient hypergonadtropic states, in relation to the cessation of hormonal treatment, and enlarged ovaries in PCOS patients.
- The role of serum adiponectin levels in women with polycystic ovarian syndrome. [Journal Article, Research Support, Non-U.S. Gov't]
- Clin Exp Obstet Gynecol 2013; 40(4):531-5.
The aim of this study was to measure serum adiponectin concentrations in women with polycystic ovarian syndrome (PCOS) and to assess possible correlations between adiponectin and the hormonal or metabolic parameters of this syndrome.Serum adiponectin levels were evaluated in 20 women with PCOS and 22 women without PCOS whose age and body mass index (BMI) matched the patients. The levels of fasting blood glucose, fasting insulin, gonadotropin, and sex steroid hormones were evaluated in both groups. The homeostasis model assessment (HOMA) score was also calculated. The serum adiponectin levels were assayed by enzyme-linked immunoabsorbent assay (ELISA).Serum adiponectin levels were significantly lower in obese women than in normal-weight women, and they were also significantly lower in PCOS patients with HOMA scores greater than 1.7 compared with those with HOMA scores lower than 1.7. When the subjects were divided in two groups based on serum adiponectin levels (> 40 microg/ml, < 40 microg/ml), 65% of patients with PCOS were included in the lower adiponectin group (p < 0.05). In addition, gonadotropin levels were increased, dependent on the adiponectin levels in women with PCOS.Adiponectin is regarded as a possible link between adiposity and insulin resistance (IR). From this data, the secretions of gonadotropin are implicated in the levels of adiponectin in women with PCOS. It is suggested that adiponectin may play an important role in the pathogenesis of PCOS.
- Maternal and fetal insulin levels at birth in women with polycystic ovary syndrome; data from a randomized controlled study on metformin. [JOURNAL ARTICLE]
- Eur J Endocrinol 2014 Mar 4.
Metformin is suggested to reduce pregnancy complications in women with polycystic ovary syndrome (PCOS). Metformin crosses the placenta and therapeutic concentrations are measured in the fetal circulation. Whether metformin treatment in pregnant PCOS women affects maternal and fetal insulin concentrations at birth is not clarified.To investigate the possible effect of metformin on insulin concentrations in umbilical cord blood and the possible association between maternal and fetal insulin concentrations.Post hoc analysis of a subgroup of PCOS women participating in a double blind randomized controlled trial.University hospital setting.Women with PCOS (N=118), aged 19-39 years.Maternal and umbilical cord insulin concentrations immediately after birth.At delivery women randomized to metformin had lower insulin concentrations than those randomized to placebo (259 ± 209 pmol/L vs. 361 ± 261 pmol/L; p = 0.020). No difference was found in insulin concentrations in umbilical venous (p = 0.95) and arterial (p = 0.39) blood between the metformin and placebo groups. The arterio-venous difference was also equal between the groups (p = 0.38). Insulin concentrations were higher in the umbilical vein than in the umbilical artery independent of randomization (70 ± 51 pmol/L vs 45 ± 48 pmol/L; p<0.0005).In PCOS, metformin treatment during pregnancy resulted in lower maternal insulin concentrations at delivery. Metformin treatment did not affect fetal insulin concentrations. Higher insulin concentrations in the umbilical vein indicate that the placenta somehow secretes insulin to the fetus. The possibility of placental insulin secretion to the fetus deserves further investigations.