Influence of Phenotypes on the Metabolic Syndrome of Women with Polycystic Ovary Syndrome over a Six-Year Follow-Up in Brazil.

BACKGROUND: We followed polycystic ovary syndrome (PCOS) women with metabolic syndrome (MS) over a six-year treatment period and evaluated the influence of PCOS phenotypes on MS and on the risk for type 2 diabetes mellitus (T2DM). METHODS: This was an observational study of 457 PCOS women, whose demographic, clinical, hormonal, and metabolic data underwent analysis. The PCOS women were divided into four groups per NIH recommendations. RESULTS: After a follow-up of a mean of six years (1-20 years), 310 patients were selected to assess the development of T2DM and MS. The clinical and biochemical parameters, along with the Rotterdam phenotypes, were evaluated. Data were analyzed using Student's t- and the Pearson chi-square tests for data variation and group proportions, respectively. Additionally, multivariate analysis was applied to evaluate the effect of PCOS phenotypes on the risk for MS and T2DM. Patients of the four PCOS phenotypes did not differ in age, body mass index, total testosterone, insulin resistance, and dyslipidemia, but phenotype A patients showed the highest risk for T2DM. A decrease in androgen levels was not followed by an improved metabolic profile; instead, there was a significant increase in the number of T2DM cases. CONCLUSION: Phenotype A women are at the highest risk for type 2 diabetes mellitus.

Racial and ethnic differences in the prevalence of metabolic syndrome and its components of metabolic syndrome in women with polycystic ovary syndrome: a regional cross-sectional study.

BACKGROUND: Polycystic ovary syndrome is a heterogeneous disorder and its presentation varies with race and ethnicity. Reproductive-age women with polycystic ovary syndrome are at increased risk of metabolic syndrome; however, it is not clear if prevalence of metabolic syndrome and clustering of its components differs based on race and ethnicity. Moreover, the majority of these women do not undergo routine screening for metabolic syndrome. OBJECTIVE: We sought to compare the prevalence of metabolic syndrome and clustering of its components in women with polycystic ovary syndrome in the United States with women in India, Brazil, Finland, and Norway. STUDY DESIGN: This is a cross-sectional study performed in 1089 women with polycystic ovary syndrome from 1999 through 2016 in 5 outpatient clinics in the United States, India, Brazil, Finland, and Norway. Polycystic ovary syndrome was defined by the Rotterdam criteria. Main outcome measures were: metabolic syndrome prevalence, blood pressure, body mass index, fasting high-density lipoprotein cholesterol, fasting triglycerides, and fasting glucose. Data from all sites were reevaluated for appropriate application of diagnostic criteria for polycystic ovary syndrome, identification of polycystic ovary syndrome phenotype, and complete metabolic workup. The US White women with polycystic ovary syndrome were used as the referent group. Logistic regression models were used to evaluate associations between race and metabolic syndrome prevalence and its components and to adjust for potential confounders, including age and body mass index. RESULTS: The median age of the entire cohort was 28 years. Women from India had the highest mean Ferriman-Gallwey score for clinical hyperandrogenism (15.6 ± 6.5, P < .001). The age-adjusted odds ratio for metabolic syndrome was highest in US Black women at 4.52 (95% confidence interval, 2.46-8.35) compared with US White women. When adjusted for age and body mass index, the prevalence was similar in the 2 groups. Significantly more Black women met body mass index and blood pressure criteria (P < .001), and fewer met fasting triglycerides criteria (P < .05). The age- and body mass index-adjusted prevalence of metabolic syndrome was highest in Indian women (odds ratio, 6.53; 95% confidence interval, 3.47-12.30) with abnormalities in glucose and fasting high-density lipoprotein cholesterol criterion and in Norwegian women (odds ratio, 2.16; 95% confidence interval, 1.17-3.98) with abnormalities in blood pressure, glucose, and fasting high-density lipoprotein cholesterol criterion. The Brazilian and Finnish cohorts had similar prevalence of metabolic syndrome and its components compared to US White women. CONCLUSION: Despite a unifying diagnosis of polycystic ovary syndrome, there are significant differences in the prevalence of metabolic syndrome and clustering of its components based on race and ethnicity, which may reflect contributions from both racial and environmental factors. Our findings indicate the prevalence of metabolic syndrome components varies in women with polycystic ovary syndrome, such that compared to White women from the United States, Black US women had the highest prevalence, whereas women from India and Norway had a higher prevalence of metabolic syndrome independent of obesity. The differences in clustering of components of metabolic syndrome based on ethnicity highlight the need to routinely perform complete metabolic screening to identify specific targets for cardiovascular risk reduction strategies in these reproductive-age women.

Trp28Arg/Ile35Thr LHB gene variants are associated with elevated testosterone levels in women with polycystic ovary syndrome.

INTRODUCTION: Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder, of multifactorial etiology, which affects 6-10% of women of reproductive age. It is considered the leading cause of anovulatory infertility, menstrual disorders and hyperandrogenism in this population. The genetic basis of PCOS is still largely unknown despite significant family clustering; determining its mode of inheritance is particularly difficult given the heterogenic presentation of the disease. MATERIALS AND METHODS: 130 Brazilian women, aged 14-42 years, who met the 2003 Rotterdam criteria for PCOS diagnosis, were included, and 96 healthy women constituted the control group. Presence of hirsutism was classified using the modified Ferriman-Gallwey score (F-G score) as absent (≤7), mild (8-14), and severe (≥15). Blood levels of luteinizing hormone (LH), total testosterone (TT), dehydroepiandrosterone sulfate (DHEA-S) and androstenedione were determined. The coding region of the luteinizing hormone beta-subunit (LHB) gene was amplified and sequenced. Differences in allelic and genotypic frequency distribution of each polymorphism across controls and cases were estimated by the Mantel-Haenszel chi-square or Fisher's exact test (p<0.05), and the probability of an association between the detection of a polymorphism and presence of a diagnosis of PCOS, by logistic regression. RESULT(S): Sequencing detected 8 polymorphisms in the LHB gene coding region. Two polymorphisms in linkage disequilibrium were significantly more prevalent in the presence of hyperandrogenemia: rs1800447/rs34349826 (Trp28Arg/Ile35Thr) (p=0.02). CONCLUSION(S): In this series, a modulatory effect of LHB polymorphisms on hyperandrogenemia phenotype of PCOS was observed; however, this finding needs to be replicated in other populations.

Polycystic ovary syndrome and obesity do not affect vascular parameters related to early atherosclerosis in young women without glucose metabolism disturbances, arterial hypertension and severe abnormalities of lipid profile.

The aim of this study was to evaluate the influence of polycystic ovary syndrome (PCOS) and obesity on vascular parameters related to early atherosclerosis (VP-EA) [brachial flow-mediated dilation (FMD), carotid intima-media thickness (CIMT) and carotid arterial compliance (CAC)] in women with minor cardiovascular risk factors (CVRFs). Twenty-five young women with PCOS and 23 eumenorrheic women matched for body mass index (BMI) were studied. The women were subdivided according to BMI and PCOS status, and comparisons were done between PCOS and Control group, regardless of BMI, and between Obese and Lean group, regardless of the presence of PCOS. Insulin resistance was higher in PCOS-group than in control-group and in obese-group than in lean-group. The median of all VP-EA evaluated were similar between PCOS-group and Control-group [FMD: 6.6 versus 8.4% (p = NS); CIMT: 48.0 versus 47.0 mm.10-2 (p = NS); CAC: 6.2 versus 5.6N-1.m4.10-10 (p = NS)] and between obese-group and lean-group [FMD: 7.8 versus 6.6% (p = NS); CIMT: 48.0 versus 47.0 mm.10-2 (p = NS); CAC: 5.7 versus 6.3N-1.m4.10-10 (p = NS)]. These results suggest that PCOS and obesity do not affect VP-EA in women with minor CVRFs.

Influence of LH and high-density lipoprotein cholesterol (HDL-C) on metformin response in women with polycystic ovary syndrome.

OBJECTIVE: To search for predictors of metformin response in women with polycystic ovary syndrome (PCOS) through a detailed analysis of clinical and laboratory parameters. STUDY DESIGN: We designed a prospective study to investigate clinical and laboratory parameters to search for predictors of metformin response in women with PCOS. A total of 53 PCOS patients were given metformin 850 mg twice a day for 6 months, after which patients were classified as responders or non-responders. Parameters analyzed for comparison between the two groups were: plasma fasting insulin glucose/insulin ratio; oral glucose tolerance test (OGTT) with insulin (120 min); HOMA and QUICKI tests; total cholesterol and fractions, triglycerides; LH, FSH, estradiol, progesterone, testosterone, androstenedione, 17-OH progesterone, and DHEAS. RESULTS: From all patients, 30 (56.6%) were responders and 23 (43.3%) were non-responders. Multinomial analysis showed that the positive response to metformin was associated with higher levels of basal LH (p=0.038) and lower levels of high-density lipoprotein cholesterol (HDL-C) (p=0.015). CONCLUSION: In weight-matched PCOS subjects, laboratory markers might predict the metformin response. Higher levels of basal LH and lower levels of HDL-C are correlated with a positive response to metformin treatment in PCOS subjects.

A função hepática em mulheres menopausadas tratadas com extrato seco padronizado do rizoma e raízes de Cimicifuga racemosa L / The hepatic function in postmenopausal women treated with a standardized dry extract of the roots and rhizome of Cimicifuga racemosa L

Objetivo: Avaliar a resposta hepática ao tratamento durante 12 meses com extrato seco padronizado de raízes e rizoma de Cimicifuga racemosa L. (Acteae racemosa L.) (CR) em mulheres menopausadas.Justificativa: O uso do CR é reconhecidamente seguro na literatura mundial, mas há referências de casos de hepatite em usuárias de CR.Método: Estudo duplo-cego, placebo-controlado, randomizado, prospectivo. Durante 12 meses consecutivos foram tratadas 64 mulheres menopausadas, divididas em dois grupos de 32, com 20mg de CR (Aplause®. Marjan) ou placebo, uma cápsula duas vezes ao dia, cada cápsula de CR contendo, no mínimo, 1mg de 27-deoxiacteína. A média etária cronológica do grupo CR foi 54,2 anos e a idade menopausal média 7,8 anos e do grupo placebo (P) 54 e 6,6 anos, respectivamente. O intervalo entre as consultas foi quatro meses, tendo sido realizadas as dosagens de transaminase glutâmico-oxalacética (TGO), transaminase glutâmico-pirúvica (TGP), gama-glutamil-transferase (GGT) e fosfatase alcalina (FAL) na consulta inicial e nas três consultas quadrimestrais do seguimento.Resultados: Não houve em ambos os grupos diferença estatística significativa entre os resultados de TGO (p=0,15), TGP (p=0,92), GGT (p=0, 92) e FAL (p=0,89) nas cinco consultas.Conclusão: O tratamento de 12 meses com CR não afetou a função hepática de uma população de mulheres menopausadas.

Comparação entre diferentes índices de avaliação da sensibilidade à insulina na síndrome dos ovários policísticos / Comparison among different insulin sensitivity indices in polycystic syndrome

Objetivo: Comparar os diferentes índices de avaliação da sensibilidade à insulina em mulheres portadoras da síndrome dos ovários policísticos (SOP), correlacionando-se com o índice de massa corpórea (IMC); avaliar o valor preditivo de IMC, insulina e glicemia de jejum na detecção da sensibilidade à insulina. Método: Foram estudadas 62 pacientes com idades variandio de 16 a 39 anos (média 25)portadoras da SOP diagnosticadas segundo Consenso 1990 (NHI). Vinte e cinco...

Estudo comparativo das neovaginas formadas pelas técnicas de McIndoe e de Frank / A comparative study of neovagine formed by Mcindo's techinique to the Frank's one

Com o objetivo de comparar as neovaginas formadas pelas técnicas de McIndoe e de Frank, foram estudadas vinte e uma pacientes portadoras de agenesia da vagina. Doze delas haviam sido submetidas a correçäo cirurgica pela técnica de McIndoe (grupo A), enquanto as outras nove haviam sido tratadas pela técnica näo cruenta de Frank, ou seja, pela invaginaçäo da fosseta vaginal sob pressäo, usando-se dilatadores de calibres progressivamente maiores (grupo B). em todos os casos, foram reavaliados exame clínico, estudo bistologico e bacteriológico, medida do pH e citologia hormonal...

Hiperandrogenismo ovariano pós-menopausal: estudo clínico e anatomopatologico de 6 casos / Postmenopausal ovarian hyperandrogenism: clinical and anatomopathologic study of six cases

O objetivo deste estudo é o relato do perfil hormonal e os achados histológicos ovarianos em seis pacientes com hiperandrogenismo pós-menopausal sugestivos de origem tumoral. As pacientes foram avaliadas através de dosagens hormonais sanguineas basais, em condiçöes de depressäo com dexametasona associada a estimulaçäo sequencial com hCG. A avaliaçäo morfológica dos ovários e das supra-renais foi realizada por ultra-sonografia e tomografia computadorizada. Após a confirmaçäo do hiperandrogenismo ovariano as pacientes foram submetidas a histerectomia e anexectomia bilateral. As dosagens hormonais foram repetidas após a cirurgia. O estudo histológico dos ovários revelou: hiperplasia bilateral de celulas estromais em 5 casos; hiperplasia estromal em 1 ovário, associada a adenocarcinoma de células claras no outro ovário (1 caso); luteoma estromal (1 caso); tumor de células de Leydig (1 caso); e, tumor de células esteroidicas da regiäo hilar (1 caso)...

Evolucao de 18 casos de hiperprolactinemia tratados com placebo e bromoergocriptina / Evolution of 18 hyperprolactinemic patients treated with placebo and bromoergocriptine

Objetivos: Avaliar a evolucao das menstruacoes, da galactorreia, dos niveis circulantes de FSH, LH, prolactina (PRL) e estradiol, e do perfil lipoproteico de pacientes hiperprolactinemicas submetidas ao tratamento clinico. Desenho: Foram estudadas 18 pacientes, 15 das quais inicialmente tratadas com placebo durante 90 dias. A seguir, caso nao houvesse normalizacao da PRL, as pacientes foram tratadas com bromoergocriptina. Onze pacientes foram acompanhadas em intervalos de 30 a 45 dias para controle clinico e laboratorial. Os incrementos da dose de bromoergocriptina foram feitos apos verificacao dos exames...

Comparacao dos perfis hipofisario, esteroidiano e lipoproteico em pacientes com galactorreia normoprolactinemica e galactorreia hiperprolactinemica / Comparison of pituitary, steroid and lipoprotein profile in patients with hyperprolactinemic and normoprolactinemic galactorrhea

Objetivos: Avaliar o comportamento dos perfis hipofisario, esteroidiano e lipoproteico em pacientes com galactorreia hiperprolactinemica e galactorreia normoprolactinemica. Desenho: Foram estudadas 39 pacientes: 18 com galactorreia hiperprolactinemica e 21 com galactorreia normoprolactinemica. A avaliacao laboratorial constou das dosagens de PRL, FSH, LH e TSH (perfil hipofisario); estradiol, testosterona, androstenediona, deidroepiandrosterona e seu sulfato, 17-alfa-hidroxiprogesterona (perfil lipoproteico). O tratamento estatistico foi realizado atraves da comparacao das medias e dos respectivos desvios padrao. Resultados: O perfil hipofisario nao diferiu entre os dois grupos exceto em relacao a prolactina...

Hiperandrogenismo no climaterio: aspectos clinicos e laboratoriais / Hyperandrogenism in climateric women: clinical and laboratorial aspects

Foram estudadas 39 mulheres climatericas e pos-menopausais portadoras de hiperandrogenismo, das quais 27 eram pos-menopausais e 12 ainda menstruavam, na Clinica Ginecologica do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, com o objetivo de avaliar os aspectos clinicos e laboratoriais no sentido de estabelecer o diagnostico etiologico. Os seguintes parametros foram avaliados: distribuicao etaria; queixas; tempo de menopausa; padrao mentrual nas pacientes com menstruacoes; exame fisico; avaliacao dos sintomas climatericos; peso corporeo; pressao arterial; dosagens hormonais e bioquimicas; estudo morfologico dos orgaos genitais, e o diagnostico etiologico...