RESUMO
PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p<0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p <0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG <33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.
Assuntos
Hirsutismo/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Oligomenorreia/sangue , Globulina de Ligação a Hormônio Sexual/biossíntese , Disfunções Sexuais Fisiológicas/sangue , Adolescente , Adulto , Algoritmos , Estudos Transversais , Feminino , Hirsutismo/complicações , Humanos , Hiperandrogenismo/sangue , Hiperandrogenismo/complicações , Inflamação , Doenças Metabólicas/sangue , Doenças Metabólicas/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Oligomenorreia/complicações , Pacientes Ambulatoriais , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Disfunções Sexuais Fisiológicas/complicações , Ultrassonografia Doppler , Adulto JovemRESUMO
CONTEXT: Anti-Müllerian hormone (AMH) measured in adolescence as biomarker for prediction of adult polycystic ovary syndrome (PCOS) is doubtful but not substantiated. OBJECTIVE: To investigate whether serum AMH levels and other PCOS-associated features in adolescence can predict the presence of PCOS in adulthood. DESIGN AND SETTING: A long-term follow-up study based on a unique adolescent study on menstrual irregularities performed between 1990 and 1997. PARTICIPANTS AND INTERVENTIONS: AMH was assayed in 271 adolescent girls. Data on PCOS features were combined with AMH levels. In 160 of the 271 (59%) participants, we collected information in adulthood about their menstrual cycle pattern and presence of PCOS (features) by questionnaire 2 decades after the initial study. RESULTS: AMH was higher in adolescent girls with oligomenorrhea compared with girls with regular cycles, median (interquartile range): 4.6 (3.1-7.5) versus 2.6 (1.7-3.8) µg/L (Pâ <â 0.001). Women with PCOS in adulthood had a higher median adolescent AMH of 6.0 compared with 2.5 µg/L in the non-PCOS group (Pâ <â 0.001). AMH at adolescence showed an area under the receiver operating characteristic curve for PCOS in adulthood of 0.78. In adolescent girls with oligomenorrhea the proportion developing PCOS in adulthood was 22.5% (95% CI, 12.4-37.4) against 5.1% (95% CI, 2.1-12.0) in girls with a regular cycle (Pâ =â 0.005). Given adolescent oligomenorrhea, adding high AMH as factor to predict adult PCOS or adult oligomenorrhea was of no value. CONCLUSIONS: Adolescent AMH either alone or adjuvant to adolescent oligomenorrhea does not contribute as prognostic marker for PCOS in adulthood. Therefore, we do not recommend routine its use in clinical practice.
Assuntos
Desenvolvimento do Adolescente/fisiologia , Hormônio Antimülleriano/sangue , Síndrome do Ovário Policístico/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Ciclo Menstrual/sangue , Distúrbios Menstruais/sangue , Distúrbios Menstruais/diagnóstico , Distúrbios Menstruais/epidemiologia , Distúrbios Menstruais/etiologia , Países Baixos/epidemiologia , Oligomenorreia/sangue , Oligomenorreia/diagnóstico , Oligomenorreia/epidemiologia , Oligomenorreia/etiologia , Ovário/diagnóstico por imagem , Ovário/crescimento & desenvolvimento , Ovário/patologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/epidemiologia , Prevalência , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVE: To test the hypothesis that the polycystic ovary syndrome (PCOS) phenotype, or its component features, is less severe in adolescents than in young adult patients, in a referred (clinical) population. DESIGN: Cross-sectional study. SETTING: Tertiary-care academic medical center. PATIENT(S): Two hundred seventy-four adolescents and young adults aged 13.0-24.9 years with PCOS according to the National Institute of Health 1990 criteria. Patients were categorized as adolescents (AD: 13.0-18.9 years; n = 91) and young adults (YA: 19.0-24.9 years; n = 183). Adolescents were further categorized as early adolescents (Early-AD: 13.0-15.9 years; n = 31) and late adolescents (Late-AD: 16.0-18.9 years; n = 60). INTERVENTION(S): History, physical examination, hormonal assays with the use of standardized protocols. MAIN OUTCOME MEASURE(S): Unadjusted and adjusted odds ratios (ORs; adjusted for body mass index [BMI] when applicable) were calculated for biochemical hyperandrogenism (HA), hirsutism (HIR), acne, and degree of oligo/amenorrhea (OA). PCOS phenotypes were classified as HIR+HA+OA, HA+OA, and HIR+OA. RESULT(S): Our analysis demonstrated minimal significant difference in the prevalence of the three PCOS phenotypes, or component features, between AD and YA patients. The risks for obesity were higher for YA versus AD, and the risk of acne was lower for YA versus AD. There was no significant difference between Early-AD and Late-AD. BMI-adjusted models did not significantly modify the main findings. CONCLUSION(S): The present study suggests that the PCOS phenotype is established in early adolescence, remains constant into adulthood, and is not related to BMI.
Assuntos
Síndrome do Ovário Policístico/epidemiologia , Acne Vulgar/sangue , Acne Vulgar/diagnóstico , Acne Vulgar/epidemiologia , Adolescente , Fatores Etários , Alabama/epidemiologia , Amenorreia/sangue , Amenorreia/diagnóstico , Amenorreia/epidemiologia , Biomarcadores/sangue , Índice de Massa Corporal , Estudos Transversais , Sulfato de Desidroepiandrosterona/sangue , Feminino , Hirsutismo/sangue , Hirsutismo/diagnóstico , Hirsutismo/epidemiologia , Humanos , Hiperandrogenismo/sangue , Hiperandrogenismo/diagnóstico , Hiperandrogenismo/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Oligomenorreia/sangue , Oligomenorreia/diagnóstico , Oligomenorreia/epidemiologia , Fenótipo , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/diagnóstico , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Globulina de Ligação a Hormônio Sexual/análise , Testosterona/sangue , Adulto JovemRESUMO
INTRODUCTION: Vitamin D (VD) plays a crucial role in calcium metabolism as well as immunological and endocrine homeostasis. Previous studies revealed strong inverse correlation between VD levels and insulin resistance, parathyroid dysfunctions and autoimmune thyroid disease. Insufficient evidence concerns its dependency of ovarian hormones. Malfunctioning of the ovaries results in menstrual disorders that are one of the most common endocrine impairments in young women of reproductive age. MATERIAL AND METHODS: The study was aimed to evaluate the correlation between 25(OH)D serum concentration and estradiol, testosterone as well as body mass index (BMI) in women with oligomenorrhea. 134 women of reproductive age with oligomenorrhea were eligible for the study. 25-hydroxyvitamin D [25(OH)D], estradiol, testosterone and sex hormone-binding globulin (SHBG) were measured using chemiluminescence immunoassay. Free androgen index (FAI) and body mass index (BMI) were calculated. RESULTS: Critical 25(OH)D deficiency (<10 ng/ml) was found in 13.4% of women, the risk of deficiency (<30 mg/dl) was diagnosed in 69.4%, while sufficient level of VD (>30 mg/ml) in 17.2% of them. Significant negative correlation was detected between 25(OH)D and estradiol serum concentrations (r=-0.2; p=0.049), as well as BMI levels (r=-0.22; p=0.01). However, no significant correlation was found between 25(OH)D and testosterone (r=-017; p=0.055), SHBG (r=0.08; p=0.4) and FAI (r=-0.1; p=0.24). CONCLUSIONS: Thorough assessment of vitamin D deficiency/insufficiency is required among patients with menstrual disorders, especially those overweighed and obese. Early screening and VD supplementation in women with estrogen-dependent disorders may become a part of routine management in order to optimize endocrine health.
Assuntos
Obesidade/sangue , Oligomenorreia/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adolescente , Adulto , Índice de Massa Corporal , Estradiol/sangue , Feminino , Humanos , Distúrbios Menstruais/sangue , Distúrbios Menstruais/epidemiologia , Obesidade/epidemiologia , Oligomenorreia/epidemiologia , Sobrepeso/sangue , Sobrepeso/epidemiologia , Fatores de Risco , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangue , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Adulto JovemRESUMO
STUDY OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism and chronic anovulation, which affects 5%-10% of reproductive-age women. Diagnosis of adult patients with PCOS is made easily with clinical and laboratory methods and the anti-Müllerian hormone (AMH) level are accepted as a good indicator. However, there is still no complete consensus on the diagnosis of PCOS in adolescents. DESIGN AND SETTING: Prospective cohort study, December 2013 to November 2014. PARTICIPANTS: The study was conducted on adolescent girls with oligomenorrhea, with at least 2 years since menarche. The study group consisted of adolescent girls with complete PCOS and incomplete PCOS. A control group was formed of healthy adolescent girls. Complete PCOS was diagnosed according to the Rotterdam criteria, as the presence of all the following characteristics: oligomenorrhea, hyperandrogenism, and polycystic ovarian morphology on ultrasound image. Incomplete PCOS was accepted as "oligomenorrhea and polycystic ovarian morphology," or "oligomenorrhea and hyperandrogenism." INTERVENTIONS AND MAIN OUTCOME MEASURES: All patients underwent a physical examination and the anthropometric assessments, insulin resistance, and acanthosis nigricans were recorded. It was also noted whether or not the patient had an acne score. The Ferriman-Gallwey score was applied to evaluate hirsutism. RESULTS: The results of this study showed that no statistically significant difference was found between the PCOS and incomplete PCOS groups and the control group with respect to AMH levels. CONCLUSION: The use of adult-specific diagnostic methods in adolescence might result in an incomplete diagnosis and inadequate treatment plan. Although the serum AMH level clearly facilitates the diagnosis of PCOS, the use of the AMH level in adolescence in PCOS diagnosis is still controversial and further studies are needed.
Assuntos
Hormônio Antimülleriano/sangue , Síndrome do Ovário Policístico/sangue , Adolescente , Estudos de Coortes , Feminino , Humanos , Menarca , Oligomenorreia/sangue , Oligomenorreia/etiologia , Estudos ProspectivosRESUMO
The aim of this study was to investigate the clinical, endocrine, metabolic features and prevalence of metabolic syndrome (MBS) in Turkish adolescents with polycystic ovary syndrome (PCOS) and the differences in metabolic parameters between adolescent PCOS with or without the presence of polycystic ovaries (PCO) on ultrasound. Subjects (n = 77) were classified into two groups: oligomenorrhea (O) and clinical and/or biochemical hyperandrogenism (HA) (n = 38), without PCO and O + HA with PCO (n = 39). The control group consisted of 33 age-matched adolescents. Adolescents with PCOS had a significantly higher body mass index (BMI), waist circumference and levels of LH, LH/FSH ratio, triglyceride, insulin, HOMA-IR, free androgen index and lower levels of SHBG and FSH. After adjustment for BMI, LH, LH: FSH ratio remained significantly higher. Adolescents with PCOS had a higher prevalence of MBS. No significant differences in lipid profiles, insulin levels and insulin sensitivity in both the PCOS groups were seen. HDL-C levels were lower in the O + HA + PCO group compared to the controls. BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS. Impact statement Many studies have investigated the effect of PCOS on metabolic and cardiovascular risks. It is thought that PCOS increases metabolic and cardiovascular risks. Increase in metabolic and cardiovascular risks associated with PCOS may be handled with early diagnosis and early intervention of PCOS in adolescents, although the diagnosis of PCOS in adolescents could be hard because of the features of PCOS overlapping normal pubertal physiological events. However, early identification of adolescent girls with PCOS may provide opportunities for prevention of well-known health risks associated with this syndrome and reduction of long-term health consequences of PCOS by reducing androgen levels and improving metabolic profile. Our results also support that BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS.
Assuntos
Hiperandrogenismo/sangue , Oligomenorreia/sangue , Síndrome do Ovário Policístico/sangue , Adolescente , Análise de Variância , Índice de Massa Corporal , Estudos de Casos e Controles , Sulfato de Desidroepiandrosterona/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hiperandrogenismo/epidemiologia , Hiperandrogenismo/etiologia , Hiperandrogenismo/fisiopatologia , Hormônio Luteinizante/sangue , Síndrome Metabólica , Oligomenorreia/etiologia , Oligomenorreia/fisiopatologia , Síndrome do Ovário Policístico/diagnóstico por imagem , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/fisiopatologia , Prolactina/sangue , Estudos Prospectivos , Fatores de Risco , Turquia/epidemiologia , UltrassonografiaRESUMO
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine and metabolic disorder, characterized by chronic anovulation/oligomenorrhea, hyperandrogenism, and insulin-resistance. Moreover, some studies propose a possible association between insulin resistance and hyperhomocysteinemia, which is a significant long-term risk for factor for atherogenesis and chronic vascular damage, especially in situations where insulin levels are increased. Insulin-sensitizing agents are used in the treatment of PCOS: in fact, inositols were shown to have insulin-mimetic properties. Synergic action to myo-inositol is that of gymnemic acids that have antidiabetic, anti-sweetener, and anti-inflammatory activities. Gymnemic acid formulations have also been found useful against obesity due to their ability to delay the glucose absorption in the blood. L-methyl-folate increases peripheral sensitivity to insulin, maintaining folatemia stable, and thus restoring normal homocysteine levels. Unlike folic acid, L-methyl folate has a higher bioavailability, no drug/food interferences, high absorption, and it is stable to UV-A exposure. The aim of our study is to compare the clinical, endocrine, and metabolic parameters in 100 PCOS women treated with myo-inositol, gymnemic acid, and l-methylfolate (Group A) or myo inositol and folic acid only (Group B), continuously for 6 months. From a clinical point of view, it was noticed a more significant improvement of the menstrual cycle regularity and a more significant reduction of BMI in Group A. Moreover, a more significant decrease of total testosterone and increase of SHBG serum levels were noticed in Group A. The metabolic assessment found a more significant decrease of total cholesterol and homocysteine levels; OGTT glycemia and insulinemia values were significantly more improved after treatment with myo-inositol + gymnemic acid. In conclusion, we can state that a good option for the treatment of PCOS is the combined administration of myo-inositol + gymnemic acid + l-methyl-folate, especially for overweight/obese patients with marked insulin resistance and with associated hyperhomocysteinemia.
Assuntos
Hiperandrogenismo/tratamento farmacológico , Inositol/uso terapêutico , Oligomenorreia/tratamento farmacológico , Síndrome do Ovário Policístico/tratamento farmacológico , Saponinas/uso terapêutico , Tetra-Hidrofolatos/uso terapêutico , Triterpenos/uso terapêutico , Adulto , Glicemia , Índice de Massa Corporal , Peso Corporal/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Humanos , Hiperandrogenismo/sangue , Inositol/administração & dosagem , Insulina/sangue , Resistência à Insulina , Ciclo Menstrual/efeitos dos fármacos , Oligomenorreia/sangue , Síndrome do Ovário Policístico/sangue , Saponinas/administração & dosagem , Tetra-Hidrofolatos/administração & dosagem , Resultado do Tratamento , Triterpenos/administração & dosagem , Adulto JovemRESUMO
Obesity has adverse effects on ovulation, menstrual cyclicity and oocyte development leading to clinical symptoms such as infertility and menstrual disorders. The Roux-en-Y gastric bypass (RYGB) leads to weight loss, improved insulin sensitivity and may improve ovarian function. In 31 premenopausal women, 18 eu- and 13 oligo-/amenorrhoic, we followed the changes in follicular phase sex hormones 3, 6 and 12 month after RYGB. The average weight loss during the first postoperative year was 39.6 kg. The insulin sensitivity and serum insulin improved markedly especially within the first three postoperative months. SHBG increased progressively and was doubled after 12 months. In contrast, total and free androgens and DHEA declined about 50% during the first three postoperative months and remained fairly constant hereafter. One year after surgery, 85% (11/13) of the women with oligo-/amenorrhea gained regular menstrual cycles. Our results indicate that some of the endocrine changes related to regulation of ovarian function occur very early after bariatric surgery.
Assuntos
Amenorreia/sangue , Fase Folicular/sangue , Derivação Gástrica , Hormônios Esteroides Gonadais/sangue , Obesidade , Oligomenorreia/sangue , Avaliação de Resultados em Cuidados de Saúde , Pré-Menopausa/sangue , Globulina de Ligação a Hormônio Sexual/metabolismo , Adulto , Amenorreia/etiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/cirurgia , Oligomenorreia/etiologia , Adulto JovemRESUMO
OBJECTIVE: ADAMTS-1 is a matrix metalloproteinase which cleaves versican in the cumulus oocyte complex under the effect of luteinizing hormone surge in the periovulatory period. Altered levels may have a role in the pathogenesis of polycystic ovary syndrome (PCOS). We aimed to determine the serum versican and ADAMTS-1 (a disintegrin and metalloproteinase with thrombospondin motif-1) levels in PCOS patients and compare the results with healthy controls. METHODS: Thirty-eight patients with PCOS and forty healthy controls aged between 15 and 22 years were included in the study. They were sampled according to their basal hormone, serum versican, and ADAMTS-1 levels. Serum versican and ADAMTS-1 levels were measured by enzyme-linked immunosorbent assay. A multivariate logistic regression model was used to identify the independent risk factors of PCOS. RESULTS: Serum versican levels were significantly decreased in the PCOS group when compared with the controls. The best versican cut-off value for PCOS was calculated to be 33.65 with 76.74% sensitivity and 52.94% specificity. Serum versican levels, homeostasis model assessment of insulin resistance index, a Ferriman-Gallwey score higher than 8, and oligomenorrhea were the strongest predictors of PCOS. Serum versican levels were significantly decreased in PCOS patients. Besides, serum ADAMTS-1 and versican levels were significantly and positively correlated with each other. CONCLUSION: Serum versican levels were significantly decreased in patients with PCOS. This suggests a possible role of versican in ovulatory dysfunction and in the pathogenesis of PCOS.
Assuntos
Proteína ADAMTS1/sangue , Síndrome do Ovário Policístico/sangue , Medição de Risco/métodos , Versicanas/sangue , Adolescente , Índice de Massa Corporal , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Resistência à Insulina , Modelos Logísticos , Análise Multivariada , Oligomenorreia/sangue , Oligomenorreia/diagnóstico , Síndrome do Ovário Policístico/diagnóstico , Curva ROC , Valores de Referência , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND/AIMS: We aimed to investigate whether the anti-Müllerian hormone (AMH) levels in adolescents with polycystic ovary syndrome (PCOS), PCOS risk, and isolated oligomenorrhea (OM) were different than in adolescents with a normal/regular menstrual cycle (NMC). METHODS: The diagnosis of PCOS was based on the 2012 Amsterdam [European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM)] criteria. The PCOS group consisted of cases meeting 3 diagnostic criteria (n = 21), and the PCOS risk group was the 'at risk' group meeting 2 diagnostic criteria (n = 20). Cases with isolated OM that did not satisfy other PCOS diagnostic criteria made up the OM group (n = 21). Thirty adolescent girls with NMCs (21-45 days) were recruited in this study. RESULTS: The AMH levels in the PCOS group were similar to those in the PCOS risk group but significantly higher than those in the OM and NMC groups. The AMH levels in the PCOS risk group were similar to those in the OM group and significantly higher than those in the NMC group. They were also significantly higher in the OM group compared to the NMC group. The specificity for PCOS and PCOS risk with a cutoff value of 7.25 ng/ml for AMH was 72.5% and the sensitivity was 58%. CONCLUSION: An AMH cutoff value of 7.25 ng/ml can be used for the diagnosis of PCOS in the adolescent period.
Assuntos
Hormônio Antimülleriano/sangue , Ciclo Menstrual/sangue , Oligomenorreia , Síndrome do Ovário Policístico , Adolescente , Feminino , Humanos , Oligomenorreia/sangue , Oligomenorreia/diagnóstico , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/diagnóstico , Valor Preditivo dos TestesRESUMO
BACKGROUND: Primary amenorrhea, oligomenorrhea and secondary amenorrhea are diagnosed commonly during adolescence. Weight aberrations are associated with menstrual disorders. Autoimmune thyroiditis is frequent during adolescence. In this study, the commonest clinical and hormonal characteristics of amenorrhea or oligomenorrhea during adolescence were investigated. METHODS: In this cross-sectional study, one hundred and thirty-eight consecutive young patients presenting with amenorrhea or oligomenorrhea referred to an adolescent endocrinology and gynecology university clinic were studied. Clinical examination and an abdominal ultrasound were performed. Testosterone, free-testosterone, estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, sex hormone binding globulin (SHBG), Δ4-androstenedione (Δ4A), free androgen index (FAI), insulin, glucose, thyroid stimulating hormone (TSH), total thyroxine (T4) (TT4), free T4 (FT4), total triiodothyronine (T3) (TT3) and free T3 (FT3). Concentrations were measured in blood samples. RESULTS: Patients with primary and secondary amenorrhea presented more often with body mass index (BMI) <18.5 and BMI >25 kg/m2, respectively. BMI values correlated positively with insulin (r=0.742) and glucose (r=0.552) concentrations and negatively with glucose/insulin ratio values (r=-0.54); BMI values and insulin concentrations correlated positively with FAI values (r=0.629 and r=0.399, respectively). In all patients, BMI values correlated positively and negatively with free testosterone (r=0.249) and SHBG (r=-0.24) concentrations, respectively. In patients with secondary amenorrhea insulin concentrations correlated negatively with SHBG concentrations (r=-0.75). In patients with oligomenorrhea BMI values correlated positively with insulin (r=0.490) and TSH (r=0.325) concentrations, and negatively with SHBG (r=-0.33) concentrations. Seventy-two percent, 21% and 7% of patients presented with TSH concentrations <2.5 µIU/mL, between 2.5 µIU/mL, 4.5 µIU/mL and >4.5 µIU/mL (subclinical hypothyroidism), respectively. Following the definition of polycystic ovary syndrome (PCOS) according to either the National Institutes of Health (NIH) criteria or those proposed in the literature by Carmina and his team, patients presented mainly with oligomenorrhea or secondary amenorrhea. There was good agreement between patients with amenorrhea or oligomenorrhea fulfilling both of the PCOS definition criteria employed. CONCLUSIONS: Among adolescent patients presenting with amenorrhea or oligomenorrhea for the first time those with low and high BMI present more often with primary and secondary amenorrhea, respectively. Obesity is involved in the development of hyperandrogenemia and hyperinsulinemia, particularly in PCOS patients. In these patients, subclinical hypothyroidism may be concealed and it should be investigated. These patients should be treated for abnormally increased or decreased BMI and be investigated for autoimmune thyroiditis.
Assuntos
Amenorreia/etiologia , Índice de Massa Corporal , Hipotireoidismo/complicações , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/complicações , Adolescente , Adulto , Amenorreia/sangue , Estudos Transversais , Feminino , Humanos , Insulina/sangue , Oligomenorreia/sangue , Globulina de Ligação a Hormônio Sexual/análiseRESUMO
The aim of this study was to evaluate and compare the effects of spironolactone and spironolactone plus metformin treatments on body mass index (BMI), hirsutism score, hormone levels, and insulin resistance in women with polycystic ovary syndrome (PCOS). Thirty-seven patients with PCOS were randomly assigned to receive spironolactone 100 mg/d (spironolactone group, 18 patients) or spironolactone 100 mg/d plus metformin 2000 mg/d (combination group, 19 patients) for 12 months. BMI, modified Ferriman-Gallway score (FGS), serum levels of regarding hormones, and homeostasis model assessment of insulin resistance (HOMA-IR) index were assessed before and after the treatments. Six patients in the spironolactone group and four patients in the combination group reported inter-menstrual vaginal bleeding during treatments. In hirsutism scores, the spironolactone therapy resulted in 25.2% reduction, while combination therapy resulted in 28.3% reduction (p > 0.05, between groups). When the groups were compared in terms of percent changes in BMI, FGS, HOMA-IR, and hormone values other than free testosterone, no significant difference was noted. In the present study, FGSs were significantly decreased in both groups; however, combination therapy was not more effective than spironolactone alone in terms of BMI, FGS, hormone levels, or insulin resistance.
Assuntos
Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Síndrome do Ovário Policístico/tratamento farmacológico , Espironolactona/uso terapêutico , Adolescente , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Sulfato de Desidroepiandrosterona/sangue , Quimioterapia Combinada , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Hirsutismo/sangue , Hirsutismo/tratamento farmacológico , Hirsutismo/etiologia , Humanos , Hidrocortisona/sangue , Resistência à Insulina , Hormônio Luteinizante/sangue , Metrorragia/induzido quimicamente , Oligomenorreia/sangue , Oligomenorreia/tratamento farmacológico , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangue , Resultado do Tratamento , Adulto JovemRESUMO
UNLABELLED: Polycystic ovary syndrome (PCOS) is a diagnosis of exclusion. We present two cases of women with oligomenorrhoea and high concentration of androstendione, suggestive of possible androgen-secreting tumour; caused by assay interference. The first patient, investigated for oligomenorrhoea, had no significant hirsutism or acne. Androstendione concentration was above 10.0 ng/ml (rr: 0.3-3.3 ng/ml). In order to rule out possible androgen-secreting tumour or hypercortisolaemia we performed 48-hour low dose dexamethasone suppression test (LDDST). This failed to demonstrate adequate suppression of androstendione (6.05 ng/ml and 9.32 ng/ml after the first and the second day respectively). Pelvic ultrasound examination showed polycystic ovaries, while abdominal CTscan failed to show any ovarian or adrenal lesion. Despite such high androstendione concentrations, urinary steroid profile (gas chromatography/mass spectrometry method) yielded normal results. Hence a possibility of androstendione assay interference was raised. The second patient was also admitted for investigations of oligomenorrhoea. Clinical examination was unremarkable. There was a high concentration of testosterone 0.78 ng/ml (rr. 0.084-0.481 ng/ml) and androstendione above 10.0 ng/ml (rr: 0.3-3.3 ng/ml). LDDST failed to demonstrate any suppression of androstendione, while recalculated concentrations of androstendione after serial dilutions were markedly lower in comparison to initial values. Therefore, such high androstendione concentrations (i.e. above the upper limit of the assay) must have resulted from assay interference. In both cases a final diagnosis of PCOS was established. CONCLUSIONS: In the absence of clinical features, contrasting with unusually high androgen levels, a possibility of androgen assay interference should be considered in differential diagnosis of hyperandrogenism or PCOS.
Assuntos
Androstenodiona/sangue , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Adulto , Dexametasona , Feminino , Humanos , Hiperandrogenismo/diagnóstico , Oligomenorreia/sangue , Síndrome do Ovário Policístico/sangue , Adulto JovemRESUMO
OBJECTIVE: Menstrual irregularity is one of the major complaints in women of reproductive age. The aim of this study was to evaluate the complications in women with different menstrual disturbances. MATERIALS AND METHODS: This is a retrospective study. A total of 576 women were screened first, and 470 women were included later [257 women with oligo/amenorrhea (149 hyperandrogenic and 108 nonhyperandrogenic women) and 213 normocyclic controls]. Endocrine and metabolic parameters and insulin resistance were compared among different menstrual patterns. RESULTS: The average duration of menstrual cycle length was positively correlated with age, levels of androgens and prolactin, lipid profiles, and the parameters of insulin resistance. Hyperandrogenic women with amenorrhea had higher levels of androgens and more lipid profiles disorders than hyperandrogenic women with oligomenorrhea. However, nonhyperandrogenic women with amenorrhea had a degree of insulin resistance and metabolic disturbance similar to that of nonhyperandrogenic women with oligomenorrhea. Interestingly, for women with normal prolactin levels, serum prolactin levels were significantly lower in amenorrhea than oligomenorrhea in both hyperandrogenic and nonhyperandrogenic groups. CONCLUSION: The degree of menstrual disturbances does not correlate with the severity of insulin resistance and metabolic disturbances in women without excess levels of androgen. For women with normal prolactin levels, amenorrheic patients had significantly lower serum prolactin levels than oligomenorrheic patients.
Assuntos
Amenorreia/sangue , Amenorreia/complicações , Resistência à Insulina , Síndrome Metabólica/complicações , Oligomenorreia/sangue , Oligomenorreia/complicações , Adulto , Androgênios/sangue , Dislipidemias/complicações , Feminino , Humanos , Hiperandrogenismo/complicações , Síndrome do Ovário Policístico/complicações , Prolactina/sangue , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
The objective was to investigate whether the associations between leptin, adiponectin, andadiposity reported in classic polycystic ovary syndrome (PCOS) are also observed in elderly women with a novel putative postmenopausal PCOS phenotype. We studied 713 postmenopausal community-dwelling women. Diagnosis of the novel phenotype required the presence of ≥3 diagnostic features including: 1) a personal history of oligomenorrhea; 2) history of infertility or miscarriage; 3) current or past clinical or hormonal evidence of hyperandrogenism; 4) central obesity; 5) biochemical evidence of insulin resistance. Women in the control group had ≤2 of these components. Mean age (±SD) was 74±8 years for the study cohort. Sixty-six women (9.3%) had the putative PCOS phenotype. Serum leptin was higher (mean 25.70±15.67 vs 14.94+9.89 ng/mL, P<.01) and adiponectin lower (mean 11.72±4.80 vs 17.31±7.45 µg/mL, P<.01) in cases vs controls. Leptin was positively, and adiponectin inversely, associated with an increasing number of phenotype features (P<.01 for linearity). In age-adjusted regression analysis, adjustment for waist circumference eliminated the association between leptin and the PCOS phenotype, but not the association between adiponectin and the PCOS phenotype. In this novel postmenopausal PCOS phenotype, adipocytokine profiles and their associations with adiposity parallel those reported in younger women with classic PCOS. These results support our hypothesis that a putative phenotype analogous to PCOS can be identified in postmenopausal women using clinical and biochemical criteria. Use of this novel phenotype could provide a basis for studies of the delayed consequences of PCOS in older women.
Assuntos
Adiponectina/sangue , Leptina/sangue , Obesidade/sangue , Síndrome do Ovário Policístico/sangue , Pós-Menopausa , Aborto Espontâneo/sangue , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Feminino , Humanos , Hiperandrogenismo/sangue , Infertilidade Feminina/sangue , Resistência à Insulina , Anamnese , Pessoa de Meia-Idade , Obesidade Abdominal/sangue , Oligomenorreia/sangue , Fenótipo , Pré-MenopausaRESUMO
OBJECTIVE: The aim of this study was to evaluate the prevalence of hyperprolactinemia in adolescents and young women with menstrual problems. STUDY DESIGN: This study included 1704 young women with menstruation-related problems. The patients were classified into group I (age, 11-20 years) or group II (age, 21-30 years); the prevalence of hyperprolactinemia was analyzed according to age and categories of menstruation-related problems. RESULTS: For primary amenorrhea and oligomenorrhea, the prevalence of hyperprolactinemia was low in both groups. However, hyperprolactinemia was a relatively common cause of secondary amenorrhea (5.5% for group I and 13.8% for group II, respectively); it was more frequent in group II (P = .001); the prevalence of prolactinoma was also higher in group II (P = .015). For abnormal uterine bleeding, hyperprolactinemia was more common in group II (2.6% for group I and 9.4% for group II; P < .001), but causes were similar. CONCLUSION: Hyperprolactinemia is not rare in young women with menstruation-related problems; its prevalence varies according to age and manifestations.
Assuntos
Amenorreia/epidemiologia , Hiperprolactinemia/epidemiologia , Oligomenorreia/epidemiologia , Adolescente , Adulto , Amenorreia/sangue , Criança , Feminino , Humanos , Hiperprolactinemia/sangue , Metrorragia/sangue , Metrorragia/epidemiologia , Oligomenorreia/sangue , Prevalência , Prolactina/sangue , Prolactinoma/sangue , Prolactinoma/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to describe the endocrine and metabolic characteristics of Chinese women with polycystic ovarian syndrome (PCOS) according to different phenotypes, including menstrual cycle pattern and body mass index (BMI). DESIGN: Retrospective study. PATIENT(S): A total of 3539 patients with PCOS and 590 controls were recruited from the Centre for Reproductive Medicine. Patients with PCOS were divided into three groups according to the characteristics of the menstrual cycle (amenorrhoea, oligomenorrhea and eumenorrhea) and the BMI (<25 kg/m(2) ; 25 ≤ and ≤ 30 kg/m(2) ; and BMI > 30 kg/m(2) ). MEASUREMENTS: Waist circumference, hip circumference, weight, height, Ferriman-Gallwey score, and endocrine and metabolic variables were measured. RESULTS: The serum testosterone, luteinizing hormone (LH) and oral glucose tolerance test 2 h-glucose levels were increased in the amenorrhoea group (P < 0·05). The triglycerides (TG) and low-density lipoprotein-cholesterol (LDL) levels were the highest in the amenorrhoea group (P < 0·05). The same trend existed in total cholesterol and non- high-density lipoprotein-cholesterol (HDL) levels, although there was no statistical significance (P > 0·05). Subjects with a BMI<25 kg/m(2) had higher values of follicle stimulating hormone (FSH), LH, LH/FSH and prolactin (P < 0·001) than the other two groups. The levels of TG, LDL and non-HDL and the indices of glucose and insulin metabolism increased with the change in BMI (P < 0·001). CONCLUSIONS: The amenorrhoea group had severe endocrine and metabolic abnormalities, which appeared to be related to latent long-term complications and higher morbidity. The degree of dysbolism was positively associated with the change in BMI.
Assuntos
Amenorreia/sangue , Hormônios/sangue , Lipídeos/sangue , Oligomenorreia/sangue , Síndrome do Ovário Policístico/sangue , Adulto , Amenorreia/etnologia , Amenorreia/metabolismo , Análise de Variância , Povo Asiático , Glicemia/metabolismo , Índice de Massa Corporal , China , Colesterol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Insulina/sangue , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Hormônio Luteinizante/sangue , Oligomenorreia/etnologia , Oligomenorreia/metabolismo , Síndrome do Ovário Policístico/etnologia , Síndrome do Ovário Policístico/metabolismo , Prolactina/sangue , Estudos Retrospectivos , Testosterona/sangue , Triglicerídeos/sangue , Adulto JovemRESUMO
OBJECTIVE: To evaluate the performance of antimullerian hormone (AMH) and inhibin B as ovarian function markers for differentiating common causes of secondary oligoamenorrhea, namely hypogonadotrophic hypogonadism (HH), polycystic ovary syndrome (PCOS), premature ovarian failure (POF), and hyperprolactinemia (HPRL). DESIGN: Retrospective analysis. SETTING: Two university hospitals. PATIENT(S): A total of 124 women with secondary oligoamenorrhea and 26 women with normal ovulation. INTERVENTION(S): Serum samples from the subjects were analyzed for AMH and inhibin B. MAIN OUTCOME MEASURE(S): Serum AMH and inhibin B concentrations. RESULT(S): Serum AMH concentration was significantly raised in women having World Health Organization group 2 anovulation, either with or without PCOS, and was significantly decreased to very low levels in POF; the diagnostic accuracy in both conditions was excellent, with areas under the receiver operating characteristic curve (AUC) of 0.913 and 0.977, respectively. The discriminatory performance between HH and PCOS was also good, with AUC 0.861. AMH remained unchanged in HH and HPRL compared with ovulatory control subjects. There were large overlap of serum inhibin B levels in the different conditions, and a significant difference from control subjects existed only in the POF group. CONCLUSION(S): Serum AMH, but not inhibin B concentration, serves as a useful diagnostic tool in the differential diagnosis of secondary oligoamenorrhea.
Assuntos
Hormônio Antimülleriano/sangue , Inibinas/sangue , Oligomenorreia/sangue , Oligomenorreia/diagnóstico , Adolescente , Adulto , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Humanos , Hiperprolactinemia/sangue , Hiperprolactinemia/complicações , Hiperprolactinemia/diagnóstico , Hipogonadismo/sangue , Hipogonadismo/complicações , Hipogonadismo/diagnóstico , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Insuficiência Ovariana Primária/sangue , Insuficiência Ovariana Primária/complicações , Insuficiência Ovariana Primária/diagnóstico , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: We hypothesized that oligomenorrhea (menstrual cyclicity ≥42 days), hyperandrogenism, low levels of sex hormone-binding globulin (SHBG), childhood insulin, and metabolic syndrome (MetS) at age 14 years would predict MetS and class III obesity (body mass index ≥40 kg/m(2)) at age 24 years. STUDY DESIGN: In this prospective study of schoolgirls, at age 14 years, the girls were categorized as regularly cycling (n = 375), oligomenorrheic (n = 18), or oligomenorrhea plus biochemical hyperandrogenism (polycystic ovary syndrome [PCOS]; n = 12), together designated PCOS. RESULTS: Significant explanatory variables for MetS at age 24 years included childhood insulin, MetS, and PCOS category (all positive) and SHBG (negative) at age 14 years. Using categorical data, top decile of childhood insulin, MetS at age 14, bottom decile of SHBG, and PCOS category were significant positive predictors for MetS at age 24. SHBG (negative), black race (positive), and oligomenorrhea (positive) were significant explanatory variables for class III obesity at age 24. Using categorical data, black race, MetS at age 14, bottom decile of SHBG, PCOS category, and top decile of childhood insulin were positive explanatory variables for class III obesity at age 24 years. CONCLUSIONS: Oligomenorrhea, PCOS (a subcohort of oligomenorrhea), hyperandrogenism, low SHBG, MetS, and childhood insulin at age 14 years may represent a critical, reversible pathway for the development of MetS and class III obesity in young adulthood.
Assuntos
Resistência à Insulina , Insulina/sangue , Síndrome Metabólica/etiologia , Obesidade Mórbida/etiologia , Oligomenorreia/complicações , Síndrome do Ovário Policístico/complicações , Globulina de Ligação a Hormônio Sexual/metabolismo , Adolescente , Biomarcadores/sangue , Índice de Massa Corporal , Criança , Progressão da Doença , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hiperaldosteronismo/epidemiologia , Incidência , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Obesidade Mórbida/sangue , Obesidade Mórbida/epidemiologia , Oligomenorreia/sangue , Oligomenorreia/epidemiologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/epidemiologia , Estudos Prospectivos , Curva ROC , Radioimunoensaio , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
CONTEXT: In women with polycystic ovary syndrome (PCOS), the basis for ovarian androgen overproduction involves an overall increase of steroidogenesis, notably in the delta-4 pathway. However, in vitro studies have suggested that excessive androgen production occurs predominantly through the delta-5 pathway. OBJECTIVE: This study was performed to assess androgen dose-responses after human chorionic gonadotropin (hCG) stimulation in PCOS and normal women. DESIGN: We conducted a prospective study to compare androgen production after iv hCG in PCOS and normal women. SETTING: The study was conducted in a General Clinical Research Center in an academic medical center. PARTICIPANTS: Women with PCOS (age, 18-37 yr; n = 10) and normal ovulatory controls (age, 18-37 yr; n = 11) were recruited. INTERVENTIONS: For dose-response studies, blood samples were obtained before and at 0.5, 24, and 48 h after iv recombinant hCG (1, 10, 25, 100, and 250 µg). A subset of subjects underwent frequent blood sampling over 24 h after iv injection of 25 µg of recombinant hCG. MAIN OUTCOME MEASURE(S): We measured basal and stimulated serum 17-hydroxyprogesterone (17-OHP), androstenedione (A), testosterone (T), dehydroepiandrosterone, estradiol, and progesterone responses after hCG administration. RESULTS: In PCOS women, maximal A and T production was observed at the lowest doses of hCG, whereas responses were minimal in normal women. Incremental responses of 17-OHP, estradiol, and progesterone were greater in PCOS compared to normal women. CONCLUSION: In PCOS women, maximal A and T responses to hCG relative to those of 17-OHP are consistent with ovarian androgen overproduction via the delta-5 pathway.