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Wang Y, Chen H, Li Y, Hao H, Liu J, Chen Y, Meng J, Zhang S, Gu W, Lyu Z, Zang L, Mu Y. Predictive factors that influence the clinical efficacy of umbilical cord-derived mesenchymal stromal cells in the treatment of type 2 diabetes mellitus. Cytotherapy 2024; 26:311-316. [PMID: 38219142 DOI: 10.1016/j.jcyt.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/20/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Our previous single-center, randomized, double-blinded, placebo-controlled phase 2 study evaluated the safety and effectiveness of human umbilical cord mesenchymal stromal cell (UC-MSC) transfusion for treating patients with type 2 diabetes mellitus (T2DM). Indeed, this potential treatment strategy was able to reduce insulin use by half in a considerable number of patients. However, many other patients' responses to UC-MSC transfusion were insignificant. The selection of patients who might benefit from UC-MSC treatment is crucial from a clinical standpoint. METHODS In this post hoc analysis, 37 patients who received UC-MSC transfusions were divided into two groups based on whether their glycated hemoglobin (hemoglobin A1c, or HbA1c) level was less than 7% after receiving UC-MSC treatment. The baseline differences between the two groups were summarized, and potential factors influencing efficacy of UC-MSCs for T2DM were analyzed by univariate and multivariate logistic regression. The correlations between the relevant hormone levels and the treatment effect were further analyzed. RESULTS At the 9-week follow-up, 59.5% of patients achieved their targeted HbA1c level. Male patients with lower baseline HbA1c and greater C-peptide area under the curve (AUCC-pep) values responded favorably to UC-MSC transfusion, according to multivariate analysis. The effectiveness of UC-MSCs transfusion was predicted by AUCC-pep (cutoff value: 14.22 ng/h/mL). Further investigation revealed that AUCC-pep was increased in male patients with greater baseline testosterone levels. CONCLUSIONS Male patients with T2DM with greater AUCC-pep may be more likely to respond clinically to UC-MSC therapy, and further large-scale multi-ethnic clinical studies should be performed to confirm the conclusion.
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Affiliation(s)
- Yuepeng Wang
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China
| | - Haixu Chen
- Institute of Geriatrics & National Clinical Research Center of Geriatrics Disease, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yijun Li
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haojie Hao
- Department of Biotherapy, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiejie Liu
- Department of Biotherapy, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yulong Chen
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junhua Meng
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Saichun Zhang
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Weijun Gu
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhaohui Lyu
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Zang
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Yiming Mu
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Kabakchieva P, Gateva A, Hristova J, Georgiev T, Kamenov Z. Analysis of 2-Arachidonoylglycerol Levels in Polycystic Ovary Syndrome in the Context of Hormonal and Metabolic Alterations and Across the Classical Phenotypes. Cannabis Cannabinoid Res 2023; 8:634-641. [PMID: 35235418 DOI: 10.1089/can.2021.0183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Ovarian folliculogenesis requires a fine balance between extra- and intra-ovarian factors. Endocannabinoids are found in the female reproductive system and are essential for a normal follicular growing process and ovulation. First, our study aimed to analyze levels of the endocannabinoid-2-arachidonoylglycerol (2-AG)-in patients with polycystic ovary syndrome (PCOS) and to compare with healthy controls. In addition, the study aimed to explore the association of 2-AG with hormonal and metabolic alterations, ovulatory dysfunction, and the presence of polycystic ovarian morphology (PCOM) across the classical PCOS phenotypes. Methods: Fifty-four women with PCOS were compared with 26 healthy controls. PCOS patients were diagnosed and phenotyped according to the Rotterdam criteria. Further analyses were performed with the classical PCOS phenotypes A and B comprising hyperandrogenism with oligo-anovulation with or without PCOM, respectively. Full medical history, clinical investigations, anthropometric measurements, laboratory tests, and ultrasound investigations were carried out in the follicular phase. Serum levels of 2-AG were measured by enzyme-linked immunosorbent assay. Results: PCOS patients (n=54) and healthy controls (n=26) showed similar metabolic parameters and anthropometric characteristics. PCOS patients were more hirsute than healthy women (p=0.001). Luteinizing hormone/follicle-stimulating hormone ratio and serum levels of androgens were significantly higher in the patient than in the control group (p=0.035, p<0.001, respectively). Free androgen index was also higher in the patient group (p=0.002). Serum levels of 2-AG did not significantly differ when comparing all PCOS patients versus healthy controls; however, further analysis of individual phenotype groups revealed that 2-AG levels in PCOS patients with phenotyope A (n=30) were significantly lower when compared with PCOS patients with phenotype B (n=20) and healthy controls (n=26). Conclusion: Serum levels of 2-AG were similar between PCOS patients and healthy controls. Nevertheless, phenotype A PCOS patients had significantly lower levels of the endocannabinoid compared with phenotype B patients and healthy controls. Collectively, these results suggest that overall serum levels of 2-AG are not a diagnostic marker for PCOS; however, their altered secretion or activity may influence normal follicular processes.
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Affiliation(s)
- Plamena Kabakchieva
- Clinic of Endocrinology, University Hospital "Alexandrovska", Department of Internal Medicine, Medical Faculty, Medical University-Sofia, Sofia, Bulgaria
- Clinic of Internal Diseases, Naval Hospital-Varna, Military Medical Academy, Bulgaria
| | - Antoaneta Gateva
- Clinic of Endocrinology, University Hospital "Alexandrovska", Department of Internal Medicine, Medical Faculty, Medical University-Sofia, Sofia, Bulgaria
| | - Julieta Hristova
- Clinical Laboratory and Clinical Pharmacology, University Hospital "Alexandrovska", Department of Clinical Laboratory, Medical University-Sofia, Sofia, Bulgaria
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital "St. Marina", First Department of Internal Medicine, Medical Faculty, Medical University-Varna, Varna, Bulgaria
| | - Zdravko Kamenov
- Clinic of Endocrinology, University Hospital "Alexandrovska", Department of Internal Medicine, Medical Faculty, Medical University-Sofia, Sofia, Bulgaria
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Elshamy AM, Shatat D, AbuoHashish NA, Safa MAE, Elgharbawy N, Ibrahim HA, Barhoma RAE, Eltabaa EF, Ahmed AS, Shalaby AM, Alabiad MA, Alorini M, Ibrahim RR. Ameliorative effect of sesame oil on experimentally induced polycystic ovary syndrome: A cross-link between XBP-1/PPAR-1, regulatory proteins for lipogenesis/steroids. Cell Biochem Funct 2023; 41:268-279. [PMID: 36810739 DOI: 10.1002/cbf.3782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/02/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a mixed endocrine/metabolic/reproductive disorder in women of reproductive age. Sesame oil (SO) contains sesame lignans & vitamin E with broad-spectrum antioxidant and anti-inflammatory effects. This study investigates the ameliorative effect of SO on experimentally induced PCOS and elucidates the possible molecular mechanisms with a deeper focus on the different signaling pathways involved. The study was carried out on 28 nonpregnant female Wister albino rats that were divided into four equal groups; Group I (control group) received oral 0.5% wt/vol carboxymethyl cellulose daily. Group II (SO group): orally administered SO (2 mL/kg body wt./day) for 21 days. Group III (PCOS group) received letrozole daily, 1 mg/kg, for 21 days. Group IV (PCOS + SO group): concomitantly administered letrozole and SO for 21 days. The serum hormonal and metabolic panel and the homogenate ATF-1, StAR, MAPK, PKA, and PI3K levels of the ovarian tissue were calorimetrically evaluated. However, endoplasmic reticulum (ER) stress was evaluated by ovarian XBP1 and PPAR-γ messenger RNA expression level using the qRT-PCR technique. Ovarian COX-2 was detected immunohistochemically. The results suggest that SO-treated PCOS rats showed a significantly improved hormonal, metabolic panel, inflammatory, and ER stress status with concomitant decreases in ATF-1, StAR, MAPK, PKA, and PI3K in ovarian rats compared to the correspondent values in PCOS without treatment. CONCLUSIONS: The protective effects of SO against PCOS are triggered by ameliorating regulatory proteins of ER stress, lipogenesis, and steroidogenesis through the PI3K/PKA and MAPK/ERK2 signaling cascades. SIGNIFICANCE STATEMENT: Polycystic ovary syndrome (PCOS) is the most common mixed endocrine-metabolic dysfunction among women within the reproductive period, with an estimated prevalence of 5%-26% worldwide. Doctors traditionally recommend metformin for PCOS patients. However, metformin is known to be associated with significant adverse effects and contraindications. This work aimed at shedding light on the ameliorative effect of sesame oil (SO), natural polyunsaturated fatty acids-rich oil, on the induced PCOS model. SO proved to have a marvelous effect on the metabolic and endocrine derangements in the PCOS rat model. We hoped to provide a valuable alternative treatment for PCOS patients to avoid the side effects of metformin and to help PCOS patients for whom metformin is contraindicated.
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Affiliation(s)
- Amira Mostafa Elshamy
- Department of Medical Biochemistry & Molecular Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doaa Shatat
- Department of Gynecology and Obstetrics, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Nashwa Elgharbawy
- Department of Internal medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hoda Ali Ibrahim
- Department of Medical Biochemistry & Molecular Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Eman Fawzy Eltabaa
- Department of Physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed S Ahmed
- Department of Anatomy & Embryology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amany Mohamed Shalaby
- Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Ali Alabiad
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammed Alorini
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Rowida Raafat Ibrahim
- Department of Medical Biochemistry & Molecular Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Bassols J, de Zegher F, Diaz M, Carreras-Badosa G, Garcia-Beltran C, Puerto-Carranza E, Oliver-Vila C, Casano P, Franco CA, Malpique R, López-Bermejo A, Ibáñez L. Effects of half-dose spiomet treatment in girls with early puberty and accelerated bone maturation: a multicenter, randomized, placebo-controlled study protocol. Trials 2023; 24:56. [PMID: 36694227 PMCID: PMC9873221 DOI: 10.1186/s13063-022-07050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A "mismatch" sequence of less prenatal weight gain and more postnatal weight gain may lead to ectopic lipid accumulation, and trigger the development of early adrenarche/pubarche and the activation of the gonadotropic axis resulting in early puberty and ending up in full-blown adolescent polycystic ovary syndrome (PCOS). In the present study, we assess whether a low-dose combination of generics that collectively reduce ectopic fat through different pathways can slow down the accelerated maturation in "mismatch" girls with early puberty. METHODS Randomized, placebo-controlled, multicenter, phase 2a, study in 64 girls [age, 8.0-9.3 years; birthweight (BW) for gestational age in lower tertile (-1.96< Z-score <-0.44), body mass index (BMI) in upper tertile (+0.44< Z-score < +1.96) and early progressive puberty (Tanner B2 at 7.7-9.0 years)]. Pharmacological intervention will be with a half-dose version of SPIOMET (mini-spiomet), a combination that reverts the PCOS phenotype in "mismatch" adolescents; mini-spiomet will contain spironolactone (25 mg/day, to raise brown adipose tissue activity), pioglitazone (3.75 mg/day, to raise adiponectin and insulin sensitivity), and metformin (425 mg/day, to raise AMPK activity and GDF15). Recruitment: 1 year; double-blind treatment: 1 year; open follow-up: 1 year; analyses and reporting: 1 year. INTERVENTIONS randomization (1:1) for placebo vs mini-spiomet. PRIMARY OUTCOME annualized bone age advancement (0-1 year) by BoneXpert; secondary outcomes: insulin, IGF-I, high-molecular-weight adiponectin (HMW-adip), sex hormone binding globulin (SHBG), ultra-sensitive C-reactive protein (usCRP), androgens, luteinizing hormone (LH), follicle-stimulating hormone (FSH), oestradiol, growth-and-differentiation factor 15 (GDF15), C-X-C motif chemokine ligand-14 (CXCL14), safety parameters, and quantification of hepato-visceral fat. DISCUSSION The present study, if successful, may provide a first proof of the concept that the rapid maturation of girls with an upward mismatch between pre- and post-natal weight gain can be slowed down with a fixed low-dose combination of old and safe generics jointly targeting a reduction of ectopic fat without necessarily lowering body weight. TRIAL REGISTRATION EudraCT 2021-006766-21. Registered on May 30, 2022.
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Affiliation(s)
- Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Francis de Zegher
- Leuven Research & Development, University of Leuven, Leuven, Belgium
| | - Marta Diaz
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Carreras-Badosa
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Cristina Garcia-Beltran
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cora Oliver-Vila
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Paula Casano
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Céline Alicia Franco
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Rita Malpique
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
- Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain.
- Department of Medical Sciences, University of Girona, Girona, Spain.
| | - Lourdes Ibáñez
- Endocrinology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
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Kayacık Günday Ö, Özdemir Erdoğan M, Pehlivan A, Yılmazer M. The effect of metformin treatment on leukocyte telomere length in patients with polycystic ovary syndrome: a prospective case-control study. J Assist Reprod Genet 2022; 39:2153-2161. [PMID: 35861921 PMCID: PMC9474966 DOI: 10.1007/s10815-022-02577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The study aimed to investigate the effect of metformin treatment on leukocyte telomere length (LTL) and the relationship of LTL with C-reactive protein (CRP), homocysteine, albumin, complete blood count, and HOMA-IR values in patients with polycystic ovary syndrome (PCOS). MATERIAL AND METHOD A prospective case-control study consisting of 30 women with PCOS and 30 healthy women without PCOS was performed. The relationship between clinical and laboratory parameters and LTL was analyzed. PCOS patients were treated with metformin (850 mg/day) for three months. Before treatment (BT) and after treatment (AT), each patient's LTL was evaluated and compared with the control group. RESULTS In the comparison between PCOS and control groups, the difference was significant for LTL, age, body mass index (BMI), and CRP (p = 0.002; p < 0.001; p = 0.001; p = 0.01, respectively). In PCOS patients, the difference between BT and AT, LTL was not statistically significant (BT: 6.06 ± 2.12; AT: 6.30 ± 1.93; p = 0.623; 95% C.I: - 1.22-0.74); however, the difference for weight was significant (BT: 83.78 ± 15.31; AT: 80.62 ± 15.40; p = 0.02; 95% CI: 1.34-4.99). The logistic regression model established by BMI (group 1: 21-24, group 2: 24-29, group 3: 29-34, group 4: > 34), age, and RDW, which predicted the PCOS group by affecting the LTL level, was statistically significant (p < 0.001/PPV = 96.3%; NPV = 88.5%). Each unit reduction in telomere length increased women's probability of PCOS by 0.4 times (p = 0.013; OR = 0.419, 95% CI: 0.211-0.835). CONCLUSION Although statistically insignificant, LTL increased after metformin use in PCOS patients, and the mean weight loss reduction was statistically significant. Telomere shortening increased the likelihood of PCOS 0.4 times.
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Affiliation(s)
- Özlem Kayacık Günday
- Department of Obstetrics and Gynecology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Müjgan Özdemir Erdoğan
- Department of Genetics, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Ayşen Pehlivan
- Department of Genetics, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Mehmet Yılmazer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Kabakchieva P, Gateva A, Velikova T, Georgiev T, Yamanishi K, Okamura H, Kamenov Z. Elevated levels of interleukin-18 are associated with several indices of general and visceral adiposity and insulin resistance in women with polycystic ovary syndrome. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:3-11. [PMID: 35263047 PMCID: PMC9991028 DOI: 10.20945/2359-3997000000442] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective Our aim was to analyze levels of proinflammatory biomarker interleukin-18 (IL-18) in healthy controls and patients with polycystic ovary syndrome (PCOS) focusing on its association with obesity, clinical, hormonal, and metabolic characteristics. Methods Fifty-eight patients with PCOS were enrolled in the study fulfilling the Rotterdam criteria and were matched for age, body mass index (BMI), and ethnicity with 30 healthy controls. Detailed anthropometric measurements, clinical investigations, hormonal and biochemical tests were obtained between the 3rd and 5th day of a menstrual cycle. A subanalysis of the PCOS group was performed separating patients into several groups according to a waist-to-height ratio (WHtR), insulin resistance (IR), and free androgen index (FAI). Serum IL-18 levels were measured using the ELISA method. Results Levels of IL-18 were similar between PCOS patients and controls. IL-18 was higher in overweight/obese women compared to normal-weight women when analyzing all participants together and separately PCOS or controls group (p < 0.001, p < 0.001, p = 0.01, respectively). Additionally, IL-18 levels were higher in high-WHtR and IR subgroups compared to low-WHtR (p < 0.001) and non-IR PCOS women (p < 0.001). PCOS women with high FAI had greater serum IL-18 levels than normal-FAI patients (p = 0.002). Levels of IL-18 correlated positively with most of the anthropometric and metabolic parameters. In multiple linear regression, age, waist circumference, and fasting insulin were independently related factors with IL-18. Conclusion Elevated levels of IL-18 were related to several indices of general and visceral adiposity and insulin resistance in PCOS.
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Affiliation(s)
- Plamena Kabakchieva
- Clinic of Endocrinology, University Hospital "Alexandrovska", Department of Internal Medicine, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria, .,Clinic of Internal Diseases, Naval Hospital - Varna, Military Medical Academy, Bulgaria
| | - Antoaneta Gateva
- Clinic of Endocrinology, University Hospital "Alexandrovska", Department of Internal Medicine, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Tsvetelina Velikova
- Laboratory of Clinical Immunology, University Hospital "Lozenetz", Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria
| | - Tsvetoslav Georgiev
- University Hospital "St. Marina", First Department of Internal Medicine, Medical Faculty, Medical University - Varna, Varna, Bulgaria
| | | | - Haruki Okamura
- Department of Psychoimmunology, Hyogo College of Medicine, Japan
| | - Zdravko Kamenov
- Clinic of Endocrinology, University Hospital "Alexandrovska", Department of Internal Medicine, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
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Cioana M, Deng J, Nadarajah A, Hou M, Qiu Y, Chen SSJ, Rivas A, Banfield L, Alfaraidi H, Alotaibi A, Thabane L, Samaan MC. Prevalence of Polycystic Ovary Syndrome in Patients With Pediatric Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2147454. [PMID: 35166782 PMCID: PMC8848210 DOI: 10.1001/jamanetworkopen.2021.47454] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The prevalence of pediatric type 2 diabetes (T2D) is increasing globally. Girls with T2D are at risk of developing polycystic ovary syndrome (PCOS), but the prevalence of PCOS among girls with T2D is unknown. OBJECTIVE To determine the prevalence of PCOS in girls with T2D and to assess the association of obesity and race with this prevalence. DATA SOURCES In this systematic review and meta-analysis, MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science: Conference Proceedings Citation Index-Science, and the gray literature were searched from inception to April 4, 2021. STUDY SELECTION Two reviewers independently screened for studies with observational study design that recruited 10 or more participants and reported the prevalence of PCOS in girls with T2D. DATA EXTRACTION AND SYNTHESIS Risk of bias was evaluated using a validated tool, and level of evidence was assessed using the Oxford Centre for Evidence-Based Medicine criteria. A random-effects meta-analysis was performed. This study follows the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. MAIN OUTCOMES AND MEASURES The main outcome of this systematic review was the prevalence of PCOS in girls with T2D. Secondary outcomes included assessing the associations of obesity and race with PCOS prevalence. RESULTS Of 722 screened studies, 6 studies involving 470 girls with T2D (mean age at diagnosis, 12.9-16.1 years) met the inclusion criteria. The prevalence (weighted percentage) of PCOS was 19.58% (95% CI, 12.02%-27.14%; I2 = 74%; P = .002). Heterogeneity was moderate to high; however, it was significantly reduced after excluding studies that did not report PCOS diagnostic criteria, leading to a calculated prevalence (weighted percentage) of 24.04% (95% CI, 15.07%-33.01%; I2 = 0%; P = .92). Associations with obesity and race could not be determined because of data paucity. CONCLUSIONS AND RELEVANCE In this meta-analysis, approximately 1 in 5 girls with T2D had PCOS, but the results of this meta-analysis should be considered with caution because studies including the larger numbers of girls did not report the criteria used to diagnose PCOS, which is a challenge during adolescence. The associations of obesity and race with PCOS prevalence among girls with T2D need further evaluation to help define at-risk subgroups and implement early assessment and treatment strategies to improve management of this T2D-related comorbidity.
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Affiliation(s)
- Milena Cioana
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Jiawen Deng
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Ajantha Nadarajah
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Maggie Hou
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Yuan Qiu
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sondra Song Jie Chen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Angelica Rivas
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Haifa Alfaraidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Division of Endocrinology, Department of Pediatrics, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahlam Alotaibi
- Department of Pediatrics, Division of Pediatric Endocrinology, King Abdullah bin Abdulaziz University Hospital, Princess Noura University, Riyadh, Saudi Arabia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, St Joseph’s Health Care, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Anti-Müllerian hormone has limited ability to predict fecundability in Chinese women: a preconception cohort study. Reprod Biomed Online 2022; 44:1055-1063. [DOI: 10.1016/j.rbmo.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/18/2022]
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Ding Y, Jiang Y, Zhu M, Zhu Q, He Y, Lu Y, Wang Y, Qi J, Feng Y, Huang R, Yin H, Li S, Sun Y. Follicular fluid lipidomic profiling reveals potential biomarkers of polycystic ovary syndrome: A pilot study. Front Endocrinol (Lausanne) 2022; 13:960274. [PMID: 36176459 PMCID: PMC9513192 DOI: 10.3389/fendo.2022.960274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder associated with multiple metabolic conditions including obesity, insulin resistance, and dyslipidemia. PCOS is the most common cause of anovulatory infertility; however, the molecular diversity of the ovarian follicle microenvironment is not fully understood. This study aimed to investigate the follicular fluid (FF) lipidomic profiles in different phenotypes of PCOS and to explore novel lipid biomarkers. METHODS A total of 25 women with PCOS and 12 women without PCOS who underwent in vitro fertilization and embryo transfer were recruited, and their FF samples were collected for the lipidomic study. Liquid chromatography-tandem mass spectrometry was used to compare the differential abundance of FF lipids between patients with different PCOS phenotypes and controls. Subsequently, correlations between specific lipid concentrations in FF and high-quality embryo rate (HQER) were analyzed to further evaluate the potential interferences of lipid levels with oocyte quality in PCOS. Candidate biomarkers were then compared via receiver operating characteristic (ROC) curve analysis. RESULTS In total, 19 lipids were identified in ovarian FF. Of these, the concentrations of ceramide (Cer) and free fatty acids (FFA) in FF were significantly increased, whereas those of lysophosphatidylglycerol (LPG) were reduced in women with PCOS compared to controls, especially in obese and insulin-resistant groups. In addition, six subclasses of ceramide, FFA, and LPG were correlated with oocyte quality. Twenty-three lipid subclasses were identified as potential biomarkers of PCOS, and ROC analysis indicated the prognostic value of Cer,36:1;2, FFA C14:1, and LPG,18:0 on HQER in patients with PCOS. CONCLUSIONS Our study showed the unique lipidomic profiles in FF from women with PCOS. Moreover, it provided metabolic signatures as well as candidate biomarkers that help to better understand the pathogenesis of PCOS.
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Affiliation(s)
- Ying Ding
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yihong Jiang
- Department of Endocrinology and Metabolism, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingjiang Zhu
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai, China
| | - Qinling Zhu
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yaqiong He
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yao Lu
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yuan Wang
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Jia Qi
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yifan Feng
- Department of Endocrinology and Metabolism, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Huang
- Department of Endocrinology and Metabolism, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiyong Yin
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai, China
| | - Shengxian Li
- Department of Endocrinology and Metabolism, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Shengxian Li, ; Yun Sun,
| | - Yun Sun
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- *Correspondence: Shengxian Li, ; Yun Sun,
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10
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Polycystic ovary syndrome and (pre)osteoarthritis: assessing the link between hyperandrogenism in young women and cartilage oligomeric matrix protein as a marker of cartilage breakdown. Clin Rheumatol 2021; 40:4217-4223. [PMID: 33948768 DOI: 10.1007/s10067-021-05753-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION OBJECTIVES: Our aim was to analyze the link between hyperandrogenism and early clinical manifestations of osteoarthritis (OA), knee cartilage thickness, and serum cartilage oligomeric matrix protein (sCOMP) levels in patients with polycystic ovary syndrome (PCOS) and to compare them with healthy volunteers. METHODS Fifty-four PCOS patients who met the Rotterdam criteria with phenotypes A, B, and C were included. They were compared with 26 age- and body mass index (BMI)-matched controls. Detailed anthropometric measurements and clinical evaluation for hyperandrogenism were performed for all participants who also filled in the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Furthermore, laboratory tests including sCOMP and hormone quantification were performed in a fasting stage. Finally, an ultrasound assessment was carried out in randomly selected 56 study participants. RESULTS PCOS women reported more prominent knee-related symptoms (p = 0.035) and more impaired activities of daily living (ADL) (p = 0.001) than controls. Cartilage thickness of the left and right medial condyle and left lateral condyle was significantly greater in PCOS group (n = 41) than in control group (n = 15) (p = 0.05, p = 0.006, and p = 0.036, respectively). COMP correlated significantly and negatively with testosterone levels (p = 0.029, r = - 0.297) in women with PCOS and the correlation remained significant after controlling for BMI. CONCLUSIONS Women with PCOS may experience knee-related symptoms and impaired ADL. They had greater knee femoral cartilage thickness. Although sCOMP levels did not significantly differ between the groups, lower levels of sCOMP may be inherent to PCOS patients with higher testosterone levels. Key Points • Although PCOS patients may experience more prominent knee related symptoms, their femoral cartilage of the knee joint is found thicker than controls. • PCOS patients did not have significantly elevated levels of sCOMP. • Lower sCOMP levels were related to higher testosterone levels.
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11
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Temur M, Taşgöz FN, Kender Ertürk N. Elevated circulating Selenoprotein P levels in patients with polycystic ovary syndrome. J OBSTET GYNAECOL 2021; 42:289-293. [PMID: 33938349 DOI: 10.1080/01443615.2021.1887112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Selenoprotein P (SeP), an hepatokine that is primarily produced by liver, has been reported to affect glucose metabolism. In this study, we aimed to measure and compare serum SeP values in patients with polycystic ovary syndrome (PCOS) and a healthy control group, and to investigate whether there was a relationship between SeP values and insulin resistance in patients with PCOS. This prospective case-control study included 40 patients with PCOS and 39 healthy women (non-PCOS) matched for age and body mass index. SeP levels were significantly higher in the PCOS group compared with the healthy controls (7.48 ± 3.80 vs. 5.17 ± 3.20 mg/ml, p = .005). Serum insulin, hs-CRP, HOMA-IR, FBG, total-testosterone, and free-testosterone levels were higher in women with PCOS than in controls. In an unadjusted model and after adjusting for potential confounders, SeP had increased odds for PCOS (p = .007). ROC curve analysis showed that the area under the ROC curves were 0.691 (95% CI: 0.576-0.806, p < .003) for SeP levels. The optimal cut-off value of SeP for detecting PCOS was ≥5.87 mgl/ml. We showed, for the first time, that serum SeP levels were increased significantly in PCOS, Our results suggest that there is a potential link between PCOS and SeP levelsIMPACT STATEMENTWhat is already known on this subject? Selenoprotein deficiency causes various dysfunctions associated with oxidative stress, but recent studies found that increased SeP levels were associated with insulin resistance. Circulating SeP levels have been found to be increased in patients with type 2 diabetes mellitus (T2DM).What the results of this study add? Our study is the first in the literature to examine the relationship between SeP levels and the presence of PCOS. Serum SeP levels were increased significantly in PCOS.What the implications are of these findings for clinical practice and/or further research? SeP seemed to have a role in PCOS. SeP can be used to predict metabolic disorders associated with PCOS and to determine treatment methods.
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Affiliation(s)
- Muzaffer Temur
- Department of Obstetrics and Gynecology, Bursa Private Doruk Hospital, Bursa, Turkey
| | - Fatma Nurgül Taşgöz
- Department of Obstetrics and Gynecology, Bursa Yüksek İhtisas Education and Research Hospital, Bursa, Turkey
| | - Nergis Kender Ertürk
- Department of Obstetrics and Gynecology, Bursa Yüksek İhtisas Education and Research Hospital, Bursa, Turkey
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12
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Zhou X, Yang X. Association between obesity and oligomenorrhea or irregular menstruation in Chinese women of childbearing age: a cross-sectional study. Gynecol Endocrinol 2020; 36:1101-1105. [PMID: 32783549 DOI: 10.1080/09513590.2020.1803823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE In this study, we aimed to investigate the relationship between body mass index (BMI), waist circumference (WC) or waist-to-hip ratio (WHR) and oligomenorrhea or irregular menstruation in Chinese women of childbearing age. METHODS A total of 1,423 Han women aged 19-39 years who were routinely examined at the Physical Examination Center of Peking University People's Hospital were enrolled by convenience sampling method. All participants were asked to fill up menstrual questionnaires. Binary logistic regression models were used to assess the odds ratio (OR) of different BMI, WC and WHR groups for the prevalence of oligomenorrhea and irregular menstruation. Moreover, we used the ROC curves to compare the predictive effects of BMI, WC and WHR on oligomenorrhea and irregular menstruation. RESULTS Among the 1,423 participants, 93 women (6.5%) had BMI ≥ 30 kg/m2, 6.5% of the participants had oligomenorrhea, and 22.6% had irregular menstrual menstruation. Overall, those with BMI ≥30 kg/m2 (OR = 2.543; 95%CI 1.332-4.856; p = .005) or WC ≥ 90 cm (OR = 2.023; 95%CI 1.198-3.416; p = .008) were more likely to have long menstrual cycle. The prevalence of irregular menstruation was higher in the BMI ≥30 kg/m2 (OR = 2.509; 95%CI 1.591-3.958; p < .001), WC ≥ 90 cm (OR = 2.299; 95%CI 1.619-3.265; p < .001) and WHR ≥ 0.86 (OR = 1.739; 95%CI 1.293-2.339; p < .001) groups. The ROC curve showed that all three anthropometric indices had predictive effect, while there was no significant difference in predicting oligomenorrhea. WC was a better predictor for irregular menstruation compared with BMI. CONCLUSIONS Obesity, oligomenorrhea and irregular menstruation were common in Chinese women of childbearing age, and obesity was associated with oligomenorrhea and irregular menstruation. Abdominal obesity might have a stronger predictive effect on irregular menstruation.
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Affiliation(s)
- Xinyu Zhou
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
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Soliman A, De Sanctis V, Alaaraj N, Hamed N. The clinical application of metformin in children and adolescents: A short update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020086. [PMID: 32921782 PMCID: PMC7717009 DOI: 10.23750/abm.v91i3.10127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022]
Abstract
Metformin is a widely used drug that results in clear benefits in relation to glucose metabolism and diabetes-related complications. The global increase in the prevalence of obesity among children and adolescents is accompanied by the appearance and increasing prevalence of insulin resistance, prediabetes, and type 2 diabetes mellitus (T2DM). In addition, children, and adolescents with premature pubarche and polycystic ovary have considerable degree of insulin resistance. The insulin sensitizing actions of metformin encouraged many investigators and physician to use it as the key drug in these conditions for both prevention and treatment. However, long term-controlled studies are still required to assess the degree and duration of effectiveness and safety of using metformin. This review tries to update physicians about the main and the new therapeutic perspectives of this drug.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | - Nada Alaaraj
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
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14
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Gunning MN, Sir Petermann T, Crisosto N, van Rijn BB, de Wilde MA, Christ JP, Uiterwaal CSPM, de Jager W, Eijkemans MJC, Kunselman AR, Legro RS, Fauser BCJM. Cardiometabolic health in offspring of women with PCOS compared to healthy controls: a systematic review and individual participant data meta-analysis. Hum Reprod Update 2020; 26:103-117. [PMID: 31867675 PMCID: PMC7007319 DOI: 10.1093/humupd/dmz036] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/28/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Women diagnosed with polycystic ovary syndrome (PCOS) suffer from an unfavorable cardiometabolic risk profile, which is already established by child-bearing age. OBJECTIVE AND RATIONALE The aim of this systematic review along with an individual participant data meta-analysis is to evaluate whether cardiometabolic features in the offspring (females and males aged 1–18 years) of women with PCOS (OPCOS) are less favorable compared to the offspring of healthy controls. SEARCH METHODS PubMed, Embase and gray literature databases were searched by three authors independently (M.N.G., M.A.W and J.C.) (last updated on 1 February 2018). Relevant key terms such as ‘offspring’ and ‘PCOS’ were combined. Outcomes were age-specific standardized scores of various cardiometabolic parameters: BMI, blood pressure, glucose, insulin, lipid profile and the sum scores of various cardiometabolic features (metabolic sum score). Linear mixed models were used for analyses with standardized beta (β) as outcome. OUTCOMES Nine relevant observational studies could be identified, which jointly included 1367 children: OPCOS and controls, originating from the Netherlands, Chile and the USA. After excluding neonates, duplicate records and follow-up screenings, a total of 885 subjects remained. In adjusted analyses, we observed that OPCOS (n = 298) exhibited increased plasma levels of fasting insulin (β = 0.21(95%CI: 0.01–0.41), P = 0.05), insulin-resistance (β = 0.21(95%CI: 0.01–0.42), P = 0.04), triglycerides (β = 0.19(95%CI: 0.02–0.36), P = 0.03) and high-density lipoprotein (HDL)-cholesterol concentrations (β = 0.31(95%CI: 0.08–0.54), P < 0.01), but a reduced birthweight (β = −116(95%CI: −195 to 38), P < 0.01) compared to controls (n = 587). After correction for multiple testing, however, differences in insulin and triglycerides lost their statistical significance. Interaction tests for sex revealed differences between males and females when comparing OPCOS versus controls. A higher 2-hour fasting insulin was observed among female OPCOS versus female controls (estimated difference for females (βf) = 0.45(95%CI: 0.07 to 0.83)) compared to the estimated difference between males ((βm) = −0.20(95%CI: −0.58 to 0.19)), with interaction-test: P = 0.03. Low-density lipoprotein–cholesterol differences in OPCOS versus controls were lower among females (βf = −0.39(95%CI: −0.62 to 0.16)), but comparable between male OPCOS and male controls (βm = 0.27(95%CI: −0.03 to 0.57)), with interaction-test: P < 0.01. Total cholesterol differences in OPCOS versus controls were also lower in females compared to the difference in male OPCOS and male controls (βf = −0.31(95%CI: −0.57 to 0.06), βm = 0.28(95%CI: −0.01 to 0.56), interaction-test: P = 0.01). The difference in HDL-cholesterol among female OPCOS versus controls (βf = 0.53(95%CI: 0.18–0.88)) was larger compared to the estimated mean difference among OPCOS males and the male controls (βm = 0.13(95%CI: −0.05−0.31), interaction-test: P < 0.01). Interaction test in metabolic sum score revealed a significant difference between females (OPCOS versus controls) and males (OPCOS versus controls); however, sub analyses performed in both sexes separately did not reveal a difference among females (OPCOS versus controls: βf = −0.14(95%CI: −1.05 to 0.77)) or males (OPCOS versus controls: βm = 0.85(95%CI: −0.10 to 1.79)), with P-value < 0.01. WIDER IMPLICATIONS We observed subtle signs of altered cardiometabolic health in OPCOS. Therefore, the unfavorable cardiovascular profile of women with PCOS at childbearing age may—next to a genetic predisposition—influence the health of their offspring. Sensitivity analyses revealed that these differences were predominantly observed among female offspring aged between 1 and 18 years. Moreover, studies with minimal risk of bias should elucidate the influence of a PCOS diagnosis in mothers on both sexes during fetal development and subsequently during childhood.
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Affiliation(s)
- Marlise N Gunning
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Teresa Sir Petermann
- Endocrinology and Metabolism, University of Chile, Santiago, Chile.,Unit of Endocrinology, Clinica Las Condes, Santiago, Chile
| | - Nicolas Crisosto
- Endocrinology and Metabolism, University of Chile, Santiago, Chile.,Unit of Endocrinology, Clinica Las Condes, Santiago, Chile
| | - Bas B van Rijn
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands.,Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Marlieke A de Wilde
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jacob P Christ
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - C S P M Uiterwaal
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilco de Jager
- Department of Pediatric Immunology, Centre for Molecular and Cellular Intervention, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marinus J C Eijkemans
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Allen R Kunselman
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
| | - Bart C J M Fauser
- Department of Reproductive Medicine, Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Abstract
Polycystic ovary syndrome (PCOS), characterized by hormonal imbalance and ovarian dysfunction, often starts during adolescence. Inconsistent diagnostic criteria, variable provider knowledge, and lack of consensus pose specific challenges for the care of women with PCOS. These factors encourage inaccurate diagnosis with both under and overdiagnosis. This unfavorable diagnostic experience exasperates affected women and limits timely opportunities for intervention to minimize associated comorbidities, especially during the transition from pediatric to adult care. Recognition of these issues in the care of adolescents and women with PCOS inspired the development of the International Evidence-Based PCOS Guidelines, which emphasize the prevention, screening, and treatment of PCOS across the reproductive lifespan. The Guidelines and accompanying meta-analyses focus on three major categories of associated comorbidities: (1) reproductive; (2) metabolic; and (3) psychological. With the exception of infertility, this article considers common manifestations and comorbidities associated with PCOS throughout the lifecycle. Healthy lifestyle interventions with prevention of excess weight gain comprise the primary intervention for all comorbidities. Hence, early identification of girls "at risk" for PCOS and those with PCOS is a priority. Extensive guidelines for provider and patient education aim to decrease the medical, psychosocial, and economic burdens attributable to PCOS and its associated comorbidities.
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16
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Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc 2019; 3:1545-1573. [PMID: 31384717 PMCID: PMC6676075 DOI: 10.1210/js.2019-00078] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected. Symptoms of PCOS arise during the early pubertal years. Both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne. Owing to the complicated interwoven pathophysiology, discerning the inciting causes is challenging. Most available clinical data communicate findings and outcomes in adult women. Whereas the Rotterdam criteria are accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated. Diagnostic features for adolescent girls are menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls. Even before definitive diagnosis of PCOS, adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being "at risk for PCOS." Management of both those at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms. Interventions can include metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne. In addition to ascertaining for associated comorbidities, management should also include regular follow-up visits and planned transition to adult care providers. Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS. Timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life.
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Affiliation(s)
- Selma Feldman Witchel
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Columbia University Medical Center, New York–Presbyterian Morgan Stanley Children’s Hospital, New York, New York
| | - Alexia S Peña
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
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17
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Torchen LC, Legro RS, Dunaif A. Distinctive Reproductive Phenotypes in Peripubertal Girls at Risk for Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2019; 104:3355-3361. [PMID: 30844044 PMCID: PMC6589072 DOI: 10.1210/jc.2018-02313] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/01/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Increased testosterone (T) levels are a cardinal feature of polycystic ovary syndrome (PCOS). Female relatives of affected women, including premenarchal daughters, have elevated T levels supporting a genetic susceptibility to this phenotype. Girls with obesity (OB-g) also have increased T levels throughout puberty, which may indicate risk for PCOS. OBJECTIVE We tested the hypothesis that premenarchal daughters of women affected with PCOS (PCOS-d) have distinctive phenotypic features compared with OB-g. DESIGN, SETTING, AND PARTICIPANTS Forty-eight PCOS-d, 30 OB-g, and 22 normal weight (NW-g) premenarchal girls were studied. Mothers of OB-g and NW-g had no evidence for PCOS. MAIN OUTCOME MEASURES Reproductive hormones were measured. RESULTS Body mass index differed by design, was highest in OB-g, followed by PCOS-d (P > 0.001). PCOS-d and OB-g had similar increases in free T levels compared with NW-g (PCOS-d vs NW-g, P = 0.01; OB-g vs NW-g, P = 0.0001). Sex hormone binding globulin levels were lowest in OB-g and lower in PCOS-d than in NW-g (PCOS-d vs NW-g, P = 0.005; OB-g vs NW-g, P < 0.0001; PCOS-d vs OB-g, P < 0.0001). Anti-Müllerian hormone (AMH) levels in PCOS-d were significantly increased compared with OB-g, who tended to have lower AMH levels than NW-g (PCOS-d vs OB-g, P < 0.0001; PCOS-d vs NW-g, P = 0.10). CONCLUSIONS Despite similarly elevated free T levels, PCOS-d had increased AMH levels compared with OB-g. This finding suggests that OB-g lack alterations in ovarian folliculogenesis, a key reproductive feature of PCOS. Causal mechanisms may differ in PCOS-d or OB-g, or elevated T in OB-g may not be an early marker for PCOS.
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Affiliation(s)
- Laura C Torchen
- Division of Endocrinology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrea Dunaif
- Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Correspondence and Reprint Requests: Andrea Dunaif, MD, Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1055, New York, New York 10029. E-mail:
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18
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Malpique R, Sánchez-Infantes D, Garcia-Beltran C, Taxerås SD, López-Bermejo A, de Zegher F, Ibáñez L. Towards a circulating marker of hepato-visceral fat excess: S100A4 in adolescent girls with polycystic ovary syndrome - Evidence from randomized clinical trials. Pediatr Obes 2019; 14:e12500. [PMID: 30653851 DOI: 10.1111/ijpo.12500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022]
Abstract
S100A4 is a marker of subcutaneous adipose tissue dysfunction. Polycystic ovary syndrome (PCOS) is often driven by hepato-visceral adiposity. PCOS phenotypes are normalized more by reduction of central fat with spironolactone/pioglitazone/metformin (SPIOMET) than by oral contraceptive (OC) treatment. We studied whether circulating S100A4 concentrations are high in adolescents with PCOS and, if so, whether they normalize more with OC or SPIOMET. Assessments included circulating S100A4, endocrine markers, body composition, abdominal fat partitioning in controls (n = 12) and girls with PCOS (n = 51; age 15.8 y; body mass index [BMI] 24.5 kg/m2 ), and 1-year changes in girls with PCOS randomized for OC (n = 27) or SPIOMET (n = 24) treatment. Mean S100A4 concentrations were 71% higher (P < 0.001) in girls with PCOS than in controls and associated with hepato-visceral adiposity (r = 0.47; P = 0.001); S100A4 concentrations decreased more (P < 0.01) with SPIOMET, those decreases associating to hepato-visceral fat loss (r = 0.50; P < 0.0001). S100A4 may become a circulating marker of hepato-visceral fat excess in adolescents with PCOS.
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Affiliation(s)
- Rita Malpique
- Endocrinology, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Network Biomedical Research Center of Diabetes and Associated Metabolic Disorders (CIBERDEM), Health Institute Carlos III, Madrid, Spain
| | | | - Cristina Garcia-Beltran
- Endocrinology, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Network Biomedical Research Center of Diabetes and Associated Metabolic Disorders (CIBERDEM), Health Institute Carlos III, Madrid, Spain
| | - Siri D Taxerås
- Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology, Hospital Dr. Josep Trueta & Girona Institute for Biomedical Research, Girona, Spain
| | - Francis de Zegher
- Department of Development & Regeneration, University of Leuven, Leuven, Belgium
| | - Lourdes Ibáñez
- Endocrinology, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Network Biomedical Research Center of Diabetes and Associated Metabolic Disorders (CIBERDEM), Health Institute Carlos III, Madrid, Spain
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19
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Ibáñez L, Oberfield SE, Witchel S, Auchus RJ, Chang RJ, Codner E, Dabadghao P, Darendeliler F, Elbarbary NS, Gambineri A, Garcia Rudaz C, Hoeger KM, López-Bermejo A, Ong K, Peña AS, Reinehr T, Santoro N, Tena-Sempere M, Tao R, Yildiz BO, Alkhayyat H, Deeb A, Joel D, Horikawa R, de Zegher F, Lee PA. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Paediatr 2018; 88:371-395. [PMID: 29156452 DOI: 10.1159/000479371] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022] Open
Abstract
This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)1. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.
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Affiliation(s)
- Lourdes Ibáñez
- Endocrinology, Hospital Sant Joan de Deu, Esplugues, Barcelona, Spain.,CIBERDEM, ISCIII, Madrid, Spain
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, CUMC, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Selma Witchel
- Division of Pediatric Endocrinology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | | | - R Jeffrey Chang
- Department of Reproductive Medicine, UCSD School of Medicine, La Jolla, California, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, University of Chile, School of Medicine, Santiago, Chile
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Alessandra Gambineri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Cecilia Garcia Rudaz
- Division of Women, Youth and Children, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kathleen M Hoeger
- Department of OBGYN, University of Rochester Medical Center, Rochester, New York, USA
| | - Abel López-Bermejo
- Pediatric Endocrinology, Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - Ken Ong
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Alexia S Peña
- The University of Adelaide and Robinson Research Institute, Adelaide, South Australia, Australia
| | - Thomas Reinehr
- University of Witten/Herdecke, Vestische Kinder- und Jugendklinik, Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Datteln, Germany
| | - Nicola Santoro
- Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Rachel Tao
- Division of Pediatric Endocrinology, CUMC, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Bulent O Yildiz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Haya Alkhayyat
- Medical University of Bahrain, BDF Hospital, Riffa, Bahrein
| | - Asma Deeb
- Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, University of Botswana Teaching Hospital, Gaborone, Botswana
| | - Reiko Horikawa
- Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Francis de Zegher
- Department Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Peter A Lee
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
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20
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Ibáñez L, Del Río L, Díaz M, Sebastiani G, Pozo ÓJ, López-Bermejo A, de Zegher F. Normalizing Ovulation Rate by Preferential Reduction of Hepato-Visceral Fat in Adolescent Girls With Polycystic Ovary Syndrome. J Adolesc Health 2017; 61:446-453. [PMID: 28712591 DOI: 10.1016/j.jadohealth.2017.04.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is an increasingly prevalent disorder in adolescent girls, commonly presenting with hirsutism/oligomenorrhea, commonly treated with an oral contraceptive (OC), and commonly followed by oligoanovulatory subfertility. We tested whether an intervention targeting the reduction of hepato-visceral adiposity is followed by a higher ovulation rate than OC treatment. METHODS This randomized, open-label, single-center, pilot proof-of-concept study (12 months on treatment, then 12 months off) was performed in adolescent girls with hirsutism and oligomenorrhea (PCOS by National Institutes of Health; no sexual activity; N = 36; mean age 16 years, body mass index 23.5 kg/m2; 94% study completion). Compared treatments were OC (ethinylestradiol-levonorgestrel) versus low-dose combination of spironolactone 50 mg/d, pioglitazone 7.5 mg/d, and metformin 850 mg/d (SPIOMET). Primary outcome was post-treatment ovulation rate inferred from menstrual diaries and salivary progesterone (12 + 12 weeks). Secondary outcomes included body composition (dual X-ray absorptiometry), abdominal fat (magnetic resonance imaging), insulinemia (oral glucose tolerance test), and androgenemia (liquid chromatography - tandem mass spectrometry). RESULTS SPIOMET was followed by a 2.5-fold higher ovulation rate than OC (p ≤ .001) and by a 6-fold higher normovulatory fraction (71% vs. 12%; p ≤ .001); oligoanovulation risk after SPIOMET was 65% lower (95% confidence interval, 40%-89%) than after OC. Higher post-treatment ovulation rates related to more on-treatment loss of hepatic fat (r2 = .27; p < .005). Visceral fat and insulinemia normalized only with SPIOMET; androgenemia normalized faster with OC but rebounded more thereafter. Body weight, lean mass, and abdominal subcutaneous fat mass remained stable in both groups. CONCLUSIONS Early SPIOMET treatment for PCOS normalized post-treatment ovulation rates more than OC. Focusing PCOS treatment on early reduction of hepato-visceral fat may prevent part of later oligoanovulatory subfertility.
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Affiliation(s)
- Lourdes Ibáñez
- Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain.
| | | | - Marta Díaz
- Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - Giorgia Sebastiani
- Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - Óscar J Pozo
- Bioanalysis Research Group, IMIM, Hospital del Mar, Barcelona, Spain
| | - Abel López-Bermejo
- Department of Pediatrics, Dr. Josep Trueta Hospital, Girona Institute for Biomedical Research, Girona, Spain
| | - Francis de Zegher
- Pediatric & Adolescent Endocrinology, Department of Development & Regeneration, University Hospital Gasthuisberg-University of Leuven, Leuven, Belgium
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21
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Abstract
Congenital adrenal hyperplasia (CAH) is classified as classical CAH and non-classical CAH (NCCAH). In the classical type, the most severe form comprises both salt-wasting and simple virilizing forms. In the non-classical form, diagnosis can be more confusing because the patient may remain asymptomatic or the condition may be associated with signs of androgen excess in the postnatal period or in the later stages of life. This review paper will include information on clinical findings, symptoms, diagnostic approaches, and treatment modules of NCCAH.
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Affiliation(s)
- Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey Phone: +90 505 578 05 37 E-mail:
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22
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Kang MJ, Yang S, Hwang IT. The impact of obesity on hyperandrogenemia in Korean girls. Ann Pediatr Endocrinol Metab 2016; 21:219-225. [PMID: 28164075 PMCID: PMC5290177 DOI: 10.6065/apem.2016.21.4.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE As metabolic complication and polycystic ovarian syndrome due to childhood obesity is rising, the role of hyperandrogenemia (HA) and hyperinsulinism is receiving attention. The aims of this study were to investigate the presence of obvious HA according to pubertal status and to find potential etiologic determinants of HA in Korean obese (OB) girls. METHODS We analyzed 91 girls aged 6-17 years (prepuberty, n=54; puberty, n=37). Each girl was classified as being either normal weight (NW) or OB. Anthropometric measurements were obtained and blood test was performed early in the morning after at least 8 hours of fasting to measure glucose, insulin, total testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular-stimulating hormone, estradiol, and progesterone. RESULTS The plasma levels of free testosterone (FT) and DHEAS were markedly higher in OB girls compared to NW girls in puberty (FT, P=0.009; DHEAS, P=0.046) but not in prepuberty (FT, P=0.183; DHEAS, P=0.052). Hyperinsulinemia and high homeostasis model assessment of insulin resistance (HOMA-IR) values were found regardless of pubertal status in OB girls. The significant related factor to HA in puberty was the body mass index Z-score (P=0.003). But HOMA-IR, LH, and progesterone levels were not relevant to HA in pubertal girls. CONCLUSION OB prepubertal girls did not show HA in the present study but they should be regularly monitored because they already had hyperinsulinemia. OB pubertal girls had significant HA and hyperinsulinemia, and obesity per se was the most important factor for HA.
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Affiliation(s)
- Min Jae Kang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang-si, Korea
| | - Seung Yang
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Il Tae Hwang
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
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23
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George JT, Kakkar R, Marshall J, Scott ML, Finkelman RD, Ho TW, Veldhuis J, Skorupskaite K, Anderson RA, McIntosh S, Webber L. Neurokinin B Receptor Antagonism in Women With Polycystic Ovary Syndrome: A Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab 2016; 101:4313-4321. [PMID: 27459523 DOI: 10.1210/jc.2016-1202] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS), the most common endocrinopathy in women, is characterized by high secretion levels of LH and T. Currently, there is no treatment licensed specifically for PCOS. OBJECTIVE The objective of this study was to investigate whether a targeted therapy would decrease LH pulse frequency in women with PCOS, subsequently reducing serum LH and T concentrations and thereby presenting a novel therapeutic approach to the management of PCOS. DESIGN This study is a double-blind, double-dummy, placebo-controlled, phase 2 trial. SETTINGS University hospitals and private clinical research centers were included. PARTICIPANTS Women with PCOS aged 18-45 years participated. INTERVENTION Intervention included AZD4901 (a specific neurokinin-3 [NK3] receptor antagonist) at a dose of 20, 40, or 80 mg/day or matching placebo for 28 days. MAIN OUTCOME MEASURE Change from baseline in the area under the LH serum concentration-time curve over 8 hours (area under the curve) on day 7 relative to placebo was measured. RESULTS Of a total 67 randomized patients, 65 were evaluable. On day 7, the following baseline-adjusted changes relative to placebo were observed in patients receiving AZD4901 80 mg/day: 1) a reduction of 52.0% (95% confidence interval [CI], 29.6-67.3%) in LH area under the curve; 2) a reduction of 28.7% (95% CI, 13.9-40.9%) in total T concentration; and 3) a reduction of 3.55 LH pulses/8 hours (95% CI, 2.0-5.1) (all nominal P < .05). CONCLUSIONS The NK3 receptor antagonist AZD4901 specifically reduced LH pulse frequency and subsequently serum LH and T concentrations, thus presenting NK3 receptor antagonism as a potential approach to treating the central neuroendocrine pathophysiology of PCOS.
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Affiliation(s)
- Jyothis T George
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rahul Kakkar
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jayne Marshall
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Martin L Scott
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard D Finkelman
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tony W Ho
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Johannes Veldhuis
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Karolina Skorupskaite
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard A Anderson
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Stuart McIntosh
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Lorraine Webber
- Diabetes Trials Unit (J.T.G.), Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, United Kingdom; AstraZeneca, Waltham, Massachusetts (R.K., M.L.S.) Mereside, Alderley Park, Macclesfield, Cheshire, United Kingdom (J.M., S.M., L.W.), Wilmington, Delaware (R.D.F.); and Gaithersburg Maryland (T.W.H.); Endocrine Research Unit (J.V.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Rochester, Minnesota; MRC Centre for Reproductive Health (K.S., R.A.A.), The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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24
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Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev 2016; 37:467-520. [PMID: 27459230 PMCID: PMC5045492 DOI: 10.1210/er.2015-1104] [Citation(s) in RCA: 694] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/20/2016] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) was hypothesized to result from functional ovarian hyperandrogenism (FOH) due to dysregulation of androgen secretion in 1989-1995. Subsequent studies have supported and amplified this hypothesis. When defined as otherwise unexplained hyperandrogenic oligoanovulation, two-thirds of PCOS cases have functionally typical FOH, characterized by 17-hydroxyprogesterone hyperresponsiveness to gonadotropin stimulation. Two-thirds of the remaining PCOS have FOH detectable by testosterone elevation after suppression of adrenal androgen production. About 3% of PCOS have a related isolated functional adrenal hyperandrogenism. The remaining PCOS cases are mild and lack evidence of steroid secretory abnormalities; most of these are obese, which we postulate to account for their atypical PCOS. Approximately half of normal women with polycystic ovarian morphology (PCOM) have subclinical FOH-related steroidogenic defects. Theca cells from polycystic ovaries of classic PCOS patients in long-term culture have an intrinsic steroidogenic dysregulation that can account for the steroidogenic abnormalities typical of FOH. These cells overexpress most steroidogenic enzymes, particularly cytochrome P450c17. Overexpression of a protein identified by genome-wide association screening, differentially expressed in normal and neoplastic development 1A.V2, in normal theca cells has reproduced this PCOS phenotype in vitro. A metabolic syndrome of obesity-related and/or intrinsic insulin resistance occurs in about half of PCOS patients, and the compensatory hyperinsulinism has tissue-selective effects, which include aggravation of hyperandrogenism. PCOS seems to arise as a complex trait that results from the interaction of diverse genetic and environmental factors. Heritable factors include PCOM, hyperandrogenemia, insulin resistance, and insulin secretory defects. Environmental factors include prenatal androgen exposure and poor fetal growth, whereas acquired obesity is a major postnatal factor. The variety of pathways involved and lack of a common thread attests to the multifactorial nature and heterogeneity of the syndrome. Further research into the fundamental basis of the disorder will be necessary to optimally correct androgen levels, ovulation, and metabolic homeostasis.
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Affiliation(s)
- Robert L Rosenfield
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
| | - David A Ehrmann
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
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25
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Domingo-Almenara X, Brezmes J, Vinaixa M, Samino S, Ramirez N, Ramon-Krauel M, Lerin C, Díaz M, Ibáñez L, Correig X, Perera-Lluna A, Yanes O. eRah: A Computational Tool Integrating Spectral Deconvolution and Alignment with Quantification and Identification of Metabolites in GC/MS-Based Metabolomics. Anal Chem 2016; 88:9821-9829. [PMID: 27584001 DOI: 10.1021/acs.analchem.6b02927] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gas chromatography coupled to mass spectrometry (GC/MS) has been a long-standing approach used for identifying small molecules due to the highly reproducible ionization process of electron impact ionization (EI). However, the use of GC-EI MS in untargeted metabolomics produces large and complex data sets characterized by coeluting compounds and extensive fragmentation of molecular ions caused by the hard electron ionization. In order to identify and extract quantitative information on metabolites across multiple biological samples, integrated computational workflows for data processing are needed. Here we introduce eRah, a free computational tool written in the open language R composed of five core functions: (i) noise filtering and baseline removal of GC/MS chromatograms, (ii) an innovative compound deconvolution process using multivariate analysis techniques based on compound match by local covariance (CMLC) and orthogonal signal deconvolution (OSD), (iii) alignment of mass spectra across samples, (iv) missing compound recovery, and (v) identification of metabolites by spectral library matching using publicly available mass spectra. eRah outputs a table with compound names, matching scores and the integrated area of compounds for each sample. The automated capabilities of eRah are demonstrated by the analysis of GC-time-of-flight (TOF) MS data from plasma samples of adolescents with hyperinsulinaemic androgen excess and healthy controls. The quantitative results of eRah are compared to centWave, the peak-picking algorithm implemented in the widely used XCMS package, MetAlign, and ChromaTOF software. Significantly dysregulated metabolites are further validated using pure standards and targeted analysis by GC-triple quadrupole (QqQ) MS, LC-QqQ, and NMR. eRah is freely available at http://CRAN.R-project.org/package=erah .
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Affiliation(s)
- Xavier Domingo-Almenara
- Metabolomics Platform, Department of Electronic Engineering (DEEEA), Universitat Rovira i Virgili , 43003 Tarragona, Catalonia, Spain.,Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain
| | - Jesus Brezmes
- Metabolomics Platform, Department of Electronic Engineering (DEEEA), Universitat Rovira i Virgili , 43003 Tarragona, Catalonia, Spain.,Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain
| | - Maria Vinaixa
- Metabolomics Platform, Department of Electronic Engineering (DEEEA), Universitat Rovira i Virgili , 43003 Tarragona, Catalonia, Spain.,Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain
| | - Sara Samino
- Metabolomics Platform, Department of Electronic Engineering (DEEEA), Universitat Rovira i Virgili , 43003 Tarragona, Catalonia, Spain.,Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain
| | - Noelia Ramirez
- Metabolomics Platform, Department of Electronic Engineering (DEEEA), Universitat Rovira i Virgili , 43003 Tarragona, Catalonia, Spain.,Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain
| | - Marta Ramon-Krauel
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, University of Barcelona , 08950 Barcelona, Catalonia, Spain
| | - Carles Lerin
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, University of Barcelona , 08950 Barcelona, Catalonia, Spain
| | - Marta Díaz
- Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain.,Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, University of Barcelona , 08950 Barcelona, Catalonia, Spain
| | - Lourdes Ibáñez
- Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain.,Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, University of Barcelona , 08950 Barcelona, Catalonia, Spain
| | - Xavier Correig
- Metabolomics Platform, Department of Electronic Engineering (DEEEA), Universitat Rovira i Virgili , 43003 Tarragona, Catalonia, Spain.,Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain
| | - Alexandre Perera-Lluna
- B2SLab, Center for Biomedical Engineering Research (CREB), CIBERBBN, Department of ESAII, Universitat Politècnica de Catalunya , 08028 Barcelona, Catalonia, Spain
| | - Oscar Yanes
- Metabolomics Platform, Department of Electronic Engineering (DEEEA), Universitat Rovira i Virgili , 43003 Tarragona, Catalonia, Spain.,Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) , 28029 Madrid, Spain
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Abstract
Polycystic ovary syndrome (PCOS) is a familial heterogeneous disorder affecting 6% to 10% of reproductive-age women. The use of criteria developed for adult women is problematic for the adolescent girl because the clinical features associated with PCOS are normal pubertal events. The recent consensus statement on PCOS in adolescents stated that hyperandrogenism and oligomenorrhea need to persist for at least 2 years to consider the diagnosis of PCOS. Although insulin resistance, hyperinsulinism, and obesity are often associated with PCOS, these features are not considered valid diagnostic criteria. Recent genomewide association studies implicate genetic loci involved in the hypothalamic-pituitary-ovarian axis.
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Affiliation(s)
- Selma Feldman Witchel
- Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
| | - Hailey Roumimper
- Division of Pediatric Endocrinology, Diabetes & Metabolism, Columbia University Medical Center, 622 West 168th Street, PH5E-522, New York, NY 10032, USA
| | - Sharon Oberfield
- Columbia University Medical Center, Columbia University, 622 West 168th Street, PH5E-522, New York, NY 10032, USA.
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Circulating Zinc-α2-glycoprotein levels and Insulin Resistance in Polycystic Ovary Syndrome. Sci Rep 2016; 6:25934. [PMID: 27180914 PMCID: PMC4867572 DOI: 10.1038/srep25934] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 04/25/2016] [Indexed: 12/24/2022] Open
Abstract
The aim of study was to assess the relationship between zinc-α2-glycoprotein (ZAG) and androgen excess with insulin resistance in polycystic ovary syndrome (PCOS) women. 99 PCOS women and 100 healthy controls were recruited. Euglycemic-hyperinsulinemic clamp (EHC) was preformed to assess their insulin sensitivity. Circulating ZAG was determined with an ELISA kit. In healthy subjects, circulating ZAG levels exhibited a characteristic diurnal rhythm in humans, with a major nocturnal rise occurring between midnight and early morning. Circulating ZAG and M-value were much lower in PCOS women than in the controls. In all population, overweight/obese subjects had significantly lower circulating ZAG levels than lean individuals. Multiple linear regression analysis revealed that only M-value and the area under the curve for glucose were independently related factors to circulating ZAG in PCOS women. Multivariate logistic regression analysis showed that circulating ZAG was significantly associated with PCOS even after controlling for anthropometric variables, blood pressure, lipid profile and hormone levels. The PCOS women with high ZAG had fewer MetS, IGT and polycystic ovaries as compared with the low ZAG PCOS women. Taken together, circulating ZAG levels are reduced in women with PCOS and ZAG may be a cytokine associated with insulin resistance in PCOS women.
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28
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Li H, Xu X, Wang X, Liao X, Li L, Yang G, Gao L. Free androgen index and Irisin in polycystic ovary syndrome. J Endocrinol Invest 2016; 39:549-56. [PMID: 26584566 DOI: 10.1007/s40618-015-0403-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/19/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE PCOS is associated with hyperandrogenism and insulin resistance (IR). Recent studies have shown that circulating Irisin levels increase in PCOS women. However, no report has demonstrated a relationship between Irisin and hyperandrogenism in PCOS women. The purpose of the study was to compare interrelationship between Irisin or androgen excess with IR in PCOS and normal subjects. METHODS 166 PCOS and 103 control women were prospectively studied. Euglycemic- hyperinsulinemic clamps were preformed to assess their insulin sensitivity, which was expressed as M value. Circulating Irisin was determined by ELISA kit. Circulating androgens were measured using ultrasensitive assays. RESULTS PCOS women with high FAI had significantly higher BMI, FAT%, TC, DHEA-S and HOMA-IR, and significantly lower levels of M values and SHBG than PCOS women with low FAI or the controls. Pearson correlations showed that in the entire population, FAI correlated positively with BMI, WHR, FAT%, blood pressure, TG, DHEA-S, LH/FSH, AUCinsulin, HOMA-IR and Irisin, and negatively with M values. In multiple stepwise regression analysis, only FAT%, DHEA-S and LH/FSH were independent related factors with FAI. CONCLUSION The elevated Irisin levels in PCOS women were associated with androgen excess. Circulating Irisin is a primary predictor of hyperandrogenism, MetS and IR in PCOS women.
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Affiliation(s)
- H Li
- Department of Endocrinology, The Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, Guizhou, China
| | - X Xu
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - X Wang
- Department of Endocrinology, The Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, Guizhou, China
| | - X Liao
- Department of Endocrinology, The Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, Guizhou, China
| | - L Li
- Key Laboratory of Diagnostic Medicine (Ministry of Education) and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - G Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - L Gao
- Department of Endocrinology, The Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, Guizhou, China.
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29
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Rubin KH, Glintborg D, Nybo M, Andersen M, Abrahamsen B. Fracture Risk Is Decreased in Women With Polycystic Ovary Syndrome: A Register-Based and Population-Based Cohort Study. J Bone Miner Res 2016; 31:709-17. [PMID: 26542642 DOI: 10.1002/jbmr.2737] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/26/2015] [Accepted: 11/04/2015] [Indexed: 01/12/2023]
Abstract
Hyperandrogenism, obesity, and hyperinsulinemia may protect against osteoporosis, whereas amenorrhea, increased cortisol, and low growth hormone may be associated with higher fracture risk in polycystic ovary syndrome (PCOS). The objective of this study was to investigate fracture risk in PCOS. In the PCOS Denmark study, women with PCOS and/or hirsutism were identified in the Danish National Patient Register (1995-2012). Each patient was assigned three age-matched controls on the index date of PCOS diagnosis. Individuals with a previous endocrine diagnosis were excluded. Within PCOS Denmark, we embedded a well-characterized subcohort of patients, PCOS OUH, diagnosed with PCOS at Odense University Hospital (n = 1217). We identified incident fractures by International Classification of Diseases, 10th Revision (ICD-10) codes and used conditional Cox regression analyses to compare fracture risk. In the PCOS Denmark study, there were 19,199 women with PCOS and 57,483 controls were included, mean age 30.6 years (range, 12-60 years). Fracture rates were decreased in PCOS Denmark (10.3/1000 patient years) versus controls (13.6/1000 patient years). The adjusted ORs were 0.76 (95% CI, 0.71 to 0.80) for all fractures, 0.82 (95% CI, 0.74 to 0.92) for major osteoporotic fractures, and 0.57 (95% CI, 0.47 to 0.70) for fractures of head and face. The risk reduction was more pronounced below the age of 30 years at diagnosis. Women with PCOS had significant more hospital contacts due to strains and sprains. In the PCOS OUH subcohort, the risk reduction of fractures did not differ between PCOS women with elevated versus normal testosterone levels and the risk reduction was nominally smaller in overweight versus normal weight PCOS women. Women with PCOS had reduced risk of fractures, in particular of the appendicular skeleton. The risk reduction was greater in women with younger age at diagnosis suggesting that the skeletal effects of PCOS may be greater in women who have not yet reached peak bone mass. Reduced participation in sports activities was probably not the reason for the reduced risk of fractures.
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Affiliation(s)
- Katrine Hass Rubin
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.,Department of Medicine, Holbaek Hospital, Holbaek, Denmark
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30
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Ganie MA, Dhingra A, Nisar S, Sreenivas V, Shah ZA, Rashid A, Masoodi S, Gupta N. Oral glucose tolerance test significantly impacts the prevalence of abnormal glucose tolerance among Indian women with polycystic ovary syndrome: lessons from a large database of two tertiary care centers on the Indian subcontinent. Fertil Steril 2016; 105:194-201.e1-3. [DOI: 10.1016/j.fertnstert.2015.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/29/2015] [Accepted: 09/02/2015] [Indexed: 12/14/2022]
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31
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Díaz M, Gallego-Escuredo JM, de Zegher F, Villarroya F, Ibáñez L. Effects of ethinylestradiol-cyproterone acetate vs. pioglitazone-flutamide-metformin on plasma FGF21 levels in adolescent girls with androgen excess. DIABETES & METABOLISM 2015; 42:196-9. [PMID: 26546387 DOI: 10.1016/j.diabet.2015.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/25/2015] [Accepted: 10/04/2015] [Indexed: 01/23/2023]
Affiliation(s)
- M Díaz
- Endocrinology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - J M Gallego-Escuredo
- Department of Biochemistry and Molecular Biology, and Institute of Biomedicine, University of Barcelona, 08028 Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, Madrid, Spain
| | - F de Zegher
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - F Villarroya
- Department of Biochemistry and Molecular Biology, and Institute of Biomedicine, University of Barcelona, 08028 Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, Madrid, Spain
| | - L Ibáñez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain.
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32
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Obermayer-Pietsch B, Trummer C, Schwetz V, Schweighofer N, Pieber T. Genetics of insulin resistance in polycystic ovary syndrome. Curr Opin Clin Nutr Metab Care 2015; 18:401-6. [PMID: 26049638 DOI: 10.1097/mco.0000000000000190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is a very common endocrine disease in women all over the world. A variety of symptoms such as hirsutism and hyperandrogenism, irregular menstrual cycles and anovulatory infertility together with metabolic dysfunction, insulin resistance, and type 2 diabetes mellitus in lean and obese individuals and the development of consecutive diseases are key problems in this heterogeneous syndrome. RECENT FINDINGS Disease-modifying and potentially disease-causing candidate genes are described. A number of genetic associations have been investigated, whereby genes related to normal-weight insulin resistance and chronic inflammation are of central interest for PCOS pathomechanisms. New insights in the pharmacogenetics of PCOS might help to individualize therapeutic options. SUMMARY Enormous progress has been made in the genetics of insulin resistance in PCOS. However, because of the individual heterogeneity of PCOS and the lack of evident functional studies, the syndrome is only partly understood to date. Large studies on selected phenotypes and therapy aspects are ongoing.
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Affiliation(s)
- Barbara Obermayer-Pietsch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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33
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Samino S, Vinaixa M, Díaz M, Beltran A, Rodríguez MA, Mallol R, Heras M, Cabre A, Garcia L, Canela N, de Zegher F, Correig X, Ibáñez L, Yanes O. Metabolomics reveals impaired maturation of HDL particles in adolescents with hyperinsulinaemic androgen excess. Sci Rep 2015; 5:11496. [PMID: 26099471 PMCID: PMC4477239 DOI: 10.1038/srep11496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/26/2015] [Indexed: 12/17/2022] Open
Abstract
Hyperinsulinaemic androgen excess (HIAE) in prepubertal and pubertal girls usually precedes a broader pathological phenotype in adulthood that is associated with anovulatory infertility, metabolic syndrome and type 2 diabetes. The metabolic derangements that determine these long-term health risks remain to be clarified. Here we use NMR and MS-based metabolomics to show that serum levels of methionine sulfoxide in HIAE girls are an indicator of the degree of oxidation of methionine-148 residue in apolipoprotein-A1. Oxidation of apo-A1 in methionine-148, in turn, leads to an impaired maturation of high-density lipoproteins (HDL) that is reflected in a decline of large HDL particles. Notably, such metabolic alterations occur in the absence of impaired glucose tolerance, hyperglycemia and hypertriglyceridemia, and were partially restored after 18 months of treatment with a low-dose combination of pioglitazone, metformin and flutamide.
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Affiliation(s)
- Sara Samino
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Centre for Omic Sciences (COS), Rovira i Virgili University, Avinguda Universitat 3, 43204 Reus, Spain
| | - Maria Vinaixa
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Department of Electronic Engineering, Rovira i Virgili University, Avinguda Països Catalans 26, 43007 Tarragona, Spain [3] Centre for Omic Sciences (COS), Rovira i Virgili University, Avinguda Universitat 3, 43204 Reus, Spain
| | - Marta Díaz
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues, Barcelona, Spain
| | - Antoni Beltran
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Centre for Omic Sciences (COS), Rovira i Virgili University, Avinguda Universitat 3, 43204 Reus, Spain
| | - Miguel A Rodríguez
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Centre for Omic Sciences (COS), Rovira i Virgili University, Avinguda Universitat 3, 43204 Reus, Spain
| | - Roger Mallol
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Department of Electronic Engineering, Rovira i Virgili University, Avinguda Països Catalans 26, 43007 Tarragona, Spain
| | - Mercedes Heras
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Carrer Sant Llorenç 21, 43201 Reus, Spain
| | - Anna Cabre
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Carrer Sant Llorenç 21, 43201 Reus, Spain
| | - Lorena Garcia
- Centre for Omic Sciences (COS), Rovira i Virgili University, Avinguda Universitat 3, 43204 Reus, Spain
| | - Nuria Canela
- Centre for Omic Sciences (COS), Rovira i Virgili University, Avinguda Universitat 3, 43204 Reus, Spain
| | - Francis de Zegher
- Paediatric Endocrinology, University Hospital Gasthuisberg, UZ Herestraat 49, 3000 Leuven, University of Leuven, Belgium
| | - Xavier Correig
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Department of Electronic Engineering, Rovira i Virgili University, Avinguda Països Catalans 26, 43007 Tarragona, Spain
| | - Lourdes Ibáñez
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues, Barcelona, Spain
| | - Oscar Yanes
- 1] Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), C/ Monforte de Lemos 3-5, 28029 Madrid, Spain [2] Department of Electronic Engineering, Rovira i Virgili University, Avinguda Països Catalans 26, 43007 Tarragona, Spain [3] Centre for Omic Sciences (COS), Rovira i Virgili University, Avinguda Universitat 3, 43204 Reus, Spain
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Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibáñez L, Pena A, Horikawa R, Gomez-Lobo V, Joel D, Tfayli H, Arslanian S, Dabadghao P, Garcia Rudaz C, Lee PA. The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Horm Res Paediatr 2015; 83:000375530. [PMID: 25833060 DOI: 10.1159/000375530] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The diagnostic criteria for polycystic ovary syndrome (PCOS) in adolescence are controversial, primarily because the diagnostic pathological features used in adult women may be normal pubertal physiological events. Hence, international pediatric and adolescent specialty societies have defined criteria that have sufficient evidence to be used for the diagnosis of PCOS in adolescents. METHODS The literature has been reviewed and evidence graded to address a series of questions regarding the diagnosis of PCOS during adolescence including the following: clinical and biochemical evidence of hyperandrogenism, criteria for oligo-anovulation and polycystic ovary morphology, diagnostic criteria to exclude other causes of hyperandrogenism and amenorrhea, role of insulin resistance, and intervention. RESULTS AND CONCLUSION Features of PCOS overlap normal pubertal development. Hence, caution should be taken before diagnosing PCOS without longitudinal evaluation. However, treatment may be indicated even in the absence of a definitive diagnosis. While obesity, insulin resistance, and hyperinsulinemia are common findings in adolescents with hyperandrogenism, these features should not be used to diagnose PCOS among adolescent girls. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Selma F Witchel
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pa., USA
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