[Treatment of hyperandrogenism and hyperinsulinemia in PCOS patients with essential amino acids. A pilot clinical study]. / Trattamento dell'perandrogenismo e dell'perinsulinemia con aminoacidi essenziali in pazienti affette da sindrome dell'ovaio policistico. Uno studio pilota.

AIM: Women with polycystic ovary syndrome (PCOS) report frequently hyperinsulinemia. The aim of this study was to evaluate the effects of 16-weeks therapy with essential amino acids supplements on metabolic and clinical indices in PCOS. METHODS: For this study ten women with PCOS and fasting hyperinsulinemia were enrolled. The study comprised 16 weeks of therapy with oral essential amino acids (Aminopril, NAMED, Milan, Italy) administered 4 g twice per day. Body mass index, hirsutism score, serum levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein B, lipoprotein(a), serum adrenal and ovarian androgens, fasting glucose and insulin concentrations, T, DHEAS, gonadotropins, and sex hormone-binding globulin (SHBG), were assessed before and after treatment with essential amino acids. RESULTS: A significant decrease in fasting insulin, total T, luteneizing hormone and follicle-stimulating hormone was reported after amino acids therapy and increase in SHBG, leading to a decrease in the free T index. In addition, a significant reduction in hirsutism score was reported. No significant decrease in mean body mass index and in lipid pattern was reported. CONCLUSION: A decline of insulin after treatment with essential amino acids was observed in women with PCOS as well as total and bioavailable T, leading to significant improvement of clinical symptoms of hyperandrogenism.

Is there an association between aspects of the metabolic syndrome and overactive bladder? A prospective cohort study in women with lower urinary tract symptoms.

OBJECTIVE: The aim of our study was to determine whether there is a link between aspects of the metabolic syndrome (MetS) and overactive bladder (OAB) in women with lower urinary tract symptoms (LUTS). STUDY DESIGN: A single-centre prospective study. We evaluated a cohort of consecutive women with LUTS attending a tertiary referral urodynamic clinic from October 2012 to January 2015. Obesity, diabetes, hypertension and dyslipidaemia were used as markers of MetS. OAB and detrusor overactivity (DO) were defined according to the International Urogynaecological Association/International Continence Society terminology. RESULTS: Eight hundred and forty women were enrolled. Three hundred and eight (36.6%) had normal weight, 260 (31%) were overweight and 272 (32.4%) obese. We identified 168 women (20%) with hypertension, 64 (7.6%) with diabetes mellitus, and 98 (11.7%) with dyslipidaemia. Seven hundred and four (83.8%) women were diagnosed symptomatically with OAB and 305 (36.3%) were diagnosed urodynamically with DO. Obesity (p<0.001) was the only independent predictor for OAB (OR 1.09, 95% CI 1.05-1.13) and DO (OR 1.06, 95% CI 1.03-1.08), respectively. CONCLUSION: Our study demonstrates a correlation between obesity and OAB/DO in female patients. However, other components of MetS do not appear to be associated with either OAB and DO. Weight reduction should be strongly recommended in women with OAB.

Drug therapy for overactive bladder.

Overactive bladder is a syndrome with a significant worldwide prevalence and economic impact on health resources. With ageing populations, the health burden of this condition that is more common in older people, is likely to increase. Following conservative therapies, medical management of overactive bladder is the mainstay of treatment, usually with antimuscarinic therapy. However, adherence is poor either due to adverse events or lack of efficacy of therapy. There have been recent developments that include a ß3-adrenoreceptor agonist and intradetrusor botulinum toxin, both of which are increasingly supported by a robust evidence base. Additionally there are emerging combination therapies and novel target agents that aim to treat this troubling syndrome. Alternative modes of delivery for existing therapies are also being explored with a view to improving adherence and efficacy. This article aims to outline the evidence base for existing and novel therapies as well as inform readers of emerging therapeutic options.