Three types of polycystic ovarian syndrome in relation to androgenic function

Morphogenesis of polycystic ovaries as assessed by pituitary-ovarian androgenic function

Despite polycystic ovaries (PCO) being a common morphology in women with polycystic ovary syndrome and regular menstruation, the regulatory principles in the morphogenesis of antral follicles have not yet been elucidated. In recognition of the complementary interaction between androgen-induced expression of the FSH receptor and FSH-augmented expression of the androgen receptor in granulose cells of antral follicles, a possible correlation of antral follicle count (AFC) and pituitary-ovarian androgenic function was investigated in 180 infertile women over days 3-5 of the menstrual cycle. Six discrete types of PCO with decreasing pituitary-ovarian androgenic function were identified: Type I (classical Stein-Leventhal syndrome), Type II (hyperandrogenemism), Type III (singular hyper-LH), Type IV (cryptic hyperandrogenism), Type V (relative LH dominancy) and Type VI (relative FSH dominancy), in parallel to a diminishing number of AFC from Type I to Type VI. Because during the early follicular phase of the cycle until the selection of the dominant follicle, antral follicles are composed of newly emerged healthy follicles plus atretic antral follicles that remain non-ovulated from previous cycles, it is proposed that the six types of PCO may represent the folliculogenetic spectra along which PCO morphogenesis proceeds.

Follicle-stimulating hormone receptor gene mutations are rare in Japanese women with premature ovarian failure and polycystic ovary syndrome

OBJECTIVE

To determine whether the known inactivating FSH receptor gene mutations are present in Japanese women with secondary amenorrhea because of premature ovarian failure (POF) and polycystic ovary syndrome (PCOS).

DESIGN

Clinical and molecular studies.

SETTING

An outpatient clinic in a university hospital.

PATIENT(S)

Fifteen women with idiopathic POF, 38 women with PCOS, and three normal controls.

INTERVENTION(S)

Extraction of DNA from blood samples for subsequent polymerase chain reaction (PCR).

MAIN OUTCOME MEASURE(S)

PCR fragments digested with MunI, BsmI, and HhaI were compared in patients and controls. PCR fragments were also analyzed by denaturing gradient gel electrophoresis (DGGE) and direct sequencing.

RESULT(S)

No inactivating mutations reported thus far in exons 6, 7, 9, and 10 of the FSH receptor gene were identified in Japanese women with POF and PCOS. DGGE analysis of PCR fragments of exon 10 also revealed no FSH receptor gene mutations in this region.

CONCLUSION(S)

Although we cannot exclude the presence of point mutations in other regions of the FSH receptor gene, the described FSH receptor mutations may be uncommon in Japanese patients with POF and PCOS.

Increased expression of LH/hCG receptors in endometrial hyperplasia and carcinoma in anovulatory women

Endometrial hyperplasias and carcinomas are well documented to occur in anovulatory women with or without polycystic ovarian syndrome (PCO), which is characterized by hypersecretion of luteinizing hormone (LH). Although overexpression of LH/human chorionic gonadotropin (hCG) receptors has been demonstrated in endometrial carcinomas, whether LH/hCG receptors are also expressed in the endometrial hyperplasias is not known. In this study, the expression of LH/hCG receptors as well as that of progesterone receptors (PR) was analyzed by immunohistochemistry in 20 cases of normal endometria and 24 cases of endometrial hyperplasia and carcinoma (9 simple hyperplasias, 6 complex hyperplasias, 6 atypical hyperplasias, and 3 well-differentiated carcinomas). Fifteen of the 24 patients were 40 years old or younger, presumably anovulatory by BBT chart. Serum levels of LH, follicular stimulating hormone (FSH), prolactin, estradiol, and testosterone were measured by radioimmunoassay. Expression of LH/hCG receptors was detected in 19 of the 21 hyperplasias with a relatively stronger staining intensity in the glandular cells of complex or atypical hyperplasia as compared with normal endometrial glands or simple hyperplasia. In addition, all of the 3 carcinoma specimens showed stronger expression of LH/hCG receptors compared with normal endometria. The expression of LH/hCG receptors was well correlated with the staining for PR. Hormonal assay revealed 3 women to have the typical endocrinological profile of PCO. These findings suggest that the increased expression of LH/hCG receptors is a feature of endometrial hyperplasia and carcinoma developing in younger anovulatory women including those with PCO.