Increased serum neopterin levels in women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) occurs in 5-10% of premenopausal women. Studies suggest that PCOS is associated with increased risk of coronary heart disease (CHD). To investigate this relationship, 15 PCOS women (group 1) and 10 healthy women (group 2) were studied. Blood leukocyte counts (white blood cells, WBC) and serum levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, sensitive C-reactive protein (sCRP), and neopterin were measured in the 2 groups. There were no significant differences in serum total cholesterol, HDL-cholesterol, or LDL-cholesterol concentrations between groups 1 and 2. Blood WBC counts and serum levels of neopterin and sCRP were significantly higher in group 1 than group 2. The median (min-max) levels were: WBC, group 1: 8.05 (5.10-9.70) cells x 10(9)/L, group 2: 6.25 (4.70-9.70) cells x 10(9)/L (p <0.01); neopterin, group 1: 10.6 (7.5-49.5) nmol/L, group 2: 9.6 (6.5-12.9) nmol/L (p < 0.05); and sCRP, group 1: 7.0 (1.2-12.0) mg/L, group 2: 2.0 (0.1-12.0) mg/L (p <0.01). This study shows that blood WBC counts and serum sCRP and neopterin levels are significantly elevated in women with PCOS. These findings support an increased risk for early-onset cardiovascular disease in women with PCOS. This is the first report that women with PCOS have higher serum neopterin levels than healthy women with regular menstrual cycles.

C-reactive protein and neopterin levels in healthy non-obese adults.

BACKGROUND: Obesity and increased waist-to-hip ratio, emphasizing the importance of truncal obesity, have been found to correlate positively with increased cardiovascular disease risk and mortality. Owing to the inflammatory nature of atherosclerosis, the aim of our study was to find possible correlations between body mass index and waist-to-hip ratio, and the inflammatory markers C-reactive protein (CRP) and neopterin in healthy lean and overweight adults. METHODS: A total of 49 healthy adults (mean age 42.4 +/- 1.8 years, 32 females and 17 males) were classified according to their body mass index (BMI) and waist-to-hip ratio values. CRP and neopterin levels were measured. RESULTS: CRP levels were found to be significantly higher in the group with BMI > or = 25 kg/m2 compared to the group with BMI < 25 kg/m2 (p = 0.014). Subjects with increased waist-to-hip ratio displayed significantly higher serum CRP and neopterin levels (p = 0.014 and p = 0.033, respectively) compared with the group in which the waist-to-hip ratio was < 0.9. A strong positive correlation was found between CRP and BMI in the whole group (r = 0.658, p = 0.0001). CONCLUSIONS: Grouping overweight subjects according to their waist-to-hip ratio, which is an indicator of truncal obesity, seems to be convenient in studying the inflammatory process in relation to the elevation of adipose tissue. Elevated CRP and neopterin levels may be useful in the assessment of cardiovascular risk in overweight as well as obese subjects.

Endocrine and metabolic effects of rosiglitazone in non-obese women with polycystic ovary disease.

We hypothesized that the administration of rosiglitazone, an insulin-sensitizing agent of the thiazolidinedione class, would improve the ovulatory dysfunction, hirsutism, hyperandrogenemia, and hyperinsulinemia of polycystic ovary syndrome (PCOS) patients. Forty women with PCOS and impaired glucose tolerance test (IGT) were randomly assigned to the 8-month treatment with rosiglitazone at either 2 mg/day or 4 mg/day. We compared changes in ovulatory function, hirsutism, hormonal levels (total and free testosterone, estradiol, estrone, androstenedione, LH and FSH), and measures of glycemic parameters (fasting and post-challenge levels of glucose and insulin, HOMA-IR, hemoglobin A1c), between the study groups. The patients' baseline characteristics were similar across all treatment arms. Fifteen of 20 women in the 2 mg group and 19 of 20 women in the 4 mg group achieved normal glucose tolerance; 14 of 20 women in the 2 mg group and 17 of 20 women in the 4 mg group achieved ovulatory menses at the end of the study period. The decreases of free testosterone levels were better in the 4 mg group than the 2 mg rosiglitazone group (-1.89+/-0.35 pg/ml vs. -2.21+/-0.39 pg/ml; P<0.01). There were neither any serious adverse events nor any liver enzyme elevations in our study patients during the treatment period. This study demonstrated that rosiglitazone improves the ovulatory dysfunction, hirsutism, hyperandrogenemia, and insulin resistance of PCOS in a dose-related fashion, with minimal adverse effects. This drug may be a good choice for lifetime treatment of patients with PCOS, especially for the ones who failed to show satisfactory results in metformin therapy.

Plasma homocysteine levels in polycystic ovary syndrome and congenital adrenal hyperplasia.

The purpose of this study was to determine whether polycystic ovary syndrome (PCOS) and nonclassic 21-hydroxylase deficiency (CAH) are related to hyperhomocysteinemia, and to investigate if there is a correlation between homocysteine levels and insulin sensitivity in women with PCOS and CAH. Fifty patients with PCOS, 50 patients with CAH and 25 control women were included in the study. Blood samplings were performed in the early follicular phase for measuring hormone profile, Vitamin B(12), folate, homocysteine levels and fasting blood glucose. Ovulatory status was assessed with timed serum progesterone measurements. Homeostasis model assessment-insulin resistance (HOMA-IR) was calculated as a measure of insulin resistance. Mean homocysteine levels were found as (8.9 + 1.9 micromol/l and 17.7 + 3.6 micromol/l) in the normal group and PCOS respectively (p<0.001), but there was no statistical significance between nonclassic 21-hydroxylase deficiency (9.0 + 2.2 micromol/l) and control group. Most of the patients in PCOS group (35 of 50) were significantly insulin resistant. However, there was no insulin resistant patient in CAH or control group. When we compare the two subgroups of PCOS women, the patients with insulin resistance had significantly higher homocysteine levels than the ones who were not insulin resistant. There were positive correlations among serum homocysteine, insulin and androgen levels in PCOS patients. There were no correlations among these parameters in CAH and control groups. Increased homocysteine levels may contribute to increased cardiovascular disease risk in patients with PCOS. The reason for hyperhomocysteinemia seems to be related to insulin resistance but not high androgen levels.

Platelet dysfunction in lean women with polycystic ovary syndrome and association with insulin sensitivity.

Platelet dysfunction and its association with insulin resistance and/or hyperandrogenemia were evaluated in 50 women with polycystic ovary syndrome (PCOS), 50 women with non-classic congenital adrenal hyperplasia (NC-CAH), and 30 women in the control group. Agonist-induced platelet aggregation was measured. Women with PCOS had significantly higher levels of platelet aggregations induced by ADP (77.4 +/- 3.3 vs. 67.3 +/- 2.8), collagen (79.7 +/- 1.8 vs. 69.1 +/- 3.9), and epinephrine (84.7 +/- 2.6 vs. 67.8 +/- 3.8), compared with controls. However platelet aggregations of women with NC-CAH because of ADP (68.2 +/- 4.22), collagen (69.5 +/- 5.4), or epinephrine (68.6 +/- 4.3) were similar to those in the control group. There were negative correlations between aggregations induced by agonists and the insulin sensitivity in women with PCOS. These correlations also appeared significant after androgen levels with covariance analysis were excluded. These covariance analyses were performed because serum androgen levels might affect platelet function. Any significant correlations were not found between androgen levels and agonist-induced platelet aggregation in women with NC-CAH. We conclude that platelet dysfunction may be an important reason for the possible cardiovascular heart diseases in women with PCOS.