The evaluation of hormonal and psychological parameters that affect bone mineral density in postmenopausal women.

OBJECTIVE: In this study we aimed to investigate the relationships between serum levels of DHEAS, reproductive hormones and low bone mineral density (BMD) in postmenopausal women. We also examined the relationship between psychological status of patients and their BMD results. PATIENTS AND METHODS: This study included postmenopausal female patients. BMD measurements were performed with dual-energy X-ray absorptiometry (DEXA). Psychological assessments of all cases were performed using the Hamilton Anxiety and Hamilton Depression scales. All patients provided fasting venous blood samples in order to determine serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and DHEAS. RESULTS: There were 33 cases (45.2%) with normal BMD levels and 40 cases (54.8%) with abnormal BMD levels (osteopenia and osteoporosis). DHEAS levels did not show any statistically significant difference according to BMD results (p = 0.431). The Hamilton Anxiety and Depression scores also did not show statistically significant differences in accordance with the BMD results (p = 0.889 and p = 0.706, respectively). CONCLUSIONS: According to our results, anxiety, depression and circulating DHEAS levels are not significantly associated with low levels of BMD, particularly at osteopenic levels. So these parameters are not useful for clinical practice in patients with low BMD in the middle-aged postmenopausal women.

Adrenal gland volume assessed by magnetic resonance imaging in women with polycystic ovary syndrome.

PURPOSE: To determine adrenal gland volume (AGV) in women with polycystic ovary syndrome (PCOS) by comparison with healthy control subjects and to investigate the relationship between AGV and hormonal status. PATIENTS AND METHODS: AGV was measured on transverse sections of T1-weighted MRI imaging data in 27 PCOS patients and 40 age-matched control subjects for this prospectively designed study. A comparative analysis of AGV in PCOS and controls was performed and possible correlations between AGV and hormonal parameters were evaluated. RESULTS: PCOS patients had significantly larger AGV compared to controls ((11.7±4.4 cm(3), 7.2±1.9 cm(3), respectively, P<0.001). A significant positive correlation was found between total AGV and dehydroepiandrosterone sulfate, 17-OH progesterone, and total and free testosterone levels in the PCOS group (r=+0.51, +0.48, +0.43, +0.62, respectively; P values<0.05). In addition, AGV was significantly negatively correlated with LH and LH/FSH ratio in the PCOS group (r= -0.55, P=0.02; r=-0.51, P=0.01, respectively). CONCLUSIONS: PCOS patients have significantly increased AGV as well as a positive correlation of AGV and androgens. We conclude that the assessment of AGV with MRI shows a significant correlation with the androgenic activity of the gland, and that hypertrophy of the adrenal gland may be involved in the pathogenesis of PCOS.

In contrast to leptin, serum concentrations of ghrelin are not related to premenstrual syndrome.

OBJECTIVE: Premenstrual syndrome (PMS) is a disorder related to mood and appetite changes during the premenstrual phase. Unfortunately, the understanding of the pathophysiology of PMS is quite poor. Though, ghrelin and leptin play important roles in the control of food intake. The aim of this study was to evaluate leptin and ghrelin serum concentrations in PMS patients. PATIENTS AND METHODS: Forty-five PMS patients diagnosed according to ICD-10 diagnostic criteria and 45 healthy women as a control group, were included in the study. These groups were matched for age, body mass index and duration of menstrual cycle. Symptoms of the patients were evaluated using "Menstrual Distress Questionnaires". Serum leptin and ghrelin serum concentrations were measured using ELISA in the postmenstrual phase (5-9 days) and 2-3 days before menstruation. Mann-Whitney U test, independent sample t-test and Wilcoxon test were used for statistical analyses. RESULTS: In the PMS group, there was no difference in the serum concentrations of ghrelin; however, leptin serum concentrations were 31.05 (± 14.16) and 16.42 (± 15.81) ng/ml during the premenstrual and postmenstrual periods, respectively (p < 0.05). Ghrelin serum concentrations in the premenstrual period were 6.9 (± 9.3) ng/ml in the PMS group and 8.8 (± 9.3) ng/ml in the control group, but this difference was not statistically significant (p = 0.79). CONCLUSIONS: Ghrelin serum concentrations were not associated with PMS, while leptin serum concentrations were found to be higher in the premenstrual period in PMS patients. Though, these two hormones work antagonistically to control the food intake and body weight, we suggest that this function is not relevant to PMS.

Can first trimester placental protein-13 and pregnancy-associated plasma protein-A predict pre-eclampsia in Turkish women?

The aim of study was to evaluate placental protein-13 (PP-13) and pregnancy-associated plasma protein-A (PAPP-A) in first trimester maternal serum, for predicting pre-eclampsia. A prospective case-control study included 30 pre-eclampsia patients and 90 control pregnant women. Pre-eclampsia patients were divided into two subgroups: early- and late-onset (9 vs 21), and PP-13 and PAPP-A levels were compared between the groups and the comparison of risks for pre-eclampsia were calculated. Results showed that there was a significant inverse correlation between PAPP-A and late pre-eclampsia (p = 0.003), with a cut-off value of 0.805 (ROC analysis area under curve = 0.751). There was a significant reverse correlation between PAPP-A and early pre-eclampsia (p = 0.02). There was no significant relationship between PP-13 and early pre-eclampsia, nor with late pre-eclampsia (p = 0.7, p = 0.6, respectively). It was concluded that neither of these markers can serve as a sufficient and reliable screening test of pre-eclampsia because of inadequate sensitivity in the Turkish pregnant population.

Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study.

PURPOSE: To investigate if maternal serum pregnancy-associated plasma protein-A levels are affected in hyperemesis gravidarum (HG). MATERIALS AND METHODS: A prospective case control study was conducted in 169 HG cases who had one or more antepartum hospitilization for HG. The control pregnancies were 132 and were selected randomly among all women who had first trimester prenatal screening in antenatal outpatient clinic between 2011 and 2012. RESULTS: Maternal serum pregnancy-associated plasma protein-A levels were significantly higher in hyperemesis gravidarum group compared with control group (p = 0.002 p < 0.05 95% CI). Power analysis of independent sample t-test, two-sided, for pregnancy-associated plasma protein-A was 0.88. Maternal serum free beta-human chorionic gonadotropin values were not different between two groups (p > 0.05). CONCLUSION: Increased pregnancy-associated plasma protein-A levels associated with HG, even after excluding potential cofounders.

Role of omentectomy and appendectomy in surgical staging of endometrioid endometrial cancer.

PURPOSE: The purpose of this study was to determine whether it was necessary to add omentectomy and appendectomy to the surgical staging of endometrioid endometrial cancer. MATERIALS AND METHODS: Records were reviewed from June 2005 to June 2009 for endometrioid endometrial cancer patients who underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, infracolic omentectomy and appendectomy. RESULTS: In total, 186 patients were included in the analysis. Disease was limited to uterus in 93% of patients and 87% of patients had Stage I disease. There was only one omental metastasis and no appendix metastasis in all stages. CONCLUSION: Routine omentectomy and appendectomy are unnecessary in surgical staging of endometrioid endometrial cancer unless there is suspicion of gross metastases during intraoperative examination.