Disturbances of Androgen Secretion and Metabotism in Polycystic Ovary Syndrome

The impact of unabated stimulation by human chorionic gonadotropin on the steroid hormone environment of pregnant rats and the spontaneous expression of ovarian cysts in female progeny

Unabated stimulation by low doses of human chorionic gonadotropin (hCG) induces ovarian cysts in pregnant rats. In order to determine the impact of these in vivo treatments on the hormonal milieu of pregnancy, and the potential impact of an aberrant cystic-ovary state during pregnancy on the resulting female offspring, pregnant rats were treated with either 0 (control), 1, or 3 IU hCG twice daily for at least 9 days, beginning on day 13 of pregnancy. Serum was harvested from control and hCG treated animals on days 15, 17, 19, and 22 of pregnancy. Control pregnant rats and animals treated with 1 IU hCG shared similar serum profiles for progesterone (P4), androstenedione (A4), 5alpha-androstane-3alpha,17beta-diol (3alpha-diol), androsterone (A5), and estrone (E1) between days 15 and 22 of pregnancy. Testosterone serum concentrations were similar for control and 1 IU hGG-treated pregnant rats between days 15 and 19 of pregnancy; whereas, on day 22, 1 IU hGG-treated pregnant rats displayed lower serum testosterone than control pregnant rats (P < or = 0.05). In contrast, serum estradiol (E2) concentrations for 1 IU hCG- treated pregnant rats were greater than E2 values observed for control rats on days 15-19 of pregnancy (P < or = 0.05). Serum testosterone and 3alpha-diol values for 3 IU hCG-treated pregnant rats differed from those of control pregnant rats only on day 19 when these values were transiently greater for these hCG-treated animals compared with serum values for control pregnant rats (P < or = 0.05). Serum A4 values for 3 IU hCG-treated pregnant rats were elevated compared to values for control pregnant rats only on days 15 and 17 (P < or = 0.05). In contrast, serum E1, A5, and E2 were elevated on days 19-22, 17-22, and 15-22, respectively, in 3 IU hCG-treated pregnant rats compared to control pregnant rats (P < or = 0.05). No pups from control pregnant rats displayed ovarian cysts during the time they were observed postnatally. In contrast, 6 of 25 pups from 3 IU hCG-treated pregnant rats displayed cystic ovaries, without corpora lutea, on day 55 of age. Serum steroid concentrations for these cyst-bearing progeny were similar to those of female progeny from control pregnant rats, whereas female progeny without ovarian cysts from 3 IU hCG-treated pregnant rats displayed differences in serum steroid values from those of progeny from control pregnant rats (P < or = 0.05). The data support the concept that an aberrant, yet physiologic hormonal environment associated with the induction of ovarian cysts during pregnancy in rats, can lead to the spontaneous establishment of an ovarian cystic state in at least a subset of the female progeny. Further, the date suggest that tonically increased ovarian estrogen production during pregnancy, reflected by tonically elevated peripheral serum estrogen concentrations, may play a pivotal role in the etiology of an ovarian cystic state in this subset of daughters from hCG-induced, cyst-bearing pregnant rats.

Variants in the 5alpha-reductase type 1 and type 2 genes are associated with polycystic ovary syndrome and the severity of hirsutism in affected women

CONTEXT

Despite the importance of dihydrotestosterone in androgen action, polymorphisms in the genes for the two isoforms of 5alpha-reductase (SRD5A1 and SRD5A2) have not been evaluated as risk factors for polycystic ovary syndrome (PCOS).

OBJECTIVE

The objective of the study was to test the hypothesis that haplotypes in the SRD5A1 and SRD5A2 genes are risk factors for PCOS and the severity of hirsutism in affected women.

DESIGN

PCOS and control subjects were genotyped for seven single-nucleotide polymorphisms in SRD5A1 and eight single-nucleotide polymorphisms in SRD5A2. Haplotypes were determined and tested for association with PCOS diagnosis and component phenotypes.

SETTING

Subjects were recruited from the reproductive endocrinology clinic at the University of Alabama at Birmingham; control subjects were recruited from the general surrounding community. Genotyping took place at Cedars-Sinai Medical Center in Los Angeles.

PARTICIPANTS

A total of 287 White women with PCOS and 187 controls participated.

MAIN MEASUREMENTS

SRD5A1 and SRD5A2 genotype, quantitative hirsutism score, and hormonal and metabolic phenotypes were assessed.

RESULTS

Haplotypes within both genes were associated with PCOS risk. The Leu allele of the Val89Leu variant in SRD5A2 was associated with protection against PCOS; this allele is known to modestly reduce 5alpha-reductase activity. Haplotypes in SRD5A1 but not SRD5A2 were also associated with the degree of hirsutism in affected women.

CONCLUSIONS

This study presents genetic evidence suggesting an important role of both isoforms of 5alpha-reductase in the pathogenesis of PCOS. That only SRD5A1 haplotypes were associated with hirsutism suggests that only this isoform is important in the hair follicle.

Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome

OBJECTIVE

To investigate the predictive value of polycystic ovaries for endocrine signs of polycystic ovary syndrome (PCOS).

DESIGN

Controlled descriptive study.

SETTING

Academic tertiary care fertility clinic.

PATIENT(S)

Normogonadotropic (FSH levels between 1 and 10 mIU/mL conversion factor to SI unit, 1.0) oligomenorrheic or amenorrheic women visiting our fertility clinic and a control group of regularly cycling, healthy, normal weight volunteers recruited by advertisement.

INTERVENTION(S)

Single blood samples and transvaginal sonography were performed.

MAIN OUTCOME MEASURE(S)

Serum levels of FSH, LH, androstenedione (A), and T and ovarian volume, ovarian stroma density, and follicle number.

RESULT(S)

In control women, the 95th percentile was calculated for ovarian volume, follicle number, and stroma count as well as endocrine parameters. The use of these upper limits of normal in the study group resulted in 217 (66%) patients with polycystic ovaries on ultrasound (defined as increased mean ovarian volume and/or mean follicle number per ovary), whereas only 120 (36%) patients exhibited elevated serum androgens (increased A and/or T concentrations) and 155 (47%) showed elevated LH levels. Sensitivity and specificity of single or combined sonographic parameters for prediction of elevated serum LH or androgen concentrations were limited.

CONCLUSION(S)

In the study group of normogonadotropic oligomenorrhea or amenorrheic infertile women, we set strict cutoff levels for various criteria used in the literature for defining PCOS. Groups defined by sonographic or endocrine PCOS criteria did overlap, but sonographic parameters had limited predictive value for abnormal hormone serum levels.

Effects of luteinizing hormone, insulin, insulin-like growth factor-I and insulin-like growth factor small binding protein 1 in the polycystic ovary syndrome

This study explores the clinical and endocrine implications of hyperinsulinaemia in the polycystic ovary syndrome (PCOS). Oral glucose tolerance tests were performed on 34 lean and 19 obese women with PCOS and on 13 lean women with normal ovaries. Insulin measurements were compared with basal gonadotrophins, androgens, insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein 1 (IGFBP-1). Unselected lean women with PCOS were found to have fasting hyperinsulinaemia and the raised serum insulin concentrations were associated with menstrual disturbance and hyperandrogenaemia. In addition, serum insulin concentrations in lean women with PCOS correlated positively with serum IGF-I and negatively with serum IGFBP-1 concentrations. Ovarian stimulation by insulin appears to be independent of luteinizing hormone (LH) and is an important feature in 30% of lean women with PCOS.

Heterogeneity of the polycystic ovary syndrome: clinical, endocrine and ultrasound features in 556 patients

This paper reports an analysis of the clinical, endocrine and ultrasound data within a population of 556 patients with ultrasound-diagnosed polycystic ovaries. Compared with those not so affected, hirsutism was associated with a higher mean serum testosterone concentration, infertility was associated with higher mean gonadotrophin concentrations, obesity was associated with a higher mean serum testosterone concentration, hyperprolactinaemia was associated with a lower mean serum testosterone concentration and smaller ovaries, alopecia was associated with lower mean serum LH and testosterone concentrations, and acanthosis nigricans was associated with obesity and a raised mean serum testosterone concentration. The heterogeneity illustrates the limitations in the use of specific clinical or endocrine criteria as requirements for the diagnosis of the polycystic ovary syndrome.

Oestradiol assays: applications and guidelines for the provision of a clinical biochemistry service

This paper reports on the provision of a clinical biochemistry service for serum oestradiol. The pathophysiology and recognised applications of oestradiol assays are discussed and the current availability of assay reagents and methodologies reviewed. Data are presented on the analytical performance of assays for serum oestradiol in the UK External Quality Assessment Scheme (UKEQAS) and general guidance is offered to laboratories providing a diagnostic service for this analyte.