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Haddad-Filho H, Tosatti JAG, Vale FM, Gomes KB, Reis FM. Updates in diagnosing polycystic ovary syndrome-related infertility. Expert Rev Mol Diagn 2023; 23:123-132. [PMID: 36856088 DOI: 10.1080/14737159.2023.2177536] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is a condition that affects approximately 13% of reproductive age women and is characterized by androgen excess, menstrual irregularity and altered ovarian morphology. PCOS presents a complex etiology and pathophysiology, which still requires a detailed investigation of biochemical signatures to identify the molecules and mechanisms that govern it. AREAS COVERED This narrative review summarizes the main molecular alterations found in the ovarian follicular fluid, endometrium and placenta of women with PCOS, and the genotypes potentially associated with the outcome of infertility treatments in PCOS. EXPERT OPINION PCOS is associated with multiple alterations in growth factors, sex steroid hormones, reactive oxygen species, proinflammatory cytokines and adipokines, which contribute to follicle arrest/ anovulation or suboptimal corpus luteum function, and ultimately to menstrual irregularity and hyperandrogenic symptoms. A panel of PCOS biomarkers should include, besides ovarian products, markers of adipose tissue function, insulin resistance, vascular health, and low-grade chronic inflammation. The effects of ovarian stimulation drugs on infertile women with PCOS are likely to be modified by genetic factors, but the available evidence is heterogeneous; therefore, future studies should evaluate standard treatments and pre-specified outcomes of interest to provide more conclusive answers.
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Affiliation(s)
- Hélio Haddad-Filho
- Graduate Program in Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Medicine, Universidade Federal de Lavras, Lavras, Brazil
| | - Jéssica A G Tosatti
- Department of Clinical and Toxicological Analyzes - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda M Vale
- Department of Clinical and Toxicological Analyzes - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karina B Gomes
- Department of Clinical and Toxicological Analyzes - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Division of Human Reproduction, Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Manique MES, Ferreira AMAP. Polycystic Ovary Syndrome in Adolescence: Challenges in Diagnosis and Management. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:425-433. [PMID: 35623621 PMCID: PMC9948137 DOI: 10.1055/s-0042-1742292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging since normal pubertal development overlap typical features of this syndrome. The authors aim to summarize the existing evidence concerning PCOS in adolescence, particularly its diagnostic criteria and therapeutic options. A search throughout medical databases such as PubMed and MedScape was performed. Diagnostic criteria include irregular menstrual cycles according to time postmenarche and evidence of clinical hyperandrogenism and/or biochemical hyperandrogenism, provided other causes have been excluded. Polycystic ovarian morphology ought not to be used as a diagnostic criterion. Treatment should target manifestations and/or comorbidities, even in the absence of a definite diagnosis. Lifestyle interventions are the first-line treatment. Combined oral contraceptives, metformin or antiandrogens may also be considered as adjuvants. Screening for PCOS in adolescence is crucial as it allows an early intervention on the symptoms and comorbidities presented leading to better long-term reproductive and metabolic outcomes.
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Affiliation(s)
| | - Ana Margarida Antunes Póvoa Ferreira
- Department of Gynecology, Unit of Reproductive Medicine, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Gynecology, Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Institute for Investigation and Innovation in Health, Universidade do Porto, Porto, Portugal
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Garoufi A, Pagoni A, Papadaki M, Marmarinos A, Karapostolakis G, Michala L, Soldatou A. Cardiovascular Risk Factors and Subclinical Atherosclerosis in Greek Adolescents with Polycystic Ovary Syndrome: Its Relationship with Body Mass Index. CHILDREN 2021; 9:children9010004. [PMID: 35053629 PMCID: PMC8773958 DOI: 10.3390/children9010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine condition affecting 6–18% of adolescents and is strongly associated with obesity and cardiovascular risk factors, enhancing the risk of atherosclerosis. Thirty-two adolescents with newly diagnosed PCOS were evaluated for lipid profile disorders, insulin resistance, inflammation, non-alcoholic fatty liver disease (NAFLD), and subclinical atherosclerosis through measurements of carotid intima–media thickness (cIMT). The relationships of the above markers with increased body mass index and abdominal obesity were investigated. Twenty-three adolescents (72%) were overweight (OW) or obese (OB). The OW/OB group had significantly higher insulin, HOMA-IR, high-sensitive C-reactive protein (hsCRP), visceral adiposity index (VAI), and lipid accumulation product (LAP) levels; and lower glucose-per-insulin ratios and HDL-C levels compared to the healthy weight group. The cIMT and small dense low-density lipoprotein cholesterol (sdLDL-C) levels did not differ between the two groups. Similarly, cIMT and sdLDL-C levels did not differ between PCOS-adolescents and healthy controls. CIMT was positively correlated with systolic blood pressure and waist circumference per height ratio. In conclusion, OW/OB PCOS-adolescents have a cluster of adverse factors predisposing them to atherosclerotic cardiovascular disease. Therefore, early cardiovascular risk assessment, as well as timely and targeted interventions, are necessary for prevention.
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Affiliation(s)
- Anastasia Garoufi
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Athanasia Pagoni
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Maria Papadaki
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry—Molecular Diagnostic, 2nd Department of Pediatrics, Medical School, NKUA, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, Greece;
| | - Georgios Karapostolakis
- Radiology Department, 401 Military General Hospital of Athens (MGHA), 138 Mesogeion Av., 11525 Athens, Greece;
| | - Lina Michala
- First Department of Obstetrics and Gynaecology, Medical School, Alexandra General Hospital, National and Kapodistrian University of Athens (NKUA), 80 Vassilissis Sofias Av., 11528 Athens, Greece;
| | - Alexandra Soldatou
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
- Correspondence:
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Lee J, Kim JH. Endocrine comorbidities of pediatric obesity. Clin Exp Pediatr 2021; 64:619-627. [PMID: 34445852 PMCID: PMC8650822 DOI: 10.3345/cep.2021.00213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 01/19/2023] Open
Abstract
Pediatric obesity has become a serious public health issue. The prevalence of obesity in children and adolescents has increased worldwide and in Korea over several decades. Obese children are more likely to be obese adults with an increased cardiovascular risk. Therefore, maintaining a healthy weight and preventing obesity during childhood are of critical importance. Moreover, obese children and adolescents often have endocrine comorbidities such as prediabetes, type 2 diabetes, dyslipidemia, metabolic syndrome, polycystic ovary syndrome, and central precocious puberty. Hence, the early implementation of obesity management using a multidisciplinary team approach and screening for these comorbidities in obese children and adolescents are required with the appropriate management of each comorbidity and/or specialist referral.
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Affiliation(s)
- Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Anagnostis P, Paparodis RD, Bosdou JK, Bothou C, Macut D, Goulis DG, Livadas S. Risk of type 2 diabetes mellitus in polycystic ovary syndrome is associated with obesity: a meta-analysis of observational studies. Endocrine 2021; 74:245-253. [PMID: 34176074 DOI: 10.1007/s12020-021-02801-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The exact risk of type 2 diabetes mellitus (T2DM) in women with polycystic ovary syndrome (PCOS) is unknown. It is also unclear if obesity independently increases T2DM risk in this population. The aim of this study was to systematically review and synthesize the best available evidence regarding the association between PCOS and T2DM, stratified according to obesity status. METHODS A comprehensive search was conducted in PubMed, CENTRAL and Scopus databases up to October 31, 2020. Data are expressed as relative risk (RR) with 95% confidence interval (CI). The I2 index was employed for heterogeneity. RESULTS The eligibility criteria were fulfilled by 23 studies (319,780 participants; 60,336 PCOS and 8847 type 2 diabetes cases). Women with PCOS demonstrated a higher risk of T2DM than those without PCOS (RR 3.45, 95% CI, 2.95-4.05, p < 0.001; I2 81.6%). This risk remained significant both in studies matched or unmatched for participants' age. With regard to body mass index (BMI), the RR for developing T2DM in obese and non-obese PCOS women compared with their non-PCOS counterparts was 3.24 (95% CI 2.25-4.65; p < 0.001; I2 30.9%) and 1.62 (95% CI 0.14-18.50; p = 0.70; I2 89.9%), respectively. The RR for developing T2DM was 3.85 (95% CI 1.99-7.43; p < 0.001; I2 46.2%) in obese compared with non-obese women with PCOS. This was also the case for overweight compared with lean women with PCOS. CONCLUSIONS Women with PCOS present an increased risk of T2DM compared with non-PCOS women only if they are obese/overweight.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Rodis D Paparodis
- Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Julia K Bosdou
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Bothou
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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