Diagnostic characteristics and metabolic risk factors of cases with polycystic ovary syndrome during adolescence

Menstrual pattern in polycystic ovary syndrome and hypothalamic-pituitary-ovarian axis immaturity in adolescents: a systematic review and meta-analysis

OBJECTIVE

To analyze differences in the menstrual pattern, age at menarche, and body mass index (BMI) in adolescents with Hypothalamic-Pituitary-Ovarian (HPO) axis immaturity and Polycystic Ovary Syndrome (PCOS) through a systematic review and meta-analysis.

METHODS

The PubMed, EMBASE, Web of Science, Virtual Health Library, Scopus databases were searched using combinations of descriptors. Study quality was assessed using the Newcastle-Ottawa Scale. For data analysis, the results were grouped into PCOS group and NPCOS group (HPO axis immaturity). We performed a meta-analysis of raw data and the inverse variance method, employing the standardized mean difference, of the age at menarche and BMI of adolescents.

RESULTS

Participants totaled 1,718 from nine selected studies. The meta-analysis showed that the PCOS group had a higher BMI than the NPCOS group (SMD 0.334; CI95% 0.073 - 0.595; p = .012). The degree of heterogeneity of the studies was approximately 40%. No significant difference in age at menarche (SMD - 0.027; CI95% -0.227 - 0.172; p = 0.790) and menstrual patterns was found, but amenorrhea was described only in adolescents with PCOS.

CONCLUSIONS

The main characteristic in menstrual pattern that differentiated PCOS patients from girls with HPO axis immaturity was amenorrhea. Also, the BMI of PCOS patients was nearly one third higher than that of adolescents with HPO axis immaturity.

Role of CPXM1 in Impaired Glucose Metabolism and Ovarian Dysfunction in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS), a common female endocrinopathy associated with both reproductive and metabolic disorders, has an unclear etiology and unsatisfactory management methods. Carboxypeptidase X, M14 family member 1 (CPXM1) is a protein involved in follicular atresia, insulin production, and adipose tissue production, though its role in PCOS is not fully understood. We used a 60% high-fat diet (HFD) plus dehydroepiandrosterone (DHEA)-induced PCOS mouse model to determine the role of CPXM1 in abnormal glucose metabolism and ovarian dysfunction in PCOS. We found that serum CPXM1 concentrations were higher in PCOS mice and positively correlated with increased levels of serum testosterone and insulin. In both ovarian and adipose tissues of PCOS mice, CPXM1 mRNA and protein levels were significantly increased but GLUT4 levels were significantly decreased. Immunohistochemistry (IHC) staining of the ovary showed increased CPXM1 expression in PCOS. In addition, the protein expression of phosphorylated protein kinase B (p-Akt) was also significantly decreased in PCOS mice. Furthermore, mRNA levels of inflammatory markers such as TNF-α, IL-6, IFN-α, and IFN-γ were increased in ovarian and adipose tissues of PCOS mice. However, IRS-1, IRS-2, and INSR levels were significantly decreased. Our results indicated for the first time that abnormally high expression of CPXM1, increased adiposity, impaired glucose tolerance, and chronic low-grade inflammation may act together in a vicious cycle in the pathophysiology of PCOS. Our research suggests the possibility of CPXM1 as a potential therapeutic target for the treatment of PCOS.

Insulin Resistance and Serum Magnesium Concentrations among Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) affects ∼1 in 10 women worldwide. Hypomagnesemia may worsen insulin resistance (IR) due to the role magnesium (Mg) plays in glucose metabolism. This review explores the relation between serum Mg and IR among women with PCOS. A review of primary research focusing on both serum Mg and women with PCOS was conducted from 2011 to 2019. Studies reviewed included human subjects, written in the English language, and limited to community-dwelling women aged ≥18 y. A total of 7 articles were reviewed. The findings from 4 epidemiological analytic studies evaluating serum Mg status suggest there may be a relation between serum Mg concentrations and IR among women with PCOS. However, among the 3 experimental trials, Mg supplementation inconsistently impacted IR among women with PCOS. Women with PCOS are more likely to underconsume Mg-rich foods and have a greater likelihood of lower serum Mg concentrations. Although it remains unclear if dietary Mg and/or supplementation should be a nutritional strategy for all women with PCOS, current research indicates an association between adequate Mg status and improved IR. Further research evaluating dietary interventions and supplementation is warranted.

Polycystic Ovary Syndrome in Adolescence

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in females, and is characterized by ovulatory dysfunction, hyperandrogenism, and polycystic ovarian morphology based on ultrasound. Controversy surrounds the optimum diagnosis and management in the adolescent population. Many patients with adult PCOS present with pathognomonic symptoms as adolescents, and there is value in early diagnosis due to the associated long-term metabolic and reproductive health sequalae. A definitive diagnosis does not need to be made prior to implementing treatment in this group of young women. The practitioner who has an adolescent presenting with signs and symptoms of PCOS, has a unique opportunity to risk stratify, screen for co-morbidities, and implement early management strategies, many of which are lifestyle modifications, to help prevent long term morbidity associated with this disease.

Effect of metformin on insulin levels, blood sugar, and body mass index in polycystic ovarian syndrome cases

Introduction:

Polycystic ovarian syndrome (PCOS) presents as an extremely heterogeneous condition that includes chronic anovulation, hyperandrogenism, hyperlipidemia, and hyperinsulinemia along with enlarged polycystic ovaries. Insulin resistance is thought to be a pathogenic factor in women having PCOS along with increased incidence of metabolic disturbances.

Materials and Methods:

After obtaining ethical clearance, the girls of various colleges in Patiala were verbally sensitized to the symptoms of PCOS, and then given semistructured proformas subsequent to written informed consent. The students suspected on self-evaluation, and on evaluation of the proformas were investigated in the Out Patient Department, and patients reporting to Obstetrics and Gynecology Department with similar symptoms were also included after written informed consent. The patients were divided with simple randomization into two groups of 25 each. Group 1 (treatment group) was put on metformin therapy for three months (500 mg thrice a day), and Group 2 (control group) were given placebo thrice a day for the same duration. The patients were followed up after three months of metformin therapy (500 mg thrice a day) in Group 1, and placebo therapy in Group 2. Body weight, fasting blood glucose, blood glucose after 2 h of 75 g of glucose, and fasting serum insulin levels were assessed initially, and then after three months.

Results:

The mean age of patients in the present study was 21.46 ± 4.45 years. About 54% patients in the present study had BMI ≥25 kg/m². About 68% of the patients had menstrual irregularity and PCO on ultrasonography (USG). About 44% patients in Group 1 (metformin) had increased insulin levels initially (>20 μU/ml), which were decreased to 16% after three months of metformin therapy. About 52% patients in Group 2 had increased insulin levels that were decreased to 48% after the placebo therapy.

Conclusion:

It has been concluded from this study that metformin significantly lowers insulin levels in patients with PCOS; in both obese and nonobese; which points towards its potential usefulness in treatment of PCOS patients, though it had no significant effect on body mass index in 12 weeks.

Metabolic Syndrome in Adolescents with Polycystic Ovary Syndrome: Prevalence on the Basis of Different Diagnostic Criteria

STUDY OBJECTIVE

Existing literature on the prevalence of metabolic syndrome (MBS) in adolescents with polycystic ovary syndrome (PCOS) is inconsistent, likely because of the application of differing diagnostic criteria. The objective was to assess the prevalence of MBS in adolescents with PCOS depending on the PCOS diagnostic criteria used.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective chart review of female patients (N = 37), ages 11-22 years, diagnosed with PCOS between January 2013 and December 2017. Patients were included only if they had received screening allowing comparison across all PCOS diagnostic criteria: National Institutes of Health, Rotterdam, Androgen Excess Society, Amsterdam, Endocrine Society, and the Pediatric Endocrine Society (PES). The presence of MBS was established using the International Diabetes Federation criteria. The proportion of patients having MBS was then calculated for each PCOS diagnostic criteria subgroup.

INTERVENTIONS AND MAIN OUTCOME MEASURES

For the entire study cohort, MBS was present in 17/37 patients (45.9%). The highest prevalence of MBS was among the subgroup of patients meeting the PES PCOS diagnostic criteria (13/25; 52.0%), whereas the lowest prevalence was in the subgroup meeting the Amsterdam PCOS criteria (6/15; 40.0%). Those diagnosed using the PES criteria also had the highest percentage of patients with 3 or more risk factors for MBS.

RESULTS AND CONCLUSION

The prevalence of MBS varied according to the specific PCOS diagnostic criteria and was highest when PES guidelines were used. The PES criteria are adolescent-specific and have thus refined the diagnosis of PCOS for this population. Our results highlight the importance of validated adolescent-specific PCOS diagnostic criteria.

Long non-coding RNA H19 is associated with polycystic ovary syndrome in Chinese women: a preliminary study

Polycystic ovary syndrome (PCOS) represents a serious reproductive and endocrine condition and is associated with high incidence rates. H19 is a compelling long noncoding RNA (lncRNA) which carries out a range of biological functions. However, prior to this study, little was known as to whether there was an association between lncRNA H19 and PCOS. In the current study, we used quantitative real-time polymerase chain reaction (qRT-PCR) to determine lncRNA H19 expression levels in peripheral blood leukocytes from patients with PCOS and compared this data with that derived from normal controls. We also screened data for potential relationships between lncRNA H19 and a range of endocrine variables in PCOS. The expression of lncRNA H19 was significantly higher in cases of PCOS than in controls. Individuals exhibiting higher expression levels of lncRNA H19 were associated with a significantly higher risk of PCOS than those with lower expression levels. Moreover, lncRNA H19 expression was positively correlated with fasting plasma glucose levels; this was the case with both raw data, and after adjustment for age and BMI in the PCOS group. However, lncRNA H19 expression showed no significant correlation with total testosterone or insulin resistance in either PCOS cases or the controls. In conclusion, we demonstrate the first evidence to indicate that lncRNA H19 is associated with PCOS, suggesting that elevated lncRNA H19 levels are a risk factor for PCOS. For susceptible individuals, lncRNA H19 may represent a useful biomarker of the early stages of endocrine and metabolic disorders in PCOS.

The prevalence of metabolic syndrome in patients with polycystic ovary syndrome: A systematic review and meta-analysis

INTRODUCTION

Polycystic ovary syndrome (PCOS) is an endocrinopathy with unknown pathophysiology among women of reproductive age. Several studies have been conducted to determine the prevalence of metabolic syndrome (MetS) among PCOS patients. However, the results were contradictory. The present study was conducted to evaluate the prevalence of MetS in PCOS patients using the related published data.

METHOD

The present systematic review was perfumed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was done using MeSH keywords in databases of PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, EBSCO, and Google scholar search engine as well as the reference list of the retrieved papers without time limit until October 2018. We used Cochran's Q test and I² Index to evaluate the heterogeneity among the studies and the random effects model was used to combine the results. Data analysis was performed using Stata ver. 11.1.

RESULTS

Forty six studies including 8946 patients with PCOS were included in the final analysis. Total heterogeneity was high (I²: 91.43%, P < 0.001). The prevalence of MetS in PCOS patients was estimated to be 30% (95%CI: 27-33). Subgroup analysis based on MetS diagnostic criteria showed an estimated prevalence of 0.27% (95%CI: 0.18-0.37), 0.30% (95%CI: 0.27-0.34), 0.32 (95%CI: 0.25-0.39), 0.32 (95%CI: 0.27-0.37) and 0.24 (95%CI: 0.14-0.34) for IDF, NECP-ATPIII, AHA NHLBI, CDS, and unknown criteria, respectively.

CONCLUSION

Considering the prevalence of MetS in PCOS patients, diagnosis of MetS in PCOS patients is necessary to reduce the mortality and morbidity rates.

Do Different Diagnostic Criteria Impact Polycystic Ovary Syndrome Diagnosis for Adolescents?

STUDY OBJECTIVE

Although early diagnosis of polycystic ovary syndrome (PCOS) in adolescents might allow for earlier treatment and prevention of chronic disorders, incorrect or premature diagnosis carries risks of unnecessary treatment and psychological distress. There is no consensus concerning which diagnostic criteria to use for adolescents and current criteria vary. The objective of this study was to determine whether using different diagnostic criteria will affect PCOS diagnosis in adolescents.

DESIGN, SETTING, AND PARTICIPANTS

Fifty-two patients aged 13-18 years with at least 2 of the following criteria were included in the study: (1) oligomenorrhea or amenorrhea; (2) Clinical or biochemical hyperandrogenism; and (3) polycystic ovaries on ultrasonography. Patients were then categorized according to the 6 different criteria for PCOS. National Institutes of Health, Rotterdam criteria, Androgen Excess Society, Amsterdam criteria, Endocrine Society criteria, and the Pediatric Endocrine Society criteria. The characteristics of adolescents who were diagnosed with PCOS were also evaluated.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Forty-one patients out of 52 (78.8%) received diagnosis with National Institutes of Health and Endocrine Society criteria, all with Rotterdam criteria, 45/52 (86.5%) with Androgen Excess Society criteria, 36/52 (69.2%) with Amsterdam criteria and 34/52 (65.4%) with the Pediatric Endocrine Society criteria.

RESULTS AND CONCLUSION

This study shows that the choice of guideline used does have a great effect on whether an adolescent received the PCOS diagnosis or not. For physicians using the broader criteria, care should be taken to ensure the patient does not receive diagnosis because of the physiological changes seen during puberty, which might mimic PCOS. For those using stricter criteria, close monitoring of patients who do not receive diagnosis is necessary to prevent chronic complications.

Poly Cystic Ovarian Syndrome: An Updated Overview

Poly Cystic Ovarian Syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. Women suffering from PCOS present with a constellation of symptoms associated with menstrual dysfunction and androgen excess, which significantly impacts their quality of life. They may be at increased risk of multiple morbidities, including obesity, insulin resistance, type II diabetes mellitus, cardiovascular disease (CVD), infertility, cancer, and psychological disorders. This review summarizes what the literature has so far provided from guidelines to diagnosis of PCOS. It will also present a general overview about the morbidities associated with this disease, specifically with its more severe classic form. Finally, the review will stress on the various aspects of treatment and screening recommendations currently used in the management of this condition.