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Mastnak L, Herman R, Ferjan S, Janež A, Jensterle M. Prolactin in Polycystic Ovary Syndrome: Metabolic Effects and Therapeutic Prospects. Life (Basel) 2023; 13:2124. [PMID: 38004264 PMCID: PMC10672473 DOI: 10.3390/life13112124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine and metabolic disorder in premenopausal women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Patients frequently present comorbidities, including obesity, insulin resistance, and impaired glucose and lipid metabolism. The diverse clinical presentation may mimic various endocrine disorders, making the diagnosis challenging in some clinical circumstances. Prolactin (PRL) is a recommended biomarker in the initial diagnostic workup to rule out hyperprolactinemia (HPRL). The traditional role of PRL is linked to lactation and the reproductive system. Recent research highlights PRL's emerging role in metabolic homeostasis. PRL influences metabolism directly by interacting with the pancreas, liver, hypothalamus, and adipose tissue. Its influence on an individual's metabolism is intricately tied to its serum concentration. While deficient and very high levels of PRL can negatively affect metabolism, intermediate-normal to moderately high levels may promote metabolic health. In women with PCOS, PRL levels may be altered. Research results on different aspects of the relationship between PCOS and the impact of various levels of PRL on metabolic homeostasis are limited and inconsistent. In this narrative literature review, we comprehensively examined data on serum PRL levels in PCOS patients. We investigated the correlation between a favorable metabolic profile and serum PRL levels in this population. Furthermore, we explored the concept of beneficial PRL effects on metabolism and discussed the potential therapeutic application of dopamine agonists in PCOS treatment. Lastly, we emphasized several promising avenues for future research in this field.
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Affiliation(s)
- Lara Mastnak
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Rok Herman
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Simona Ferjan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Mahboobifard F, Rahmati M, Amiri M, Azizi F, Ramezani Tehrani F. To what extent does polycystic ovary syndrome influence the cut-off value of prolactin? Findings of a community-based study. Adv Med Sci 2022; 67:79-86. [PMID: 34998115 DOI: 10.1016/j.advms.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/03/2021] [Accepted: 12/17/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) and hyperprolactinemia are the most frequent endocrine disorders in women which share several common features. There are inconsistent results regarding the existence of a possible pathophysiological interplay between these endocrinopathies and the elevation of prolactin (PRL) in PCOS. The purpose of this study was to explore the upper reference limit of PRL in PCOS women. PATIENTS AND METHODS This study is a cross-sectional analysis using data collected from two population-based PCOS prevalence studies. After considering the exclusion criteria, 216 women with PCOS diagnosed based on the Rotterdam criteria and 702 eumenorrheic non-hirsute controls, were enrolled. The age distribution of PRL and the effect of PCOS on the percentiles of serum PRL were compared between the PCOS group and controls. The possible contributing factors for the elevation of PRL were evaluated. RESULTS In the subgroup of women with PCOS, aged ≤35 years, the age-adjusted model of quantile regression revealed a significant elevation of PRL from the 60th percentile onwards, leading to an increase of nearly 10 ng/ml (p = 0.023, 95% CI 1.3-17.62) of the 95th percentile of PRL. Hyperprolactinemic PCOS women had higher levels of luteinizing hormone (LH). CONCLUSIONS In PCOS women, aged ≤35 years, the upper reference limit of serum PRL was approximately 1.5-fold higher than in controls. The pathway underlying PRL elevation in PCOS might be attributed to a decline in central dopaminergic tone associated with PCOS which leads to an increase in levels of both - PRL and LH.
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Rodier C, Courbière B, Fernandes S, Vermalle M, Florence B, Resseguier N, Brue T, Cuny T. Metoclopramide Test in Hyperprolactinemic Women With Polycystic Ovarian Syndrome: Old Wine Into New Bottles? Front Endocrinol (Lausanne) 2022; 13:832361. [PMID: 35250884 PMCID: PMC8895271 DOI: 10.3389/fendo.2022.832361] [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: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Polycystic ovarian syndrome (PCOS) is the most frequent etiology of anovulation, hyperandrogenism and infertility in women. Its pathophysiology remains poorly elucidated. Hyperprolactinemia (hPRL) is common in women of reproductive age and may partially mimic the clinical phenotype of PCOS. The simultaneous finding of both conditions is therefore not rare, however there are conflicting studies on whether a link exists between them. MATERIALS AND METHODS We conducted a retrospective monocentric study between 2015 and 2021 and among women who were referred for possible PCOS, we selected those who met the ESHRE/Rotterdam definition criteria. hPRL was defined as two values above the upper limit of normal with at least one measurement in our centre. RESULTS A total of 430 women were selected, of whom 179 met the PCOS criteria. 50 out of 179 patients (27.9%) had at least one elevated value of PRL and 21 (11.7%) had hPRL according to our definition. Among the 21 women of the PCOS/hPRL cohort, 5 (23.8%) had a microprolactinoma and all of them had PRL level ≥ 60 ng/ml. The remaining cases were macroprolactinemia (n=5), iatrogenic hPRL (n=4), primary hypothyroidism (n=1) or unexplained (n=6) despite exhaustive investigations. The metoclopramide test resulted in an increase of basal PRL < 300% in all prolactinomas and ≥ 300% in all the other etiologies. CONCLUSION hPRL was a common finding in PCOS women, secondary to a microprolactinoma in a quarter of cases. Metoclopramide test performed in women with hPRL below 60 ng/ml appeared as a helpful tool 1) to discriminate pituitary causes from others etiologies, 2) to potentially avoid unnecessary pituitary MRI.
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Affiliation(s)
- Claire Rodier
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Blandine Courbière
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- CNRS, IRD, IMBE, Avignon Université, Aix Marseille Univ, Marseille, France
| | - Sara Fernandes
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Marie Vermalle
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Bretelle Florence
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Noémie Resseguier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
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Delcour C, Robin G, Young J, Dewailly D. PCOS and Hyperprolactinemia: what do we know in 2019? CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119871921. [PMID: 31523136 PMCID: PMC6734626 DOI: 10.1177/1179558119871921] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 07/31/2019] [Indexed: 12/16/2022]
Abstract
Polycystic ovary syndrome (PCOS) and hyperprolactinemia (HPRL) are the two most common etiologies of anovulation in women. Since the 1950s, some authors think that there is a pathophysiological link between PCOS and HPRL. Since then, many authors have speculated about the link between these two endocrine entities, but no hypothesis proposed so far could ever be confirmed. Furthermore, PCOS and HPRL are frequent endocrine diseases and a fortuitous association cannot be excluded. The evolution of knowledge about PCOS and HPRL shows that studies conducted before the 2000s are obsolete given current knowledge. Indeed, most of the studies were conducted before consensual diagnosis criteria of PCOS and included small numbers of patients. In addition, the investigation of HPRL in these studies relied on obsolete methods and did not look for the presence of macroprolactinemia. It is therefore possible that HPRL that has been attributed to PCOS corresponded in fact to macroprolactinemia or to pituitary microadenomas of small sizes that could not be detected with the imaging methods of the time. Recent studies that have conducted a rigorous etiological investigation show that HPRL found in PCOS correspond either to non-permanent increase of prolactin levels, to macroprolactinemia or to other etiologies. None of this recent study found HPRL related to PCOS in these patients. Thus, the link between PCOS and HPRL seems to be more of a myth than a well-established medical reality and we believe that the discovery of an HPRL in a PCOS patient needs a standard etiological investigation of HPRL.
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Affiliation(s)
- Clémence Delcour
- Department of Obstetrics and Gynecology, Robert-Debré hospital, AP-HP, Paris, France
- INSERM, U1141, Paris Diderot university, Sorbonne Paris Cité, Paris, France
| | - Geoffroy Robin
- CHU Lille, Department of Reproductive Medicine & Lille University, Lille, France
- EA 4308, Lille University, Lille, France
| | - Jacques Young
- Department of Endocrinology and Reproductive Medicine, CHU Kremlin Bicetre, Paris, France
| | - Didier Dewailly
- INSERM U1172 Team 2, JPARC, Université de Lille, 59000 Lille, France
- Didier Dewailly, INSERM U1172 Team 2, JPARC, Université de LilleI, 52 rue Paul Duez, Lille, 59000, France.
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Hill LD, Ewens KG, Maher BS, York TP, Legro RS, Dunaif A, Strauss JF. Catechol-O-methyltransferase (COMT) single nucleotide polymorphisms and haplotypes are not major risk factors for polycystic ovary syndrome. Mol Cell Endocrinol 2012; 350:72-7. [PMID: 22178088 PMCID: PMC3264817 DOI: 10.1016/j.mce.2011.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/17/2011] [Accepted: 11/18/2011] [Indexed: 10/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects 5-8% of reproductive age women. The primary features of PCOS are hyperandrogenemia, chronic anovulation and infertility. It has been suggested that defects in ovarian steroid metabolism contribute to the follicular growth arrest and abnormal production of ovarian steroid hormones that are characteristic of PCOS. 2-Methoxyestradiol (2-ME) is formed by the action of catechol-O-methyltransferase (COMT) on 2-hydroxyestradiol. COMT expression is increased in the follicles and ovarian stroma of women with PCOS. Moreover, 2-ME decreases granulosa cell proliferation and steroidogenesis, raising the possibility that ovarian dysfunction associated with PCOS is due, in part, to increased synthesis of 2-ME resulting from increased COMT activity. Four single-nucleotide polymorphisms (SNPs) (rs6269, rs4633, rs4818, rs4680) in the COMT gene characterize haplotypes, which are associated with large variations in COMT enzymatic activity. The aim of this study was to determine whether individual COMT SNPs and the COMT haplotypes are associated with PCOS using a family-based test of association and linkage. Additionally, we examined the relationships between COMT SNPs and haplotypes with quantitative variables usually assessed in the evaluation of women with PCOS. There were no significant correlations between genotype and total testosterone, non-SHBG bound testosterone and BMI. However, we found that the prolactin level in women with PCOS varied significantly with COMT haplotype, and suggest that this association reflects a genetic factor influencing the stress response. Our findings suggest that common variants and haplotypes of the COMT gene are not major contributors to risk for PCOS, but that COMT genotype may influence prolactin levels.
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Affiliation(s)
- Lori D Hill
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
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Robin G, Catteau-Jonard S, Young J, Dewailly D. [Physiopathological link between polycystic ovary syndrome and hyperprolactinemia: myth or reality?]. ACTA ACUST UNITED AC 2011; 39:141-5. [PMID: 21388855 DOI: 10.1016/j.gyobfe.2010.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 09/28/2010] [Indexed: 11/17/2022]
Abstract
Polycystic ovary syndrome (PCOS) and hyperprolactinemia are the two most common etiologies of disorders of the cycle in women. In clinical practice, it is not unusual to find hyperprolactinemia associated with clinical, hormonal and ultrasound features of PCOS. However, currently, there is no evidence of a pathophysiological link between these two entities. Thus, this association seems to be fortuitous. Therefore, hyperprolactinemia in women with PCOS must lead to etiological investigations, including eliminating macroprolactinemia (excess of "big prolactin" and/or "big-big prolactin"). Finally, symptomatic hyperprolactinemias (excluding macroprolactinemia) can "mask" an underlying PCOS through a gonadotropic inhibition. Moreover, symptomatic hyperprolactinemias can provide clinical and ultrasound features of a "moderate" PCOS. Therefore, in agreement with the consensus of Rotterdam, PCOS must remain a diagnosis of exclusion, after eliminating symptomatic hyperprolactinemias (excluded macroprolactinemia) and all other etiologies of hyperandrogenism.
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Affiliation(s)
- Geoffroy Robin
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, Lille cedex, France.
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Filho RB, Domingues L, Naves L, Ferraz E, Alves A, Casulari LA. Polycystic ovary syndrome and hyperprolactinemia are distinct entities. Gynecol Endocrinol 2007; 23:267-72. [PMID: 17558684 DOI: 10.1080/09513590701297708] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The aims of the present study were to identify the cause of hyperprolactinemia in polycystic ovary syndrome (PCOS) and to compare prolactin (PRL) levels between PCOS women without hyperprolactinemia and women with insulin resistance and without PCOS. A group of 82 women (age: 27.1 +/- 7.6 years) with PCOS was included in the study. Their PRL levels were measured and compared with those of women with insulin resistance without PCOS (controls; n = 42; age: 29.2 +/- 8.2 years). Among the 82 PCOS women, 13 (16%) presented high PRL levels (103.9 +/- 136.0 microg/l). The causes of hyperprolactinemia were: pituitary tumor (responding to cabergoline) in nine cases (69%; PRL range: 28.6 - 538 microg/l); oral hormonal contraceptive treatment in two cases (15%; PRL: 46 and 55 microg/l, respectively); and use of buspirone and tianeptine in one case (8%; PRL: 37.1 microg/l); one case (8%; PRL: 34.4 microg/l) had macroprolactinemia. In drug-induced hyperprolactinemic patients PRL levels normalized after treatment interruption. The average PRL level in the 69 remaining patients was 12.1 +/- 5.5 microg/l, a value not statistically different from that of the control group (11.8 +/- 4.9 microg/l). This result leads us to conclude that PCOS patients with increased PRL levels must be investigated for other causes of hyperprolactinemia, because hyperprolactinemia is not a clinical manifestation of PCOS.
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Lowenstein EJ. Diagnosis and management of the dermatologic manifestations of the polycystic ovary syndrome. Dermatol Ther 2007; 19:210-23. [PMID: 17004997 DOI: 10.1111/j.1529-8019.2006.00077.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a complex phenotypic spectrum of primarily hyperandrogenic signs and symptoms. PCOS is the most common endocrine disturbance to affect women of reproductive years. Although patients affected are often very disturbed by the cutaneous manifestations, including acne, hirsutism, alopecia, obesity, and acanthosis nigricans, the clinical manifestations of PCOS ramify far beyond the skin. PCOS frequently causes menstrual abnormalities and infertility. Insulin resistance is both pathogenic and a cause of numerous serious health consequences. The accurate diagnosis and recognition of cutaneous hyperandrogenism in PCOS are discussed. The differential diagnosis is reviewed. The work-up and approach to evaluation of patients with PCOS is presented. Although no uniform treatment approach for the management of the cutaneous manifestations of PCOS has been agreed upon, the data on various treatment options and the author's treatment approach to these patients are presented.
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Affiliation(s)
- Eve J Lowenstein
- SUNY Health Science Center Department of Dermatology, Brooklyn, New York 11203, USA.
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Vanky E, Kjøtrød SB, Maesel A, Bjerve KS, Carlsen SM. Dexamethasone reduces androgen levels in metformin-treated patients with polycystic ovary syndrome. Fertil Steril 2004; 81:459-62. [PMID: 14967392 DOI: 10.1016/j.fertnstert.2003.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Revised: 06/23/2003] [Accepted: 06/23/2003] [Indexed: 11/20/2022]
Abstract
Women with polycystic ovary syndrome treated with metformin and lifestyle advice were studied. Additional treatment with dexamethasone, but not with bromocriptine, further reduced circulating androgen levels.
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Abstract
This review sets in context significant recent advances in the understanding of the pathophysiology of polycystic ovary syndrome (PCOS). The occurrence of variable insulin sensitivity in individuals is discussed. Information is presented to demonstrate that prolonged anovulation decreases insulin sensitivity and, conversely, that improvement in insulin sensitivity normalizes ovarian function in PCOS. In addition, a meta-analysis of studies on metformin and troglitazone treatment in PCOS is presented.
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Affiliation(s)
- Roy Taylor
- Human Metabolism Research Group, Medical School, Newcastle upon Tyne, UK
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Estopiñán García V, Martínez Burgui JA, Ballester Ferrer A, Velilla Moliner J. [Prolactin and polycystic ovary syndrome]. Med Clin (Barc) 2001; 116:759. [PMID: 11412704 DOI: 10.1016/s0025-7753(01)71978-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Analysis of the evidence linking PCOS and hyperprolactinemia suggests that these conditions have independent origins. Elevated prolactin serum levels are documented in the early studies of patients with polycystic ovaries. However, recent investigators using serial serum sampling have excluded transient elevations of prolactin and have shown a less frequent association of these disorders. Treatment of individuals with both PCOS and hyperprolactinemia is distinct from the management of the individual with only one of these conditions. Upon evaluating the therapeutic alternatives for dysfunctional uterine bleeding and hirsutism in these patients, the effect of exogenous estrogen and progesterone on the secretion of prolactin must be considered. The addition of a dopamine agonist (e.g., bromocriptine or cabergoline) to a regimen of clomiphene citrate must also be considered as ovulation induction options for these women. Finally, future discoveries about the relationship between PCOS and hyperprolactinemia will require a better understanding of how the hypothalamus regulates the pituitary secretion of LH and prolactin.
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Affiliation(s)
- N Bracero
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Marsden PJ, Murdoch AP, Taylor R. Adipocyte insulin action following ovulation in polycystic ovarian syndrome. Hum Reprod 1999; 14:2216-22. [PMID: 10469683 DOI: 10.1093/humrep/14.9.2216] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The role of anovulation and insulin resistance in the pathogenesis of polycystic ovarian syndrome (PCOS) remains to be determined. The aim of this study was to investigate whether the metabolic abnormality of insulin resistance in PCOS reflects, rather than causes, the ovarian dysfunction. Eight subjects with classical PCOS were studied on two occasions. Adipocyte insulin sensitivity together with hormonal and metabolic changes were investigated in patients with PCOS following prolonged amenorrhoea and then again in the early follicular phase after ovulation. Insulin receptor binding in amenorrhoeic subjects with PCOS was low at 0.78 +/- 0.08% and this increased to 1.18 +/- 0.19% after an ovulatory cycle (P < 0.05). Maximal insulin stimulated 3-O-methylglucose uptake was 0.70 +/- 0. 14 during amenorrhoea and increased to 1.08 +/- 0.25 pmol/10 cm(2) cell membrane (P < 0.05). Plasma testosterone fell (4.0 +/- 0.4 to 2. 3 +/- 0.2 nmol/l; P < 0.001), luteinizing hormone fell (17.6 +/- 2.3 to 6.7 +/- 0.8 IU/l; P < 0.001) but plasma insulin concentrations remained unchanged following ovulation (14.6 +/- 1.9 and 15.7 +/- 3. 8 pmol/l during amenorrhoea and after ovulation respectively). The results of this study suggest that chronic anovulation per se appears to modify the factors contributing to cellular insulin resistance seen in PCOS.
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Affiliation(s)
- P J Marsden
- Department of Obstetrics and Gynaecology, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
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Abstract
OBJECTIVE To review the pathophysiology, clinical manifestations, current diagnostic procedures, and treatment options for disorders involving PRL production. Common clinical dilemmas are discussed in a pragmatic fashion to guide the practitioner. DESIGN A world literature search of basic sciences and medical articles from the last three decades was performed using computerized MEDLINE. Recent endocrine and reproductive endocrine textbooks also were reviewed. Studies were selected for their degree of contribution to the basic sciences and clinical understanding of the disorder and for the quality of their study design and content. The information was summarized and grouped according to its relevance and application to specific sections of the manuscript. Studies were evaluated and critically used to support the views of the authors and to suggest specific clinical management strategies. RESULT(S) Disorders derived from abnormal PRL production are relatively common in clinical practice. Infertility, menstrual disorders, and galactorrhea are the most frequent manifestations encountered in women. Although frequently benign, the disorder occasionally may have severe consequences. CONCLUSION(S) An understanding of the underlying physiology and pathophysiology coupled with the awareness of the heterogeneous presentation of this disorder should help the clinician to approach it successfully.
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Affiliation(s)
- R A Yazigi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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Affiliation(s)
- S Franks
- Department of Obstetrics and Gynaecology, St. Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, University of London, United Kingdom
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Marsden PJ, Murdoch A, Taylor R. Severe impairment of insulin action in adipocytes from amenorrheic subjects with polycystic ovary syndrome. Metabolism 1994; 43:1536-42. [PMID: 7990708 DOI: 10.1016/0026-0495(94)90013-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Adipose tissue was used to characterize the metabolic abnormality of insulin resistance in polycystic ovary syndrome (PCOS). Nine patients with PCOS were studied during a period of amenorrhea and confirmed to be chronically anovulatory by vaginal ultrasound and plasma progesterone measurements. These were compared with six age- and body mass index (BMI)-matched controls (BMI, 27.2 +/- 2.2 in PCOS and 24.7 +/- 2.3 in control subjects). Insulin receptor binding was measured and insulin action was assessed by measuring initial rates of 3-O-methylglucose uptake and by inhibition of lipolysis. The maximum specific insulin receptor binding was 0.62% +/- 0.12% and 1.78% +/- 0.18% per 10-cm2 cell surface (mean +/- SEM) in PCOS and control subjects, respectively (P < .001). Maximum rates of glucose transport were also impaired as compared with controls, with 3-O-methylglucose transport being 0.90 +/- 0.15 versus 1.57 +/- 0.28 pmol/10 cm2/5 s, respectively (P < .05). The concentration of insulin required for half-maximal stimulation of glucose uptake was 165 +/- 36 versus 32 +/- 10 pmol in PCOS and control subjects, respectively (P < .05). The maximum percentage lipolysis inhibition (mean +/- SEM) was 9.5% +/- 1.6% in PCOS and 28.3% +/- 7.2% in control patients, respectively (P < .01). These data demonstrate that there are both insulin binding and postreceptor defects in adipocytes from amenorrheic PCOS subjects. The degree of defect in adipocyte insulin action is greater than would have been anticipated from in vivo data.
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Affiliation(s)
- P J Marsden
- Department of Medicine, University of Newcastle-upon-Tyne, UK
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Affiliation(s)
- E Dahlgren
- Department of Obstetrics and Gynecology, University of Gothenburg, Sweden
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Affiliation(s)
- J A Eden
- School of Obstetrics and Gynaecology, Royal Hospital for Women, Paddington, NSW
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Ferrari E, Bossolo PA, Foppa S, Dalzano M, Comis S, Morelli MP, Peveri V, Mengozzi A. Prolactin secretion in polycystic ovary syndrome: circadian rhythmicity and dynamic aspects. Gynecol Endocrinol 1988; 2:101-11. [PMID: 3188970 DOI: 10.3109/09513598809023618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The circadian rhythms of plasma prolactin (PRL) and cortisol and of oral temperature were simultaneously studied in 24 women with polycystic ovary syndrome (PCOS). The PRL response to thyrotropin-releasing hormone (TRH) and domperidone was also evaluated in some of these patients. The physiological circadian chrono-organization of prolactin and cortisol secretion and of oral temperature was maintained in PCOS. The PRL responsiveness to the specific stimulations fell within normal limits. These results do not support the hypothesis of an impaired central dopaminergic regulation of prolactin secretion in PCOS.
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Affiliation(s)
- E Ferrari
- Department of Internal Medicine and Medical Therapy, University of Pavia, Italy
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21
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Venturoli S, Porcu E, Fabbri R, Magrini O, Gammi L, Paradisi R, Forcacci M, Bolzani R, Flamigni C. Episodic pulsatile secretion of FSH, LH, prolactin, oestradiol, oestrone, and LH circadian variations in polycystic ovary syndrome. Clin Endocrinol (Oxf) 1988; 28:93-107. [PMID: 3139335 DOI: 10.1111/j.1365-2265.1988.tb01208.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pulsatile secretion of LH, FSH, PRL, oestradiol and oestrone was studied in a group of 16 patients with micropolycystic ovary syndrome (PCOS) and compared with that of normal ovulatory women in the fifth to sixth day of the cycle. Hormone concentrations were measured at 10 min intervals for 8 h starting at 0930 h. In seven subjects, the study was prolonged for 24 h, with 20 min interval samples, in an attempt to evaluate the circadian rhythm of LH by cosinor analysis. Significant fluctuations occurred in the concentration of each hormone. Values shown are mean +/- SD. PCOS subjects had high LH mean values (27.9 +/- 5.9 IU/l) (P less than 0.005). LH pulse amplitude was higher than controls (11.6 +/- 3.7 IU/l versus 5.2 +/- 1.8 IU/l; P less than 0.005) while no consistent changes in frequency or interpulse interval (62.0 +/- 10.7 min versus 65.8 +/- 19.2 min; P = NS) were found. A mean of 4.8 +/- 1.2 pulses of FSH occurred in 8 h and the mean pulse amplitude was 2.68 +/- 1.11 with no differences from controls. All patients were normoprolactinaemic. A mean of 5.5 +/- 1.9 pulses occurred in 8 h, the interpulse interval was 76.1 +/- 14.4 min and the amplitude was 2.87 +/- 0.76 ng/ml and there were no significant differences from controls; 75% of PRL pulses showed a temporal relationship with LH pulses. Oestrone mean basal values were higher in PCOS (47.2 +/- 12.5 pg/ml) than controls (32.0 +/- 9.9 pg/ml; P less than 0.02), while no differences were observed as regards oestradiol. Oestradiol pulse amplitude was nearly the same as oestrone (43.6 +/- 18.8 pg/ml and 37.7 +/- 16.1 pg/ml, respectively); 6.0 +/- 2.2 pulses and 6.0 +/- 1.6 pulses occurred in 8 h with an interpulse interval of 81.1 +/- 27.1 min and 71.8 +/- 11.1 min, respectively. Sixty-five per cent of LH pulses were followed by an oestradiol and oestrone peak. The mean time of the appearance was 17 +/- 15 min and 25 +/- 23 min, respectively. In the PCOS group a consistent 24 h rhythm in mean plasma LH levels was found with the highest hormone values at 1720 h (P less than 0.05) unrelated to apparent sleep and different from that of adult women. Pulse frequency showed a significant slowing during the night with the longest interpulse interval at 0327 h (P less than 0.03) while no significant periodicity was observed in LH pulse amplitude.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- S Venturoli
- Institute of Reproductive Physiology and Pathology, University of Bologna, Italy
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22
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Murdoch AP, McClean KG, Watson MJ, Dunlop W, Kendall Taylor P. Treatment of hirsutism in polycystic ovary syndrome with bromocriptine. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1987; 94:358-65. [PMID: 3555604 DOI: 10.1111/j.1471-0528.1987.tb03105.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The value of bromocriptine in the treatment of hirsutism in polycystic ovary syndrome (PCO) was assessed subjectively and photographically in a double-blind trial in 22 women studied for 1 year. Menstrual frequency was recorded. Circulating concentrations of oestradiol, oestrone, testosterone, androstenedione, and sex hormone binding globulin (SHBG) were determined before treatment and after 6 and 12 months therapy. On the same occasions gonadotrophin concentrations (mean of 24 samples) and their response to 100 micrograms LHRH were determined. No evidence was found to support a therapeutic role for bromocriptine in the treatment of hirsutism or menstrual regulation in PCO. No biochemical changes were seen specific to bromocriptine therapy.
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