Dyslipidemia in women with polycystic ovary syndrome: incidence, pattern and predictors.

One hundred forty-two women with polycystic ovary syndrome (PCOS) with an average body mass index (BMI) of 29.1 kg/m(2) and average age of 25.12 years were studied. By BMI, 30.2% were normal, 38.0% were overweight and 31.6% were obese. Thirty-one eumenorrheic women matched for BMI and age, with no evidence of hyperandrogenism, were recruited as controls. The incidence of dyslipidemia in the PCOS group was twice that of the Control group (76.1% versus 32.25%). The most frequent abnormalities were low high-density lipoprotein cholesterol (HDL-C; 57.6%) and high triglyceride (TG) (28.3%). HDL-C was significantly lower in all subgroups of women with PCOS when compared to the subgroups of normal women. No significant differences were seen in the total cholesterol (p = 0.307), low-density lipoprotein cholesterol (LDL-C; p = 0.283) and TGs (p = 0.113) levels among the subgroups. An independent effect on HDL-C was detected for glucose (p = 0.004) and fasting insulin (p = 0.01); on TG for age (p = 0.003) and homeostatic model assessment insulin resistance (p = 0.03) and on total cholesterol and LDL-C for age (p = 0.02 and p = 0.033, respectively). In conclusion, dyslipidemia is common in women with PCOS, mainly due to low HDL-C levels. BMI has a significant impact on this abnormality.

Prevalence of abnormalities of glucose metabolism in patients with polycystic ovary syndrome.

Patients with polycystic ovary syndrome (PCOS) present a higher risk for abnormalities of glucose metabolism (AGM). For to study this in our population, we submitted 85 patients, with body mass index (BMI) of 28.5 +/- 6.6 kg/m(2) and aged 25.5 +/- 5.4 years old, to an oral glucose tolerance test (OGTT), and assessed the impact of BMI on the prevalence of impaired glucose tolerance (IGT) and of diabetes mellitus (DM). The states of glucose tolerance were classified considering fasting plasma glucose (FPG) according to the American Diabetes Association (ADA) criterion and plasma glucose at 120 minutes according to the Word Health Organization (WHO) criterion. According to the ADA criteria, 83.5% classified as normal and 16.5% as with AGM, with 15.3% presenting impaired fasting glucose and 1.2% DM, while according to the WHO criteria, 68.2% were classified as normal and 31.8% as with AGM, with 27.0% of them presenting IGT and 4.8% DM. Seventy-three percent of PCOS patients with IGT by WHO criterion had normal FPG by ADA criterion. The prevalence of AGM for both criteria increased with the body mass index. In conclusion, we found a higher prevalence of AGM in PCOS patients than that found in the general population, being the highest in obese patients. Glycemia at 120 minutes on the OGTT identified more patients with AGM than fasting glycemia. We recommended that the assessment of AGM must be done by the OGTT in all patients with PCOS.

Impact of body mass index on blood pressure levels in patients with polycystic ovary syndrome.

As there is controversy about the prevalence of hypertension in patients with polycystic ovary syndrome (PCOS) and, up to the present moment, no studies have evaluated the impact of body mass index (BMI) on blood pressure levels (BP) in these patients, we studied retrospectively sixty-nine patients with PCOS, with BMI of 29.0 +/- 6.7 kg/m(2) and aged 25.6 +/-5.6 yr, subdivided into three groups according to BMI (normal, overweight and obese) and evaluated regarding BP (mercury sphygmomanometer), basal hormonal profile, fasting glucose, and insulin sensitivity (HOMA-IR). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were normal (118.1 +/- 17.0 and 74.7+/- 11.5 mmHg, respectively), with a hypertension prevalence of 20.3%. Of these patients, 78.6% were obese and 21.4% were overweight. When the groups were compared according to BMI, a significant increase in SBP and DBP was observed (higher in overweight and obese patients for SBP and higher in obese for DBP), as well as a significant progressive increase in glucose, insulin, homeostatic model assessment, and a significant progressive decline in LH levels. When the patients were subdivided as normotensive or hypertensive, a significant difference was observed only for BMI (28.2 +/- 6.1 and 34.7 +/- 8.6 kg/m(2), respectively; p = 0.007). In conclusion, we observed a significant and progressive impact of BMI on blood pressure levels in our patients with polycystic ovary syndrome.

Metabolic syndrome in women with polycystic ovary syndrome: prevalence, characteristics and predictors.

The aim of this study was to determine the prevalence of metabolic syndrome in women with polycystic ovary syndrome, as well as its characteristics and predictors. Seventh-three women, with body mass index of 30.4 +/- 7.8 kg/m2 and 25.0 +/- 6.0 years old, subdivided according to body mass index, were studied retrospectively. There was no significant mean age difference among body mass index groups (p = 0.228). Prevalence of metabolic syndrome was 38.4%, with a null prevalence for normal (n = 18), 23.8% for overweight (n = 17), 62.9% for obese (n = 28), and 85.5% for morbidly obese women (n = 7). Women with metabolic syndrome were older than women without metabolic syndrome (27.3 +/- 5.3 vs. 24.2 +/- 4.6 vs. years old; p = 0.031) and presented a higher body mass index (36.3 +/- 7.7 vs. 26.9 +/- 5.4; p < 0.001). There was no difference for degree of hirsutism and menstrual patterns between women with and without metabolic syndrome (p = 0.593 and p = 0.119, respectively). Regarding laboratory parameters, DHEAS was lower (1,646 +/- 1,007 vs. 2,594 +/- 1,563; p = 0.007) and HOMA-IR were higher (9.9 +/- 9.7 vs. 4.6 +/- 4.7; p = 0.004) in women with metabolic syndrome (p = 0.031 and p < 0.001, respectively). The best predictors of metabolic syndrome were waist circumference > 88 cm, HDL-cholesterol < 50 mg/dL and triglycerides >or= 150 mg/dL.

Metabolism of triglyceride-rich lipoproteins and lipid transfer to high-density lipoprotein in young obese and normal-weight patients with polycystic ovary syndrome.

OBJECTIVE: To clarify whether the metabolism of triglyceride-rich lipoproteins and lipid transfer to high-density lipoprotein (HDL) are altered in patients with polycystic ovary syndrome (PCOS). DESIGN: Case-control study. SETTING: Endocrinology clinics. PATIENT(S): Eight normal-weight (NW) and 15 obese (Ob) patients with PCOS were compared with 10 NW and 10 Ob women without PCOS paired for age and body mass index. INTERVENTION(S): Determination of triglyceride-rich lipoprotein metabolism and lipid transfer to HDL. MAIN OUTCOME MEASURE(S): Participants were injected triglyceride-rich emulsions labeled with (14)C-cholesteryl esters and (3)H-triglycerides and the fractional clearance rate (FCR, in min(-1)) of labels was determined. Lipid transfer from artificial nanoemulsions to HDL was performed by incubating radioactively labeled lipid nanoemulsions with plasma during 1 hour, followed by radioactive counting of HDL-containing supernatant after chemical precipitation. RESULT(S): Lipolysis estimated by triglyceride FCR was equal in PCOS groups (NW = 0.043 +/- 0.032, Ob = 0.033 +/- 0.009) and respective controls (NW = 0.039 +/- 0.015, Ob = 0.044 +/- 0.019). However, the remnant removal as estimated by cholesteryl ester FCR was reduced in both PCOS groups (NW = 0.005 +/- 0.006, Ob = 0.005 +/- 0.005) compared with controls (NW = 0.016 +/- 0.006, Ob = 0.011 +/- 0.072). Lipid transfer rates were not different among groups, but triglyceride transfer rates were positively correlated with homeostasis model assessment estimate of insulin resistance in PCOS. CONCLUSION(S): PCOS patients showed decreased removal of atherogenic remnants even when fasting glucose was <100 mg/dL. This reinforces the usefulness of the measures taken to prevent cardiovascular events in PCOS patients.

Ovarian hyperthecosis in the context of an adrenal incidentaloma in a postmenopausal woman.

Adrenal incidentaloma is not infrequent and can be found in hirsute women. We report a case of a 54-year-old woman with amenorrhea and hirsutism of abrupt onset and mild signs of virilization that had an adrenal incidentaloma coexisting with ovarian hyperthecosis. Basal total and free testosterone were 191 ng/dL and 179 pmol/L. Pelvic ultrasonography disclosed a right ovary with 10.3 cc and a left ovary with 9.8 cc without nodules or cysts, and computerized tomography of the abdomen disclosed a normal right adrenal gland. On the left adrenal gland a solid nodule with 0.8 cm was seen. After GnRHa administration, total testosterone was 23 ng/dL and free testosterone was 17 pmol/L. In view of a suppression of testosterone by GnRHa, the patient was submitted to a hystero-oophorectomy by laparoscopy. Symmetrically enlarged ovaries were seen. No tumor was apparent. Histology showed hyperthecosis, with foci of luteinized stromal cells. Only atretic follicles were detected. No hilar cell hyperplasia was seen. In conclusion, the presence of an adrenal mass in a hirsute woman can lead to a wrong diagnosis. In this case the suppression GnRHa test was fundamental to determine the origin of hyperandrogenemia.

Ovarian hyperthecosis in the context of an adrenal incidentaloma in a postmenopausal woman / Coexistência de incidentaloma adrenal e hipertecose de ovário em mulher menopausada

Adrenal incidentaloma is not infrequent and can be found in hirsute women. We report a case of a 54-year-old woman with amenorrhea and hirsutism of abrupt onset and mild signs of virilization that had an adrenal incidentaloma coexisting with ovarian hyperthecosis. Basal total and free testosterone were 191 ng/dL and 179 pmol/L. Pelvic ultrasonography disclosed a right ovary with 10.3 cc and a left ovary with 9.8 cc without nodules or cysts, and computerized tomography of the abdomen disclosed a normal right adrenal gland. On the left adrenal gland a solid nodule with 0.8 cm was seen. After GnRHa administration, total testosterone was 23 ng/dL and free testosterone was 17 pmol/L. In view of a suppression of testosterone by GnRHa, the patient was submitted to a hystero-oophorectomy by laparoscopy. Symmetrically enlarged ovaries were seen. No tumor was apparent. Histology showed hyperthecosis, with foci of luteinized stromal cells. Only atretic follicles were detected. No hilar cell hyperplasia was seen. In conclusion, the presence of an adrenal mass in a hirsute woman can lead to a wrong diagnosis. In this case the suppression GnRHa test was fundamental to determine the origin of hyperandrogenemia.

Os incidentalomas adrenais não são infreqüentes e podem ser encontrados em pacientes com hirsutismo. Nesse relato, apresentamos o caso de coexistência de um incidentaloma adrenal com hipertecose de ovário, em uma mulher com 54 anos de idade com amenorréia e hirsutismo de início abrupto e sinais leves de virilização. As testosteronas total e livre basal foram de 191 ng/dL e 179 pmol/L, respectivamente. O ultra-som pélvico demonstrou o ovário direito com 10,3 cc e ovário esquerdo com 9,8 cc, sem nódulos ou cistos e a tomografia computadorizada de abdome demonstrou adrenal direita adrenal e nódulo sólido de 0,8 cm na adrenal esquerda. Após a administração de análogo de GnRH, as testosteronas total e livre foram de 23 ng/dL e 17 pmol/L, respectivamente. Considerando a supressão da concentração de testosterona pelo análogo de GnRH, a paciente foi submetida a histeroooforectomia por via laparoscópica. O diagnóstico histológico foi de hipertecose, com focos de células estromais luteinizadas. Somente folículos atréticos foram visualizados. Não se detectou hiperplasia de células hilares. Em conclusão, a presença de massa adrenal em uma paciente com hirsutismo pode levar ao diagnóstico errado. Neste caso, o teste de supressão com análogo de GnRH foi fundamental para se determinar a origem da hiperandrogenemia.

Prevalence of abnormalities of glucose metabolism in patients with polycystic ovary syndrome

Patients with polycystic ovary syndrome (PCOS) present a higher risk for abnormalities of glucose metabolism (AGM). For to study this in our population, we submitted 85 patients, with body mass index (BMI) of 28.5 ± 6.6 kg/m² and aged 25.5 ± 5.4 years old, to an oral glucose tolerance test (OGTT), and assessed the impact of BMI on the prevalence of impaired glucose tolerance (IGT) and of diabetes mellitus (DM). The states of glucose tolerance were classified considering fasting plasma glucose (FPG) according to the American Diabetes Association (ADA) criterion and plasma glucose at 120 minutes according to the Word Health Organization (WHO) criterion. According to the ADA criteria, 83.5 percent classified as normal and 16.5 percent as with AGM, with 15.3 percent presenting impaired fasting glucose and 1.2 percent DM, while according to the WHO criteria, 68.2 percent were classified as normal and 31.8 percent as with AGM, with 27.0 percent of them presenting IGT and 4.8 percent DM. Seventy-three percent of PCOS patients with IGT by WHO criterion had normal FPG by ADA criterion. The prevalence of AGM for both criteria increased with the body mass index. In conclusion, we found a higher prevalence of AGM in PCOS patients than that found in the general population, being the highest in obese patients. Glycemia at 120 minutes on the OGTT identified more patients with AGM than fasting glycemia. We recommended that the assessment of AGM must be done by the OGTT in all patients with PCOS.

Pacientes com a síndrome dos ovários policísticos (SOP) têm um risco maior para desenvolver anormalidades do metabolismo da glicose (AMG). Para avaliarmos a prevalência dessas anormalidades na nossa população, submetemos 85 pacientes, com índice de massa corporal (IMC) de 28,5 ± 6,6 kg/m² e média etária de 25,5 ± 5,4 anos, a teste de tolerância oral à glicose (TTOG). Os estados de tolerância à glicose foram classificados considerando a glicemia de jejum (GJ; American Diabetes Association - ADA) e glicemia aos 120 minutos (G120; Organização Mundial de Saúde - OMS). De acordo com a ADA, 83,5 por cento das pacientes foram normais e 16,5 por cento com AMG, com 15,3 por cento apresentando glicemia de jejum imprópria e 1,2 por cento diabetes mellitus (DM). De acordo com a OMS, 68,2 por cento foram normais e 31,8 por cento com AMG, com 27,0 por cento apresentando intolerância à glicose (IG) e 4,8 por cento DM. Observamos que 73 por cento das pacientes com IG pelos critérios da OMS apresentavam GJ normal pelos critérios da ADA. A prevalência de AMG para ambos os critérios foi maior entre as pacientes com IMC mais elevado. Conclusão: encontramos maior prevalência de AMG nas pacientes com a SOP do que na população geral, sendo mais elevada entre as pacientes obesas. Além disso, a G120 no TTOG identificou maior número de pacientes com AMG do que a GJ. Assim, recomendamos avaliação de AMG através do TTOG para todas as pacientes portadoras da SOP.

Impact of body mass index on blood pressure levels in patients with polycystic ovary syndrome

As there is controversy about the prevalence of hypertension in patients with polycystic ovary syndrome (PCOS) and, up to the present moment, no studies have evaluated the impact of body mass index (BMI) on blood pressure levels (BP) in these patients, we studied retrospectively sixty-nine patients with PCOS, with BMI of 29.0 ± 6.7 kg/m² and aged 25.6 ± 5.6 yr, subdivided into three groups according to BMI (normal, overweight and obese) and evaluated regarding BP (mercury sphygmomanometer), basal hormonal profile, fasting glucose, and insulin sensitivity (HOMA-IR). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were normal (118.1 ± 17.0 and 74.7 ± 11.5 mmHg, respectively), with a hypertension prevalence of 20.3 percent. Of these patients, 78.6 percent were obese and 21.4 percent were overweight. When the groups were compared according to BMI, a significant increase in SBP and DBP was observed (higher in overweight and obese patients for SBP and higher in obese for DBP), as well as a significant progressive increase in glucose, insulin, homeostatic model assessment, and a significant progressive decline in LH levels. When the patients were subdivided as normotensive or hypertensive, a significant difference was observed only for BMI (28.2 ± 6.1 and 34.7 ± 8.6 kg/m², respectively; p = 0.007). In conclusion, we observed a significant and progressive impact of BMI on blood pressure levels in our patients with polycystic ovary syndrome.

Como há controvérsia sobre a prevalência de hipertensão arterial em pacientes com a síndrome dos ovários policísticos (SOP) e, até o momento, nenhum estudo avaliou o impacto do índice de massa corporal (IMC) sobre a pressão arterial (PA), foram estudados retrospectivamente 69 pacientes com a SOP, com IMC de 29,0 ± 6,7 kg/m² e idade de 25,6 ± 5,6 anos, subdivididos em 3 grupos de acordo com o IMC (normal, sobrepeso e obesos) e avaliados com relação à PA, perfil hormonal basal, glicemia de jejum e sensibilidade à insulina (HOMA-IR). As médias das pressões arteriais sistólica (PAS) e diastólica (PAD) foram normais (118,1 ± 17,0 e 74,7 ± 11,5 mmHg, respectivamente), com uma prevalência de hipertensão de 20,3 por cento. Das pacientes hipertensas, 78,6 por cento eram obesas e 21,4 por cento apresentavam sobrepeso. Quando os grupos, subdivididos de acordo com o IMC, foram comparados, aumento significativo da PAS e PAD foi observado (PAS maior nas pacientes com sobrepeso e obesas e PAD maior nas pacientes obesas), assim como um aumento progressivo da glicemia, insulina e HOMA-IR, e um decréscimo significante e progressivo de LH. Quando as pacientes foram subdivididas em normotensas e hipertensas, diferença significativa foi observada somente para IMC (28,2 ± 6,1 e 34,7 ± 8,6 kg/m², respectivamente; p = 0,007). Em conclusão, observamos um impacto significativo e progressivo do IMC sobre os níveis pressóricos em nossas pacientes com a síndrome dos ovários policísticos.

Metabolic syndrome in women with polycystic ovary syndrome: prevalence, characteristics and predictors

The aim of this study was to determine the prevalence of metabolic syndrome in women with polycystic ovary syndrome, as well as its characteristics and predictors. Seventh-three women, with body mass index of 30.4 ± 7.8 kg/m² and 25.0 ± 6.0 years old, subdivided according to body mass index, were studied retrospectively. There was no significant mean age difference among body mass index groups (p = 0.228). Prevalence of metabolic syndrome was 38.4 percent, with a null prevalence for normal (n = 18), 23.8 percent for overweight (n = 17), 62.9 percent for obese (n = 28), and 85.5 percent for morbidly obese women (n = 7). Women with metabolic syndrome were older than women without metabolic syndrome (27.3 ± 5.3 vs. 24.2 ± 4.6 vs. years old; p = 0.031) and presented a higher body mass index (36.3 ± 7.7 vs. 26.9 ± 5.4; p < 0.001). There was no difference for degree of hirsutism and menstrual patterns between women with and without metabolic syndrome (p = 0.593 and p = 0.119, respectively). Regarding laboratory parameters, DHEAS was lower (1,646 ± 1,007 vs. 2,594 ± 1,563; p = 0.007) and HOMA-IR were higher (9.9 ± 9.7 vs. 4.6 ± 4.7; p = 0.004) in women with metabolic syndrome (p = 0.031 and p < 0.001, respectively). The best predictors of metabolic syndrome were waist circumference > 88 cm, HDL-cholesterol < 50 mg/dL and triglycerides > 150 mg/dL.

O objetivo deste estudo foi o de determinar a prevalência, características e preditores da síndrome metabólica em mulheres com a síndrome dos ovários policísticos. Setenta e três mulheres, com índice de massa corporal de 30,4 ± 7,8 kg/m² e 25,0 ± 6,0 anos de idade, subdivididas de acordo com o índice de massa corporal, foram estudadas retrospectivamente. Não se observou diferença significativa de idade entre os grupos (p = 0,228). A prevalência da síndrome metabólica foi de 38,4 por cento, estando ausente nas mulheres com índice de massa corporal normal (n = 18) e presente em 23,8 por cento das com sobrepeso (n = 17), 62,9 por cento das obesas (n = 28) e 85,5 por cento das obesas mórbidas (n = 7). Quando comparadas, as mulheres com síndrome metabólica apresentaram uma idade mais avançada (27,3 ± 5,3 vs. 24,2 ± 4,6 anos; p = 0,031) e um índice de massa corporal maior (36,3 ± 7,7 vs. 26,9 ± 5,4; p < 0,001) que as mulheres sem a síndrome, não havendo diferença significativa com relação ao grau de hirsutismo (p = 0,593) e padrão menstrual (p = 0,119). Com relação aos parâmetros laboratoriais, a concentração de DHEAS foi menor (1.646 ± 1.007 vs. 2.594 ± 1.563; p = 0,007) e o valor do HOMA-IR foi maior (9,9 ± 9,7 vs. 4,6 ± 4,7; p = 0,004) nas pacientes com a síndrome metabólica. Os melhores preditores para a presença da síndrome metabólica foram a circunferência abdominal > 88 cm, HDL-colesterol < 50 mg/dL e triglicérides > 150 mg/dL.