Polycystic Ovary Syndrome and Metabolic Syndrome: Clinical and Laboratory Findings and Non-Alcoholic Fatty Liver Disease Assessed by Elastography / Síndrome dos ovários policísticos e síndrome metabólica: Achados clínicos e laboratoriais e doença hepática gordurosa não alcoólica avaliada por elastografia

Abstract Objective To evaluate the association between polycystic ovary syndrome (PCOS) and metabolic syndrome (MetS), adding liver assessment through elastography and ultrasound, for correlation with non-alcoholic fatty liver disease (NAFLD). Metabolic syndrome occurs in~43% of women with PCOS, and NAFLD is the hepatic expression of MetS. Methods One hundred women, 50 with PCOS and 50 controls, matched by age (18- 35 years) and body mass index (BMI) were included, restricted to patients with overweight and obesity grade 1, at the Assis Chateaubrian Maternity School, Universidade Federal do Ceará, Brazil. For the diagnosis of PCOS, we adopted the Rotterdam criteria, and for the diagnosis of MetS, the criteria of the National Cholesterol Education Program (NCEP/ATP III). Hepatic elastography and ultrasound were performed to assess liver stiffness and echotexture, respectively. Results The average ages were 29.1 (±5.3) and 30.54 (±4.39) years, for the PCOS and the control group, respectively. Patients with PCOS had a risk 4 times higher of having MetS, odds ratio (95% confidence interval)=4.14, than those in the control group. Women with PCOS had higher average of abdominal circumference (100.9±9.08 cm vs 94.96±6.99 cm) and triglycerides (162±54.63 mg/dL vs 137.54±36.91mg/dL) and lower average of HDL cholesterol (45.66±6.88 mg/dL vs 49.78±7.05 mg/dL), with statistically significant difference. Hepatic steatosis was observed on ultrasound in women with PCOS; however, with no statistically significant difference. There was no change to NAFLD at elastography in any group. Conclusion Women with PCOS had 4-fold higher frequency of MetS andmore hepatic steatosis, with no statistically significant difference. There was no change in liver stiffness between the groups at elastography. The results can be extended only to populations of overweight and obesity grade 1, with PCOS or not. They cannot be generalized to other untested groups.

Resumo Objetivo Avaliar a associação entre a síndrome do ovário policístico (SOP) e a síndrome metabólica (SM), agregando avaliação do fígado por elastografia e ultrassonografia, para correlação com doença hepática gordurosa não alcoólica (DHGNA). A SM ocorre em cerca de 43% dasmulheres comSOP, e DHGNA é a expressão hepática da SM. Métodos Foramincluídas 100 mulheres, pareadas por idade (18-35 anos) e índice de massa corporal (IMC), 50 comSOP e 50 controles com sobrepeso e obesidade grau I, na Maternidade-Escola Assis Chateaubriand, Brasil. Para o diagnóstico de SOP, adotamos os critérios de Rotterdam e, para o diagnóstico de SM, os critérios do National Cholesterol Education Program (NCEP/ATP III). Elastografia hepática e ultrassonografia foram realizadas para avaliar a rigidez e a ecotextura do fígado, respectivamente. Resultados As médias de idade foram de 29,1 (±5,3) e 30,54 (±4,39) anos para os grupos SOP e controle, respectivamente. Pacientes com SOP apresentaram risco 4 vezes maior de SM do que aquelas no grupo controle [[razão de chances (intervalo de confiança de 95%) = 4,14]. Mulheres com SOP tiveram maior média de circunferência abdominal (100,9±9,08cm vs 94,96±6,99 cm) e triglicérides (162±54,63 mg/dL vs 137,54±36,91 mg/dL) e menor média de colesterol HDL (45,66±6,88 mg/dL vs 49,78±7,05mg/dL), com diferença estatisticamente significativa. Esteatose hepática foi observada em ultrassonografias de mulheres com SOP, porém sem diferença estatisticamente significativa. Não houve mudança para DHGNA na elastografia em nenhum dos grupos. Conclusão Mulheres com SOP tiveram frequência quatro vezes maior de SM e mais esteatose hepática, sem diferença estatisticamente significativa. Não houve mudança na rigidez do fígado entre os grupos na elastografia. Os resultados podem ser estendidos apenas a populações com sobrepeso e obesidade grau 1, com SOP ou não. Eles não podem ser generalizados para outros grupos não testados.

Increased sympathetic cardiac autonomic modulation after two consecutive tilt tests in women with polycystic ovary syndrome / Aumento da modulação autonômica cardíaca simpática após dois testes de inclinação consecutivos em mulheres com síndrome dos ovários policísticos

Abstract Objective The present study aimed to analyze cardiac autonomic modulation via spectral and symbolic analysis of heart rate variability (HRV) in women with polycystic ovary syndrome (PCOS) who were subjected to two consecutive tilt tests. Methods A total of 64 women were selected and divided into 2 groups: control (without PCOS), and PCOS. Concentrations of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, homocysteine, sex hormone-binding globulin, thyroid stimulating hormone, fasting insulin, testosterone, androstenedione, and 17-hydroxyprogesterone levels, triglycerides, free androgen index (FAI), and homeostasis assessment model (HOMA-IR) were assessed. Cardiac autonomic modulation was evaluated by spectral and symbolic analyses during two consecutive tilt tests (two moments) and supine moments before, between and after (three moments) the tilt tests. Results Women with PCOS had higher fasting insulin, HOMA-IR indexes, testosterone and FAI. Additionally, we observed that the PCOS group had greater sympathetic autonomic cardiac modulation in supine 2, tilt 1, and supine 3 moments compared with controls. Conclusion Women with PCOS had higher autonomic sympathetic cardiac modulation even after a second tilt test. No adaptation to this provocative test was observed. Spectral analysis was more sensitive for identifying differences between groups than the symbolic analysis.

Resumo Objetivo O presente estudo teve como objetivo analisar a modulação autonômica cardíaca por análise espectral e simbólica da variabilidade da frequência cardíaca (VFC) em mulheres com síndrome dos ovários policísticos (SOP) que foram submetidas a dois testes consecutivos de inclinação. Métodos Um total de 64 mulheres foram selecionadas e divididas em 2 grupos: controle (sem SOP) e SOP. Concentrações de hormônio folículo-estimulante, hormônio luteinizante, prolactina, estradiol, homocisteína, globulina de ligação a hormônios sexuais, hormônio estimulante da tireóide, insulina em jejum, testosterona e androstenediona e níveis de 17-hidroxiprogesterona, triglicerídeos, índice de andrógeno livre (FAI) e homeostase modelo de avaliação (HOMA-IR) foram avaliados. A modulação autonômica cardíaca foi avaliada por análises espectrais e simbólicas durante dois testes de inclinação consecutivos (dois momentos) e momentos supinos antes, entre e após (três momentos) os testes de inclinação. Resultados Mulheres com SOP apresentaram insulina em jejuM, índices HOMA-IR, testosterona e FAI mais altos. Além disso, observamos que o grupo PCOS apresentou maior modulação cardíaca autonômica simpática nos momentos supino 2, inclinado 1 e supino 3 em comparação aos controles. Conclusão Mulheres com SOP apresentaram modulação cardíaca simpática autonômica mais alta mesmo após um segundo teste de inclinação. Nenhuma adaptação a esse teste provocativo foi observada. A análise espectral foi mais sensível para identificar diferenças entre os grupos do que a análise simbólica.

Síndrome dos ovários policísticos: conceito, epidemiologia e fisiopatologia aplicada à prática clínica / Polycystic ovary syndrome: concept, epidemiology and pathophysiology applied to clinical practice

Desde 1935, quando Stein e Leventhal descreveram o quadro dos "ovários policísticos", muitos estudos foram desenvolvidos no sentido de aprimorar os conhecimentos sobre esse tema. Contínuas discussões relativas a fisiopatologia, associações clínicas, repercussões sobre a saúde reprodutiva e conduta terapêutica foram realizadas ao longo desse intervalo de tempo. Do ponto de vista clínico, a síndrome dos ovários policísticos (SOP) tem se destacado como uma das desordens endócrinas mais comuns na idade reprodutiva, e sua prevalência varia de 6% a 10% em mulheres na menacme. A sua etiologia ainda permanece uma incógnita, tendo em vista que vários fatores devem estar envolvidos na sua gênese. A sua relação com os desvios do metabolismo lipídico e glicídico tem sido alvo de muitos estudos, pois hoje a SOP é vista como uma doença metabólica, com todas as suas implicações. O foco deixou de ser exclusivamente o sistema reprodutor, mas sim o organismo como um todo, o que tem gerado o interesse e a preocupação de outros profissionais da saúde sobre essas pacientes. Nesta matéria de capa, são abordados todos os aspectos dessa intrigante doença, como a etiologia, a fisiopatologia, a terapia e, especialmente, os desequilíbrios metabólicos que elevam os riscos de doenças cardiovasculares e diabetes nessas pacientes, sobretudo nas obesas. Com tantos recursos científicos disponíveis nos dias de hoje, não é mais possível ao ginecologista, isoladamente, abordar com competência todos os passos dessa terapia complexa das pacientes com SOP. Há necessidade do apoio de outros profissionais da área da saúde, como psicólogo, nutricionista, educador físico, entre outros. Não há dúvidas de que os fenômenos biológicos, psicológicos, sociais e ambientais são todos interdependentes e de que a abordagem das pacientes com SOP deve ser holística e multiprofissional.(AU)

Síndrome de ovarios poliquísticos. Entidad que demanda diagnóstico temprano / Polycystic ovary syndrome, an entity demanding an early diagnosis

RESUMEN El síndrome de ovario poliquístico se ha convertido en un problema de salud pública, siendo el más común de los desórdenes endocrinos en mujeres en edad reproductiva con estudios que reportan una prevalencia de hasta un 21%. El diagnóstico de esta entidad es importante debido a que representa riesgos metabólicos, cardiovasculares y afecta la capacidad reproductiva de estas pacientes. Se realizó una revisión bibliográfica de los principales artículos relacionados sobre el tema, resumiendo los aspectos fundamentales de este problema de salud.

ABSTRACT Polycystic ovary syndrome has become a public health problem, being the most common of the endocrine disorders in reproductive-age women, with studies reporting prevalence by 21 %. The diagnosis of this entity is important because it represents metabolic and cardiovascular risk, and affects the reproductive capacity of these patients. The authors carried out bibliographic review of the main articles related with the theme, summarizing the basic aspects of this health problem.

Could semiquantitative analysis of real-time ultrasound elastography distinguish more liver parenchyma alterations of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome?

ABSTRACT Objective: Nonalcoholic fatty liver disease is the commonest diffuse liver disease, of which women with polycystic ovary syndrome are at an increased risk. The aim of the present study was to assess the diagnostic value of the semiquantitative strain parameters of real-time ultrasound elastography for nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. Subjects and methods: Thirty-five polycystic ovary syndrome patients with nonalcoholic fatty liver disease, 70 polycystic ovary syndrome patients without nonalcoholic fatty liver disease, and 70 healthy female controls of reproductive age were included. All participants underwent ultrasonic examination and semiquantitative analysis of real-time ultrasound elastography of the liver. Results: Main semi quantitative strain parameters, such as average strain value, differed significantly among groups polycystic ovary syndrome with nonalcoholic fatty liver disease, polycystic ovary syndrome without nonalcoholic fatty liver disease, and control (87.02 ± 10.16 vs. 96.31 ± 11.44 vs. 104.49 ± 7.28, p < 0.001). Clinical and laboratory parameters differed significantly between the two subgroups with low or high average strain value. For diagnostic value of average strain value for elevated aminotransferase, the area under the curve was 0.808 (range 0.721-0.895). In multiple linear regression analysis, polycystic ovary syndrome, waist circumference, and metabolic syndrome were stand-alone independent factors associated with average strain value among subjects without nonalcoholic fatty liver disease. Conclusion: Semiquantitative real-time ultrasound elastography analysis could distinguish liver parenchyma alterations in patients with polycystic ovary syndrome more sensitively. The diagnostic value of the proposed method for nonalcoholic fatty liver disease need further research.

Síndrome de ovario poliquístico: casos confirmados y tratamiento en consulta externa del Hospital Escuela Universitario / Polycystic ovary syndrome: confirmed cases and treatment in the outpatient clinic of ̈Hospital Escuela Universitario

El síndrome de ovario poliquísticoes unaendocrinopatía frecuente en la mujer en edad fértil, causado por exceso de andrógenos y es causa de infertilidad anovulatoria. Actualmente uno de los criterios utilizados para el diagnóstico, son los de Rotterdam y para esto se necesita de la clínica (hiperandrogenismo y disfunción ovulatoria), exámenes de laboratorio (hiperandrogenismo) y/o ultrasonido característico de dicho síndrome. Objetivo:determinar el síndrome de ovario poliquístico confirmado por métodos laboratoriales e imágenes y tratamiento indicado en consulta externa del Hospital Escuela Universitario. Material y métodos: estudio retrospectivo, transversal, no aleatorio. Se revisaron 56 expedientes de pacientes con el diagnóstico de síndrome de ovario poliquístico valorados mediante criterios de Rotterdam, 31(55.4%) tenian diagnóstico ultrasonográfico. Se utilizó un instrumento de recolección de datos tipo cuestionario registrandose lo siguiente: edad, sintomatología, exámenes laboratoriales, diagnóstico con descripción ultrasonográficas y tratamiento farmacológico. Resultados: con el diagnóstico de síndrome ovario poliquístico, 31(55.4%) teníandiagnósticos1 Médico especialista en ginecología y obstetricia, Hospital Escuela Universitario2Estudiante de sexto año, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras.Autor de correspondencia: Silder Moncada Correo electrónico: silderjavier78@gmail.comRecibido: 19/09/2017Aceptado: 07/02/2019ultrasonográficos, en 26(83.9%) pacientes no se encontró consignado en el expediente síntomas de hiperandrogenismo, se consignó acantosis nigricans en 2(6.5%), alopecia y acné 3(9.7%), respectivamente como signo hiperandrogénico. Los fármacos utilizados para tratar síndrome de ovario poliquístico fueron metformina y anticonceptivos orales. Conclusión: el diagnóstico y tratamiento de síndrome de ovario poliquístico no sigue protocolos estandarizados, ya que de los 31 expedientes con resultado por ultrasonido, solo 5(16.1%) reunían los criterios para el diagnóstico de dicha patología...(AU)

Síndrome de ovario poliquístico / Polycystic ovary syndrome

El síndrome de ovario poliquísticos (SOP) representa una de las endocrinopatías más frecuentes en la mujer y es la principal causa de hiperandrogenismo (HA). Se trata de un trastorno complejo, multifactorial, poligénico con influencias ambientales. Aunque se han propuestos diferentes criterios para su diagnóstico, se prefiere el uso del más abarcativo (Criterio de Rotterdam) con la presencia de 2 de 3 de los siguientes: 1) HA clínico o bioquímico, 2) oligoanovulación crónica (OA), 3) poliquistosis ovárica por ecografía, excluyendo otras etiologías. Es frecuente su asociación con comorbilidades metabólicas (obesidad, diabetes 2, dislipidemia, apnea del sueño, etc.) y trastornos reproductivos (hiperplasia endometrial e infertilidad), sobre todo en los fenotipos clásicos, con HA y OA. El tratamiento estará orientado a las características clínicas de cada paciente y al deseo reproductivo. La pérdida de peso en aquellas con sobrepeso u obesidad o ambos factores puede restaurar los ciclos menstruales y disminuir el riesgo metabólico y representa la primera línea de tratamiento. Los anticonceptivos orales (ACO) son el tratamiento farmacológico de elección ya que atenúan las manifestaciones de HA y ofrecen protección endometrial. En las pacientes con oligoanovulación que buscan embarazo, el citrato de clomifeno es el tratamiento aconsejado en primera instancia. La metformina podría usarse en aquellas con intolerancia a la glucosa o diabetes 2 y también como segunda línea de tratamiento para restaurar los ciclos e inducir la ovulación. (AU)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women, the main cause of hyperandrogenism (HA). It is a complex, multifactorial polygenic disorder with environmental influences. Although there have been proposed different criteria for diagnosis, using the most comprehensive (Criteria Rotterdam) with the presence of 2 of 3 of the following is preferred: 1) HA clinical or biochemical, 2) oligo-anovulation chronic (OA), 3) polycystic ovaries by ultrasound, excluding other etiologies. It is frequently associated with metabolic comorbidities (obesity, type 2 diabetes, dyslipidemia, sleep apnea, etc.) and reproductive disorders (endometrial hyperplasia and infertility), especially in the classical phenotypes, with HA and OA. The treatment will be oriented to the clinical characteristics of each patient and reproductive desire. Weight loss in those who are overweight and / or obesity can restore menstrual cycles and decrease metabolic risk and represents the first line of treatment. Oral contraceptives (OC) are the pharmacological treatment of choice as it attenuates the manifestations of HA and offer endometrial protection. In patients seeking pregnancy with oligo-anovulation, clomiphene citrate would be used at first instance. Metformin may be used in those with impaired glucose tolerance or type 2 diabetes and also as a second-line treatment to restore cycles and induce ovulation. (AU)

Alteraciones neuroendocrinas del síndrome de poliquistosis ovárica en la adolescencia / Neuroendrocrine anormalities in adolescents with polycystiz ovary sindrome

El síndrome de poliquistosis ovárica (SPCO) es una de las endocrinopatías más comunes que afecta a las mujeres en edad reproductiva, su expresión clínica comienza en edad perimenárquica y si bien fue descripto hace más de 70 años, hasta el presente, el(los) mecanismo(s) fisiopatológico(s) que lo origina(n) no se conoce(n) con certeza. Debido a la gran heterogeneidad en la expresión clínica y bioquímica que caracteriza al SPCO es probable que existan subgrupos de pacientes en las que sea posible identificar alguno de los mecanismos implicados en la patogenia como el responsable de los principales signos y síntomas observados. La presente revisión propone conocer en profundidad las anormalidades neuroendocrinas como uno de los principales componentes del síndrome. En nuestra experiencia, las adolescentes con SPCO presentan hipersecreción de LH (aumento de la masa de LH secretada por pulso, de la frecuencia de pulsos y de la tasa de producción), y un patrón desordenado de secreción de LH (mayores valores de ApEn) en relación a adolescentes eumenorreicas. Varias líneas de evidencia sugieren que uno de los mecanismos responsables de estos defectos es el aumento de frecuencia de secreción del GnRH. Las adolescentes con SPCO secretan moléculas de LH con mayor actividad biológica y mayor proporción de isoformas con punto isoeléctrico más alcalino que las adolescentes eumenorreicas. La preponderancia de isoformas más básicas y más bioactivas en estas pacientes se relaciona con elevados niveles séricos de 17-hidroxiprogesterona, androstenodiona (A) y testosterona (T). El aumento de la frecuencia de pulsos de GnRH y un microambiente hormonal caracterizado por exceso de andrógenos podrían conjuntamente promover la predominante secreción de este tipo de isoformas de LH. En ausencia de obesidad, las pacientes con SPCO presentan un incremento de la tasa de producción de GH y un patrón de secreción más ordenado (menores valores de ApEn, similar al patrón de secreción de GH observado en el varón adulto). La mayor secreción de GH podría potenciar la acción gonadotrófica sobre la esteroideogénesis ovárica. Analizando la sincronía entre pares de hormonas relacionadas mediante dos técnicas complementarias (cross ApEn y cross correlación) se demuestra que las adolescentes con SPCO presentan un deterioro en las asociaciones entre LH-andrógenos comparadas con las adolescentes eumenorreicas. El desacople de la secreción bihormonal (LH-A y LH-T) en adolescentes con SPCO es consistente con defectos en el control de la secreción ovárica de andrógenos dependiente de LH y con una alteración en el control negativo que ejercen los andrógenos sobre la secreción GnRH/LH. Estas alteraciones neuroendocrinas en la unidad GnRH/LH y andrógenos ováricos podrían promover el hiperandrogenismo y alterar la maduración folicular.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women in reproductive age, frequently begins during adolescence causing menstrual irregularity and hirsutism. Although described up more than seventy years ago, the primary pathophysiologic mechanisms underlying this disorder remain unknown.There is not a single etiologic factor that fully accounts for the spectrum of abnormalities in the PCOS. This review addresses current knowledge about the neuroendocrine abnormalities as a major component of the syndrome. From this perspective, adolescents with PCOS exhibit an accelerated frequency and/or higher amplitude of LH pulses, augmentation of secretory burst mass, and a more disorderly LH release (higher ApEn) than eumenorrheic adolescents. Several lines of evidence suggest that the mechanisms underlying the defects in LH secretion in PCOS include an increased frequency of GnRH secretion. These patients also show elevated in vitro LH bioactivity and a preponderance of basic LH isoforms, which correlate positively with elevated serum of 17-hydroxyprogesterone, androstenedione (A), and testosterone (T) concentrations. Heightened GnRH drive of gonadotropin secretion and steroid-permissive milieu appear to jointly promote elevated secretion of basic LH isoforms. Non obese adolescents with PCOS secrete GH at a higher rate and with more orderly patterns (resembling a male profile) than controls. Indeed, GH appears to act as a co-gonadotropin. When synchronicity of paired hormone profiles was appraised by two independent, but complementary, statistical tools (cross-entropy and cross correlation), concomitant uncoupling of the pairwise synchrony of LH - androgens was demonstrated in girls with PCOS. Asynchrony of LH-A and LH-T pairs further localizes a pathway defect to LH-dependent feedforward control of ovarian androgen secretion. These abnormalities are also consistent with altered androgen negative feed-back regulation of GnRH/LH output. These data suggest that in PCOS there are anomalies of signaling between GnRH/LH and ovarian androgens that promote hiperandrogenism and impaired follicle maturation.

Impaction of laparoscopic ovarian electrocautery on doppler indices of stromal blood flow in women with polycystic ovary syndrome

Polycystic ovary syndrom [PCOS] is characterized by infertility, oligomenorrhea, and hyperandrogenism. Clomiphene citrate [CC], an antiestrogen, is first-line treatment for PCOS, if CC fails to induce ovulation, laparascopic electrocautery of the ovaries is offered. In this prospective controlled study, 52 women with clomiphen-resistant PCOS [group 1] and 46 women with regular menstrual cycles as a control group [group 2] were included. Hormonal profile and doppler blood flow changes within the ovarian stroma befor and after laparascopic ovarian electrocautery [LOE] in women with clomiphen- resistant polycystic ovary syndrome assessed and compared between groups. The doppler indices [pulsatility index and resistance index] of ovarian stromal blood flow were significantly lower in group 1 befor LOE than in group 2. The serum levels of testosteron [T] and LH were significantly reduced in group 1 after LOE compared with in group 1 befor LOE [P < 0.05]. Doppler indices [pulsatility index and resistance index] of ovarian stromal blood flow were significantly increased after LOE. Laparascopic electrocautery reduced serum T and LH and reduced ovarian blood flow velocities, which may explain the reduction of ovarian hyperstimulation syndrome in women with PCOS after LOE. Laparascopic electrocautery of the ovaries is now accepted as the preferred first-line treatment of women with PCOS who are resistant to clomiphen citrate. All affected women could be considered for this treatment

PCO Prevalance in adolescents with menstrual irregularity

This is a comparative cross - sectional prospective study with the aim of evaluation of prevalence and correlation between menstrual irregularity and PCO in postmenarcheal age. This evaluation has done in two groups of healthy adolescent girls 12-19 years old who admitted in shahid Mostafa Khomeini hospital, IRIB Clinic and a private clinic. We compared 47 adolescent girls who had irregular menstruation [as study group] with 22 adolescent girls who had normal menses [as control group] We did abdominal ultrasonography [US] in both groups and evaluated US features of PCO on them. This research shows that PCO was seen to be more common in adolescent girls with menstrual irregularity [42/5% vs 13.6%, p < 0.011] with a tendency to be more frequent in oligomenorrhea-amenorrhea group than in polymenorrhea [51.6% vs 25% P > 0.08]. We have also seen increased LH/FSH in 86.9% and abnormal androgens profiles in 69.5% in girls with PCO. These results suggest that US changes compatible with PCO is a frequent finding in adolescent girls with menstrual disturbance preferably in those with oligoamenorreha

Idiopathic hirsutism or polycystic ovary syndrome

Polycystic ovarian syndrome [PCOS] is a common reproductive disorder, the most important symptoms of which are hirsutism, acne and irregular menstruation. Subjects who had idiopathic hirsutism also suffer from excess hair and have Laboratory results and ultrasound findings, which are similar to PCO. The aim of this study is to find a relationship between idiopathic hirsutism and PCOS. For this reason, PCO were detected using ultrasound imaging in a series of 173 women who presented with significant hirsutism and in some cases with irregular menstruation. Patients were divided in to 3 groups: those with hirsutism and regular menstruation [cycles > 8 per year, group 1, n=96], those with hirsutism and oligomenorrhoea [cycles < 8 per year, group 2, n= 99] and those with hirsutism and amenorrhoea [cycles < 2 per year, group 3, n= 33]. These 3 groups were compared with subjects with normal ovaries and regular cycles of 26-34 days and without hirsutism [n= 29] and also with a group of women with PCO and regular cycles who had no sign of hirsutism [n=90]. PCO were found in 86% of group 1, 97% of group 2 and 94% of women within group 3. The results suggest that the term "idiopathic hirsutim" may not be appropriate. Sensitivity of biochemical tests for PCO amongst women of group 1, 2 and 3 were 100%, 91% and 76% respectively. This was in the case when at least one of these biochemical tests were reported to be abnormal: luteinizing hormone level > 9 U/L, testosterone level > 2.2 nmol/L, sex hormone binding globulin < 32 nmol/L or free androgen index > 4.5

[Is polycystic ovary syndrom caused by bulimia nervosa?]

Ninety four females who attended at the ultrasound department of Royal Hospital for Women underwent a transabdominal ultrasound to detect polycystic ovaries [PCO]. Thirty-seven individuals had scan normal ovaries and 38 had scan evidence of polycystic ovary [PCO]. All the subjects were sent a bulimia investigation test [Edinburgh] [BITE] questionnaire for abnormal eating behaviour. A total of 76 responses was received [81%]. Overall, most of women with PCO had abnormal BITE score and their mean BITE score showed a significant increase compared to those with normal ovaries. BITE score was significantly correlated with age

Sonographic estimation of uterine dimensions in women with different parities and in cases of polycystic ovary syndrome

The mean uterine dimensions [length, transverse and anteroposterior diameters] in 53 normal nulliparous women were ultrasonically estimated to be 71 mm, 49 mm and 32 mm, respectively. In 40 normal multiparous women they were 77 mm and 37 mm, respectively, while in 32 grandmultiparous women [para >5] they were 83 mm, 60 mm and 42 mm, respectively. There is significant increase in all uterine dimensions with increasing parity. In 23 women with clinical polycystic ovary syndrome [PCOS], the uterine dimensions were 66 mm, 43 mm and 30 mm, respectively. The uteri of these women had significantly smaller length and transverse diameters than normal nulligravidae. A uterine length of 70 mm or less and a transverse diameter of 42 mm or less were significantly commoner in PCOS cases than normal nulligravidae. This may be an additional helpful ultrasonic measurement in the diagnosis of PCOS

Acne vulgaris and polycystic ovaries: a clinical, ultrasonographic and hormonal study

There is a strong debate about the association between acne vulgaris and polycystic ovaries [PCO]. To determine this possible association, this study was performed on 25 women suffering from acne vulgaris and 10 control cases. These patients were subjected to good history taking, through general and dermatological examination, ultrasonographic examination of the ovaries and radioimmunoassay of serum testosterone and serum prolactin. This study revealed that PCO were present in 48% of women with acne vulgaris. There was high incidence of menstrual disorders, hirsutism and infertility among these patients. Serum testosterone and serum prolactin were found to be significantly higher in acne patients when compared to the control group. On the other hand, the levels of these hormones showed statistically insignificant difference between acne patients with PCO compared to those without PCO