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Mitra S, Saharia GK, Jena SK. Cardio-metabolic risk in Rotterdam clinical phenotypes of PCOS. ANNALES D'ENDOCRINOLOGIE 2024; 85:44-47. [PMID: 37328054 DOI: 10.1016/j.ando.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/14/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND AIMS Elevated anti-Müllerian hormone (AMH) in polycystic ovary syndrome (PCOS) characterizes the clinical severity of the 4 phenotypes; but whether it also reflects the corresponding differences in cardio-metabolic risk remains to be elucidated. This study aimed to compare metabolic profile between the 4 clinical phenotypes of PCOS and to determine the influence of AMH levels on metabolic severity. METHODS One hundred and forty-four women with PCOS, aged between 20 and 40years, were recruited in this cross-sectional study and categorized according to the 4 phenotypes of the Rotterdam criteria. Anthropometry and blood pressure were recorded. Fasting lipid profile, fasting glucose, fasting insulin, homeostasis model assessment insulin resistance, total testosterone and AMH were estimated. Clinical, anthropometric and metabolic profiles were compared between the 4 phenotypes. RESULTS There were significant differences in menstrual abnormalities, weight, hip circumference, clinical hyperandrogenism, ovarian volume and AMH levels between the 4 phenotypes. Cardio-metabolic risk factors and rates of metabolic syndrome (MS) and insulin resistance (IR) were comparable. CONCLUSION Cardio-metabolic risk is similar in all phenotypes of PCOS despite differences in anthropometry and AMH levels. All women diagnosed with PCOS should undergo screening and lifelong surveillance for MS, IR and cardiovascular diseases, irrespective of clinical phenotype or AMH level. This needs further validation in prospective multi-center studies across the country, with larger sample sizes and adequate power.
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Affiliation(s)
- Subarna Mitra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, 751019 Odisha, India.
| | - Gautom K Saharia
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, 751019 Odisha, India
| | - Saubhagya K Jena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, 751019 Odisha, India
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Carmina E. Need to Introduce the Finding of Obesity or Normal Body Weight in the Current Diagnostic Criteria and in the Classification of PCOS. Diagnostics (Basel) 2022; 12:diagnostics12102555. [PMID: 36292244 PMCID: PMC9601283 DOI: 10.3390/diagnostics12102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/28/2022] Open
Abstract
The diagnosis of PCOS is based on the Rotterdam guidelines: chronic anovulation, hyperandrogenism (biologic or clinical) and polycystic ovaries on ultrasound. Two of these three criteria are sufficient for making diagnosis of PCOS. However, one characteristic that is often associated to PCOS (obesity with severe insulin resistance and metabolic alteration regarding glucose metabolism and lipid pattern) has remained out of the current classification of PCOS. Because of this, patients with different metabolic and cardiovascular risk may be included in the same phenotype, and it makes more difficult to establish clear strategies of follow-up and treatment of the patients with increased risks, and also may hide genetic or environmental differences between PCOS patients. Our recent study has shown that metabolic alterations are linked to the weight and not to the Rotterdam phenotypes. Because of this, we suggest a new classification of PCOS phenotypes that divides each Rotterdam phenotype in obese (ob) or lean (l) sub-phenotype. An improved classification of PCOS may be essential for permitting new progress in our understanding of pathogenesis and treatment of PCOS (or of the different disorders that are part of PCOS).
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Affiliation(s)
- Enrico Carmina
- Endocrinology Unit, University of Palermo School of Medicine, 90149 Palermo, Italy
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Chiaffarino F, Cipriani S, Dalmartello M, Ricci E, Esposito G, Fedele F, La Vecchia C, Negri E, Parazzini F. Prevalence of Polycystic Ovary Syndrome in European countries and USA: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 279:159-170. [DOI: 10.1016/j.ejogrb.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
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Carmina E, Lobo RA. Comparing Lean and Obese PCOS in Different PCOS Phenotypes: Evidence That the Body Weight Is More Important than the Rotterdam Phenotype in Influencing the Metabolic Status. Diagnostics (Basel) 2022; 12:diagnostics12102313. [PMID: 36292002 PMCID: PMC9600591 DOI: 10.3390/diagnostics12102313] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Polycystic Ovary Syndrome (PCOS) represents a heterogeneous disorder and, using Rotterdam diagnostic criteria, four main phenotypes (A, B, C, and D) have been distinguished. However, it remains unclear whether lean versus obesity status influences findings in the various phenotypes of women with PCOS. 274 women with PCOS were consecutively assessed. Among these women, there were 149 with phenotype A, 24 with phenotype B, 94 with phenotype C, and 7 with phenotype D. We found normal body weight to be very common (65%) in phenotype C patients, common (43%) in phenotype A and D patients, and less represented (but still 25%) in phenotype B patients. Obesity was common in phenotype B (54%) and phenotype A (33%) patients and uncommon in phenotype C (only 11%) and phenotype D (14%) patients. Obese and lean patients of each phenotype were compared. Compared to the phenotype C PCOS patients, both phenotype A and B patients had higher total testosterone circulating values and higher luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio (p < 0.01) while anti-Mullerian hormone (AMH) levels were higher only in phenotype A PCOS patients. Instead, in the three obese PCOS phenotypes no differences in serum insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) calculation, and lipid blood values were observed. Analysis of data of lean patients gave similar results. Compared to the phenotype C PCOS patients, both phenotype A and B patients had higher total testosterone circulating values and higher LH/FSH ratio (p < 0.01) while AMH levels were higher only in phenotype A PCOS patients. However, no differences were observed in the circulating insulin levels, HOMA-IR calculation, or blood lipids between the three groups of lean PCOS patients. We conclude that Rotterdam phenotypes express the differences between PCOS patients in terms of ovulatory pattern and androgen secretion but fail to differentiate between obese patients with altered metabolic patterns and lean patients with normal metabolic patterns. A new classification of PCOS patients is needed and it should consider the influence of body weight on the metabolic patterns of PCOS patients.
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Affiliation(s)
- Enrico Carmina
- Endocrinology Unit, University of Palermo School of Medicine, 90133 Palermo, Italy
- Correspondence: or
| | - Rogerio A. Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10027, USA
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Nautiyal H, Imam SS, Alshehri S, Ghoneim MM, Afzal M, Alzarea SI, Güven E, Al-Abbasi FA, Kazmi I. Polycystic Ovarian Syndrome: A Complex Disease with a Genetics Approach. Biomedicines 2022; 10:biomedicines10030540. [PMID: 35327342 PMCID: PMC8945152 DOI: 10.3390/biomedicines10030540] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder affecting females in their reproductive age. The early diagnosis of PCOS is complicated and complex due to overlapping symptoms of this disease. The most accepted diagnostic approach today is the Rotterdam Consensus (2003), which supports the positive diagnosis of PCOS when patients present two out of the following three symptoms: biochemical and clinical signs of hyperandrogenism, oligo, and anovulation, also polycystic ovarian morphology on sonography. Genetic variance, epigenetic changes, and disturbed lifestyle lead to the development of pathophysiological disturbances, which include hyperandrogenism, insulin resistance, and chronic inflammation in PCOS females. At the molecular level, different proteins and molecular and signaling pathways are involved in disease progression, which leads to the failure of a single genetic diagnostic approach. The genetic approach to elucidate the mechanism of pathogenesis of PCOS was recently developed, whereby four phenotypic variances of PCOS categorize PCOS patients into classic, ovulatory, and non-hyperandrogenic types. Genetic studies help to identify the root cause for the development of this PCOS. PCOS genetic inheritance is autosomal dominant but the latest investigations revealed it as a multigene origin disease. Different genetic loci and specific genes have been identified so far as being associated with this disease. Genome-wide association studies (GWAS) and related genetic studies have changed the scenario for the diagnosis and treatment of this reproductive and metabolic condition known as PCOS. This review article briefly discusses different genes associated directly or indirectly with disease development and progression.
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Affiliation(s)
- Himani Nautiyal
- Siddhartha Institute of Pharmacy, Near IT-Park, Sahastradhara Road, Dehradun 248001, India;
| | - Syed Sarim Imam
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.S.I.); (S.A.)
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.S.I.); (S.A.)
| | - Mohammed M. Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah 13713, Saudi Arabia;
| | - Muhammad Afzal
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka 72341, Saudi Arabia;
- Correspondence: (M.A.); (I.K.)
| | - Sami I. Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka 72341, Saudi Arabia;
| | - Emine Güven
- Biomedical Engineering Department, Faculty of Engineering, Düzce University, Düzce 81620, Turkey;
| | - Fahad A. Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Correspondence: (M.A.); (I.K.)
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Xing C, Zhang J, Zhao H, He B. Effect of Sex Hormone-Binding Globulin on Polycystic Ovary Syndrome: Mechanisms, Manifestations, Genetics, and Treatment. Int J Womens Health 2022; 14:91-105. [PMID: 35140526 PMCID: PMC8818772 DOI: 10.2147/ijwh.s344542] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases causing infertility in women of childbearing age. It is characterized by hyperandrogenemia (HA), chronic anovulation, and polycystic ovary morphology (PCOM). Most women with PCOS have metabolic abnormalities. Sex hormone-binding globulin (SHBG), a transport carrier that binds estrogen and androgens and regulates their biological activity, is usually used as an indicator of hyperandrogenism in women with PCOS. Low serum SHBG levels are considered a biomarker of metabolic abnormalities and are associated with insulin resistance (IR), HA, and abnormal glucose and lipid metabolism in PCOS patients. SHBG is also related to the long-term prognosis of PCOS, whereas SHBG gene polymorphism is associated with PCOS risk. In addition, the administration of metformin (MET), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), thiazolidinediones (TZDs), compound oral contraceptives (COCs), as well as nutrient supplements such as inositol (MI), vitamin D, and synbiotics can regulate SHBG levels to ameliorate PCOS complications and improve prognosis. This review focuses on the interaction between SHBG and various PCOS complications as well as the regulation of SHBG by various drugs and nutrients and its therapeutic effects on PCOS.
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Affiliation(s)
- Chuan Xing
- The First Department of Endocrine, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China
| | - Jiaqi Zhang
- The First Department of Endocrine, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China
| | - Han Zhao
- The First Department of Endocrine, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China
| | - Bing He
- The First Department of Endocrine, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China
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7
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Krentowska A, Kowalska I. Metabolic syndrome and its components in different phenotypes of polycystic ovary syndrome. Diabetes Metab Res Rev 2022; 38:e3464. [PMID: 33988288 DOI: 10.1002/dmrr.3464] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/03/2021] [Indexed: 01/22/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-age women. Important factors in its pathogenesis are hyperinsulinaemia and insulin resistance, which lead to higher risk of metabolic syndrome (MetS) and its complications. With the implementation of the Rotterdam diagnostic criteria in 2003, the group of PCOS patients became highly heterogeneous, with varying metabolic risk reported for different phenotypes of the syndrome. The aim of the present review is to assess the prevalence and severity of MetS and its components in patients with the four phenotypes of PCOS. A comprehensive search of Pubmed database was performed to identify studies comparing metabolic characteristics between PCOS patients with different phenotypes of the syndrome. The results of 60 studies published between 2004 and 2020 were retrieved and analysed. More adverse metabolic profile was observed in PCOS patients with hyperandrogenic phenotypes in comparison to normoandrogenic patients, as well as in classic phenotypes, defined by National Institutes of Health criteria, in comparison to newer phenotypes introduced by the Rotterdam criteria. In the majority of observations, normoandrogenic PCOS patients did not differ significantly from controls in terms of metabolic characteristics, although some East Asian studies reported more adverse metabolic profile in normoandrogenic phenotype in comparison to healthy women. In conclusion, metabolic abnormalities in PCOS seem to be associated with joint effects of hyperandrogenism, insulin resistance and visceral obesity. The differences observed between the four phenotypes of PCOS underline the need for individualised diagnostic and therapeutic approach.
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Affiliation(s)
- Anna Krentowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
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Ma L, Cao Y, Ma Y, Zhai J. Association between hyperandrogenism and adverse pregnancy outcomes in patients with different polycystic ovary syndrome phenotypes undergoing in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Gynecol Endocrinol 2021; 37:694-701. [PMID: 33703999 DOI: 10.1080/09513590.2021.1897096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To study the association between hyperandrogenism (HA) and adverse pregnancy outcomes in patients with different polycystic ovary syndrome phenotypes undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). METHODS We reviewed all eligible articles published up to October 2020 after searching in PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, and CNKI databases. The primary outcomes were the clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR), whereas the secondary outcomes were the number of retrieved oocytes and endometrial thickness. Risk ratios (RRs) or mean differences with 95% confidence intervals (CIs) were calculated to estimate the HA impact on IVF/ICSI outcomes in patients with polycystic ovary syndrome (PCOS) phenotypes. RESULTS Of the 789 trials identified, nine retrospective studies involving 3037 patients with PCOS were included. Compared to the PCOS group with normal androgen levels, the PCOS group with HA exhibited increased MR (RR: 1.56, 95% CI: 1.13, 2.16); the CPR (RR: 0.88, 95% CI: 0.77, 1.01) and LBR (RR: 0.79, 95% CI: 0.55, 1.11) were not significantly different between these groups. Subgroup analysis revealed that the CPR was lower in the polycystic ovarian (PCO)-morphology + HA + oligo-anovulation (AO) group than in the PCO + AO group (RR: 0.81, 95% CI: 0.67, 0.99). Among Asians, the PCOS/HA group had increased MR (RR: 1.56, 95% CI: 1.06, 2.31) and showed thinner endometrial thickness. However, among Caucasians, no differences were observed between the two groups. CONCLUSIONS HA may have adverse effects on clinical pregnancy and miscarriage outcomes in different PCOS phenotypes, particularly among Asians.
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Affiliation(s)
- Linna Ma
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yurong Cao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Ma
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhai
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Abdalla MA, Deshmukh H, Mohammed I, Atkin S, Reid M, Sathyapalan T. The Effect of Free Androgen Index on the Quality of Life of Women With Polycystic Ovary Syndrome: A Cross-Sectional Study. Front Physiol 2021; 12:652559. [PMID: 34108885 PMCID: PMC8181761 DOI: 10.3389/fphys.2021.652559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Free androgen index (FAI) and anti-Mullerian hormone (AMH) are independently associated with polycystic ovary syndrome (PCOS). This study aimed to describe the relationship between these two markers and health-related quality of life (HR-QoL) in women with PCOS. Methods: This cross-sectional study consisted of 81 women in the Hull PCOS biobank, who fulfilled the Rotterdam consensus criteria for the diagnosis of PCOS. The primary outcome was to measure the various domains of the QoL in the modified polycystic ovary syndrome questionnaire (MPCOSQ). Results: Mean age of the study participants was 28 ± 6.0 years, mean body mass index (BMI) 33.5 ± 7.8 kg/m2, mean FAI (6 ± 5.5), free testosterone (2.99 ± 0.75) and mean AMH (3.5 ± 0.8 units). In linear regression analysis, the FAI was associated with overall mean MPCOSQ score (Beta = 0.53, P-value = 0.0002), and with depression (Beta = 0.45, P-value = 0.01), hirsutism (Beta = 0.99, P-value = 0.0002) and menstrual irregularity (Beta = 0.31, P-value = 0.04). However, with adjustment for age and BMI, FAI was only associated with the hirsutism domain (Beta = 0.94, P-value = 0.001) of the MPCOSQ. FAI was also associated with the weight domain (Beta = 0.63 P-value = 0.005) of MPCOSQ. However, AMH was not associated with the overall mean MPCOSQ score or with any of its domains. Conclusion: FAI but not AMH was associated with QoL in women with PCOS, and this effect was mediated by BMI.
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Affiliation(s)
- Mohammed Altigani Abdalla
- Department of Academic Diabetes, Endocrinology, and Metabolism, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Harshal Deshmukh
- Department of Academic Diabetes, Endocrinology, and Metabolism, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Irfaan Mohammed
- Department of Academic Diabetes, Endocrinology, and Metabolism, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Stephen Atkin
- School of Postgraduate Studies and Research, RCSI Medical University of Bahrain, Muharraq, Bahrain
| | - Marie Reid
- Department of Psychology, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Thozhukat Sathyapalan
- Department of Academic Diabetes, Endocrinology, and Metabolism, Hull York Medical School, University of Hull, Hull, United Kingdom
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Pirotta S, Joham A, Grieger JA, Tay CT, Bahri-Khomami M, Lujan M, Lim SS, Moran LJ. Obesity and the Risk of Infertility, Gestational Diabetes, and Type 2 Diabetes in Polycystic Ovary Syndrome. Semin Reprod Med 2021; 38:342-351. [PMID: 33873233 DOI: 10.1055/s-0041-1726866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review describes the relationship between obesity and the most common reproductive (infertility) and metabolic (gestational diabetes mellitus [GDM] and type 2 diabetes mellitus [T2DM]) consequences in polycystic ovary syndrome (PCOS). It also describes the vital role of lifestyle management for PCOS. PCOS is a heterogeneous endocrine disorder common in reproductive-age women. Consensus on the exact etiological mechanisms of PCOS is unreached. Overweight or obesity is present in at least 60% of the PCOS population, but the condition occurs irrespective of BMI, with excess BMI increasing both the prevalence and severity of clinical features. Use of lifestyle therapies (nutrition, physical activity, and/or behavioral) for the prevention and management of excess weight gain, infertility, GDM, and T2DM is a vital component of best-practice PCOS care. Lifestyle management is recommended for all women with PCOS as the first-line treatment with or without medications. Due to a lack of high-quality trials demonstrating the efficacy of specific lifestyle approaches, PCOS lifestyle recommendations are as those for the general population. This review summarizes current knowledge relating to obesity and its impact on fertility, GDM, and T2DM. It also summarizes the lifestyle recommendations to best manage these conditions in women with PCOS and obesity.
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Affiliation(s)
- Stephanie Pirotta
- Health and Social Care Unit, SPHPM, Monash University, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
| | - Jessica A Grieger
- Adelaide Medical School, University of Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Chau Tien Tay
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Mahnaz Bahri-Khomami
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Marla Lujan
- Division of Nutritional Sciences, Cornell University, New York
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
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11
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Kamrul-Hasan ABM, Aalpona FTZ, Mustari M, Akter F, Rahman MM, Selim S. Divergences in Clinical, Anthropometric, Metabolic, and Hormonal Parameters among Different Phenotypes of Polycystic Ovary Syndrome Presenting at Endocrinology Outpatient Departments: A Multicenter Study from Bangladesh. J Hum Reprod Sci 2021; 13:277-284. [PMID: 33627976 PMCID: PMC7879835 DOI: 10.4103/jhrs.jhrs_34_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/04/2020] [Accepted: 08/10/2020] [Indexed: 11/04/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is a heterogeneous androgen-excess disorder. Data comparing the PCOS phenotypes in Bangladesh are scarce. Objectives The objective of this study was to find out the distribution of Rotterdam classified PCOS phenotypes and to compare the phenotypes concerning clinical, anthropometric, metabolic, and hormonal parameters. Subjects and Methods In this cross-sectional study, 370 PCOS cases in the age group of 20-45 years diagnosed by the Rotterdam consensus criteria were recruited from the endocrinology outpatient departments of several tertiary hospitals of Bangladesh. Metabolic syndrome (MetS) was diagnosed using the International Diabetes Federation criteria. Results The prevalence of phenotypes A, B, C, and D were 59.2%, 14.1%, 11.9%, and 14.9%, respectively. More than one-third (34.6%) of the women had pre-hypertension (pre-HTN)/hypertension (HTN), 34.1% had abnormal glucose intolerance (AGT), 93.0% had dyslipidemia, and 57.0% had MetS. The hyperandrogenic phenotypes (A, B, and C) had higher prevalence of pre-HTN/HTN, AGT, dyslipidemia, and MetS compared to the normoandrogenic phenotype D, though the differences were statistically insignificant. The clinical and biochemical markers of hyperandrogenism (Ferriman-Gallwey score, hirsutism, acne, and serum testosterone levels) did not differ among the hyperandrogenic phenotypes. The serum prolactin level was highest in phenotype C. No differences were observed in most other clinical, anthropometric, metabolic, and hormonal parameters among the four phenotypes. Conclusion Phenotype A is the most prevalent phenotype of PCOS in our setting. The prevalence of MetS was considerably high. Most of the clinical, anthropometric, and metabolic parameters were similar across the four PCOS phenotypes in this study.
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Affiliation(s)
- A B M Kamrul-Hasan
- Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Fatema Tuz Zahura Aalpona
- Department of Gynecology and Obstetrics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh
| | - Marufa Mustari
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Farhana Akter
- Department of Endocrinology, Chittagong Medical College, Chittagong, Bangladesh
| | | | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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12
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Dadachanji R, Patil A, Joshi B, Mukherjee S. Elucidating the impact of obesity on hormonal and metabolic perturbations in polycystic ovary syndrome phenotypes in Indian women. PLoS One 2021; 16:e0246862. [PMID: 33635862 PMCID: PMC7909663 DOI: 10.1371/journal.pone.0246862] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
Polycystic ovary syndrome is a complex endocrinopathy with heterogeneous presentation and multifactorial etiology. We have undertaken this case-control study to compare metabolic and endocrine characteristics in different phenotypic subgroups of women with PCOS and the impact of obesity on them. Women with PCOS (n = 489) were classified into 4 phenotypes according to Rotterdam criteria. Comparisons of clinical, biochemical and hormonal parameters were performed across all phenotypic groups of PCOS and with controls (n = 270) by Welch’s ANOVA with subsequent Games-Howell post-hoc test. We found maximum prevalence of normoandrogenic phenotype D, which is milder form of PCOS in terms of insulin resistance, gonadotropin levels and dyslipidemia, followed by phenotype A, in our total study population. After classification of the study group into lean and obese groups, only few insulin and lipid-related traits showed marked differences between phenotypes. Further, we noted that obese women showed adverse metabolic but not androgenic traits compared to lean counterparts in the same phenotype. Metabolic syndrome frequency is increased in hyperandrogenic phenotypes with HDL-C and waist circumference being most predominant contributing factors in total, lean and obese groups. We demonstrate that in our study population there is greater occurrence of phenotype D of PCOS. Our study highlights the importance of clinicians concurrently employing Rotterdam criteria along with obesity status for ascertaining accurate PCOS status and formulating suitable therapeutic intervention.
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Affiliation(s)
- Roshan Dadachanji
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Anushree Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Srabani Mukherjee
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
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13
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Spritzer PM, Ramos RB, Marchesan LB, de Oliveira M, Carmina E. Metabolic profile of women with PCOS in Brazil: a systematic review and meta-analysis. Diabetol Metab Syndr 2021; 13:18. [PMID: 33593439 PMCID: PMC7885437 DOI: 10.1186/s13098-021-00636-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine disease affecting women of reproductive age and associated with reproductive and metabolic dysfunction. Few studies are available regarding metabolic traits in Brazilian women with PCOS. The aim of this systematic review and meta-analysis was to summarize the available evidence regarding metabolic traits and comorbidities in Brazilian women with polycystic ovary syndrome (PCOS). METHODS We systematically searched PubMed, Cochrane Central Register of Controlled Trials, and Embase for cross-sectional, case-control, or cohort studies focusing on populations of different regions from Brazil, published until July 31, 2019. Studies were selected if they reported PCOS diagnostic criteria. Studies without a control group were included if they presented relevant metabolic data. RESULTS Of 4856 studies initially identified, 27 were included in the systematic review and 12 were included in the meta-analysis, for a total of 995 women with PCOS defined by Rotterdam criteria and 2275 controls from different regions of Brazil. Obesity, metabolic syndrome and IGT were prevalent, and standard mean differences for BMI (SMD 0.67, 95% CI, 0.29, 1.05), waist circumference (SMD 0.22, 95% CI 0.02, 0.41), systolic (SMD 0.66, 95% CI 0.30, 1.01) and diastolic blood pressure (SMD 0.55, 95% CI 0.24, 0.87), glucose (SMD 0.21, 95% CI 0.04, 0.38) and HOMA (SMD 0.78, 95% CI 0.52, 1.04) were significantly higher in Brazilian women with PCOS compared to controls. Lipid profile was more adverse in PCOS vs. non-PCOS women. Between-study heterogeneities were low/moderate for glucose and HOMA and moderate/high for the other variables. CONCLUSIONS The data of this systematic review and meta-analysis indicate that Brazilian women with PCOS have a worse metabolic profile than women without PCOS with no important regional differences. The prevalence of metabolic changes is intermediate in Brazil vs. other countries.
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Affiliation(s)
- Poli Mara Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
- Department of Physiology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
- Post-Graduate Program in Endocrinology, Medicine School, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-003, Brazil.
| | - Ramon Bossardi Ramos
- Post-Graduate Program in Endocrinology, Medicine School, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
| | - Lucas Bandeira Marchesan
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Post-Graduate Program in Endocrinology, Medicine School, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Monica de Oliveira
- Instituto de Medicina Integral Professor Fernando Figueira Hospital, Recife, Pernambuco, Brazil
| | - Enrico Carmina
- University of Palermo School of Medicine, Palermo, Italy
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14
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Harris HR, Cushing-Haugen KL, Webb PM, Nagle CM, Jordan SJ, Risch HA, Rossing MA, Doherty JA, Goodman MT, Modugno F, Ness RB, Moysich KB, Kjær SK, Høgdall E, Jensen A, Schildkraut JM, Berchuck A, Cramer DW, Bandera EV, Rodriguez L, Wentzensen N, Kotsopoulos J, Narod SA, McLaughlin JR, Anton-Culver H, Ziogas A, Pearce CL, Wu AH, Lindström S, Terry KL. Association between genetically predicted polycystic ovary syndrome and ovarian cancer: a Mendelian randomization study. Int J Epidemiol 2020; 48:822-830. [PMID: 31211375 DOI: 10.1093/ije/dyz113] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a complex endocrine disorder with an estimated prevalence of 4-21% in reproductive aged women. Recently, the Ovarian Cancer Association Consortium (OCAC) reported a decreased risk of invasive ovarian cancer among women with self-reported PCOS. However, given the limitations of self-reported PCOS, the validity of these observed associations remains uncertain. Therefore, we sought to use Mendelian randomization with genetic markers as a proxy for PCOS, to examine the association between PCOS and ovarian cancer. METHODS Utilizing 14 single nucleotide polymorphisms (SNPs) previously associated with PCOS we assessed the association between genetically predicted PCOS and ovarian cancer risk, overall and by histotype, using summary statistics from a previously conducted genome-wide association study (GWAS) of ovarian cancer among European ancestry women within the OCAC (22 406 with invasive disease, 3103 with borderline disease and 40 941 controls). RESULTS An inverse association was observed between genetically predicted PCOS and invasive ovarian cancer risk: odds ratio (OR)=0.92 [95% confidence interval (CI)=0.85-0.99; P = 0.03]. When results were examined by histotype, the strongest inverse association was observed between genetically predicted PCOS and endometrioid tumors (OR = 0.77; 95% CI = 0.65-0.92; P = 0.003). Adjustment for individual-level body mass index, oral contraceptive use and parity did not materially change the associations. CONCLUSION Our study provides evidence for a relationship between PCOS and reduced ovarian cancer risk, overall and among specific histotypes of invasive ovarian cancer. These results lend support to our previous observational study results. Future studies are needed to understand mechanisms underlying this association.
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Affiliation(s)
- Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kara L Cushing-Haugen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Christina M Nagle
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Susan J Jordan
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Public Health, University of Queensland, Herston, Queensland, Australia
| | | | - Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jennifer A Doherty
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marc T Goodman
- Caner Prevention and Genetics Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Biomedical Sciences, Community and Population Health Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Francesmary Modugno
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Roberta B Ness
- The University of Texas School of Public Health, Houston, TX, USA
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Susanne K Kjær
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Estrid Høgdall
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Allan Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Joellen M Schildkraut
- Department of Public Health Sciences, The University of Virginia, Charlottesville, VA, USA
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Daniel W Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisa V Bandera
- Division of Obstetrics and Gynecology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lorna Rodriguez
- Division of Obstetrics and Gynecology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Joanne Kotsopoulos
- Epidemiology Division, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Epidemiology Division, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - John R McLaughlin
- Public Health Ontario, Samuel Lunenfeld Research Institute, Toronto, Canada
| | - Hoda Anton-Culver
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Argyrios Ziogas
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Celeste L Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Sara Lindström
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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15
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Polak AM, Adamska A, Krentowska A, Łebkowska A, Hryniewicka J, Adamski M, Kowalska I. Body Composition, Serum Concentrations of Androgens and Insulin Resistance in Different Polycystic Ovary Syndrome Phenotypes. J Clin Med 2020; 9:jcm9030732. [PMID: 32182752 PMCID: PMC7141288 DOI: 10.3390/jcm9030732] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/22/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023] Open
Abstract
Insulin resistance and hyperandrogenemia observed in polycystic ovary syndrome (PCOS) are associated with metabolic disturbances and could be connected with body composition pattern. To date, several studies defining the parameters of body composition using dual energy X-ray absorptiometry (DXA) method in the group of PCOS patients have been published, however, without the analysis in different phenotypes. The aim of the present study was to investigate the relationships between serum androgens concentration, insulin resistance and distribution of fat mass using DXA method in various PCOS phenotypes according to the Rotterdam criteria. We examined 146 women: 34 (38%) had PCOS phenotype A, 20 (23%) phenotype B, 20 (23%) phenotype C and 15 (16%) phenotype D (with mean age of each phenotype 25 years), and 57 control subjects (mean age of 25.5 years). Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Serum concentrations of testosterone, androstenedione and dehydroepiandrosterone sulfate (DHEA-S) were assessed and free androgen index (FAI) was calculated. In phenotypes A, B and C, we observed higher FAI in comparison to the control group (all p < 0.01). Serum concentrations of androstenedione and DHEA-S were higher in phenotypes A and C in comparison to the control group (all p < 0.01). However, only in phenotype A we found higher visceral adipose tissue (VAT) mass and android/gynoid ratio (A/G ratio) in comparison to the control group (all p < 0.01). In phenotype A, we observed connection of VAT with FAI (r = 0.58, p < 0.01). Accordingly, A/G ratio was related with FAI in all phenotypes (all p < 0.05). Additionally, in phenotype C, A/G ratio was related to serum concentrations of DHEA-S and androstenedione (r = 0.46, p = 0.03; r = 0.53, p = 0.01, respectively). We also found connections of HOMA-IR with VAT and A/G ratio in all phenotypes (all p < 0.05). Women with phenotype A had higher amount of VAT and A/G ratio in comparison to the control group. Serum concentration of androgens and insulin resistance are connected with VAT and A/G ratio in normoandrogenic and hyperandrogenic PCOS phenotypes.
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Affiliation(s)
- Aleksandra Maria Polak
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, 15-276 Białystok, Poland; (A.M.P.); (A.K.); (A.Ł.); (I.K.)
| | - Agnieszka Adamska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland;
- Correspondence: ; Tel.: +48-85-7468660; Fax: +48-85-744-7611
| | - Anna Krentowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, 15-276 Białystok, Poland; (A.M.P.); (A.K.); (A.Ł.); (I.K.)
| | - Agnieszka Łebkowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, 15-276 Białystok, Poland; (A.M.P.); (A.K.); (A.Ł.); (I.K.)
| | - Justyna Hryniewicka
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland;
| | - Marcin Adamski
- Faculty of Computer Science, Bialystok University of Technology, 15-351 Białystok, Poland;
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, 15-276 Białystok, Poland; (A.M.P.); (A.K.); (A.Ł.); (I.K.)
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16
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Belenkaia LV, Lazareva LM, Walker W, Lizneva DV, Suturina LV. Criteria, phenotypes and prevalence of polycystic ovary syndrome. ACTA ACUST UNITED AC 2020; 71:211-223. [PMID: 31089072 DOI: 10.23736/s0026-4784.19.04404-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Polycystic ovarian syndrome (PCOS) is known as one of the most frequent endocrine diseases in women worldwide. However, this term does not completely capture the diversity of clinical signs associated with this syndrome e.g., menstrual irregularity and clinical features of androgen excess, which are though commonplace in women with PCOS, they are not included under the definition of PCOS, limited to polycystic ovarian morphology (PCOM). Utilizing the most globally accepted criterion used today in the diagnosis of PCOS, the authors of this article review and discuss the historical and current context of evidence as well as their limitations. This review addresses the phenotypic approach and age-dependent aspects of PCOS in adolescents, adult and peri/postmenopausal women, as presented in the NIH (1990, 2012), Rotterdam (2003), AE-PCOS Society (2006) consensuses and in the latest evidence-based international guideline (2018). Global data on the epidemiology of PCOS, including prevalence and distribution of polycystic ovarian syndrome phenotypes, is also analyzed in the article. Lastly, the authors discuss the importance and current need to perform more epidemiological studies focused on PCOS.
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Affiliation(s)
- Liliia V Belenkaia
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russia
| | - Lyudmila M Lazareva
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russia
| | - Walidah Walker
- Research Administration Office, Augusta University, Augusta, GA, USA
| | - Daria V Lizneva
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Larisa V Suturina
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russia -
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17
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Khan MJ, Ullah A, Basit S. Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives. Appl Clin Genet 2019; 12:249-260. [PMID: 31920361 PMCID: PMC6935309 DOI: 10.2147/tacg.s200341] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/05/2019] [Indexed: 12/18/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common infertility disorder affecting a significant proportion of the global population. It is the main cause of anovulatory infertility in women and is the most common endocrinopathy affecting reproductive-aged women, with a prevalence of 8-13% depending on the criteria used and population studied. The disease is multifactorial and complex and, therefore, often difficult to diagnose due to overlapping symptoms. Multiple etiological factors have been implicated in PCOS. Due to the complex pathophysiology involving multiple pathways and proteins, single genetic diagnostic tests cannot be determined. Progress has been achieved in the management and diagnosis of PCOS; however, not much is known about the molecular players and signaling pathways underlying it. Conclusively PCOS is a polygenic and multifactorial syndromic disorder. Many genes have been associated with PCOS, which affect fertility either directly or indirectly. However, studies conducted on PCOS patients from multiple families failed to find a fully penetrant variant(s). The present study was designed to review the current genetic understanding of the disease. In the present review, we have discussed the clinical spectrum, the genetics, and the variants identified as being associated with PCOS. The mechanisms by which variants in the genes confer risk to PCOS and the nature of the physical and genetic interaction between the genetic elements underlying PCOS remain to be determined. Elucidation of genetic players and cellular pathways underlying PCOS will certainly increase our understanding of the pathophysiology of this syndrome. The study also discusses the current status of the treatment modalities for PCOS, which is important to find new ways of treatment.
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Affiliation(s)
- Muhammad Jaseem Khan
- Institute of Paramedical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Anwar Ullah
- Institute of Paramedical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Sulman Basit
- Center for Genetics and Inherited Diseases, Taibah University Almadinah Almunawwarrah, Peshawar, Saudi Arabia
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18
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Carmina E, Nasrallah MP, Guastella E, Lobo RA. Characterization of metabolic changes in the phenotypes of women with polycystic ovary syndrome in a large Mediterranean population from Sicily. Clin Endocrinol (Oxf) 2019; 91:553-560. [PMID: 31306504 DOI: 10.1111/cen.14063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To better characterize the metabolic alterations in various phenotypes of polycystic ovary syndrome (PCOS) in a large homogeneous (Sicilian) Mediterranean population with a low prevalence of obesity. DESIGN Retrospective study. PATIENTS A total of 1215 consecutively evaluated women with PCOS divided into four Rotterdam phenotypes (A, B, C and D) and in 108 matched ovulatory, nonhyperandrogenic women. MEASUREMENTS BMI, fasting glucose, total cholesterol, HDL cholesterol, triglycerides, LDL cholesterol and an oral glucose tolerance test. RESULTS The overall prevalence of obesity was 31%, metabolic syndrome 6.6%, diabetes 2.1%, altered glucose metabolism 13.1%, and abnormal lipid profile 60%. Phenotype B had the highest prevalence of obesity, metabolic syndrome, altered glucose metabolism and lipid abnormalities compared to other PCOS phenotypes and controls. Phenotype A was more obese and more women had metabolic syndrome compared to phenotypes C and D but phenotype C had a similar prevalence of altered glucose metabolism and lipid abnormalities compared to phenotype A which had a higher BMI. These metabolic abnormalities in A and C were higher compared to phenotype D and controls. Multivariate analysis showed that BMI predicts only abnormalities in fasting glucose and triglycerides, while there was no association with androgens. CONCLUSIONS In Mediterranean women with PCOS from Sicily with a lower prevalence of obesity, the prevalence of diabetes, altered glucose metabolism and metabolic syndrome were much lower than reported in US studies. Phenotype B was the most metabolically affected phenotype, followed by phenotype A. Phenotype C had an intermediate disorder but with a high prevalence of altered glucose metabolism and lipid alterations. Only the normoandrogenic phenotype D had no metabolic abnormalities.
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Affiliation(s)
- Enrico Carmina
- Department of Health Sciences, Child and Mother Care, and General and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Mona P Nasrallah
- Department of Internal Medicine, Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon
| | - Ettore Guastella
- Department of Health Sciences, Child and Mother Care, and General and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Rogerio A Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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19
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A cross-sectional comparison of clinical and endocrine parameters among phenotypes of polycystic ovarian syndrome in iranian population. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Cela V, Obino MER, Alberga Y, Pinelli S, Sergiampietri C, Casarosa E, Simi G, Papini F, Artini PG. Ovarian response to controlled ovarian stimulation in women with different polycystic ovary syndrome phenotypes. Gynecol Endocrinol 2018; 34:518-523. [PMID: 29271274 DOI: 10.1080/09513590.2017.1412429] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Controlled ovarian stimulation (COH) in PCOS is a challenge for fertility expert both ovarian hyperstimulation syndrome (OHSS) and oocytes immaturity are the two major complication. Ovarian response to COH vary widely among POCS patients and while some patients are more likely to show resistance to COH, other experienced an exaggerated response. The aim of our study is to investigate a possible correlation between PCOS phenotypes and the variety of ovarian response to COH and ART outcomes in patients with different PCOS phenotypes. We retrospectively analyzed a total of 71 cycles performed in 44 PCOS infertile patients attending ART at Centre of Infertility and Assisted Reproduction of Pisa University between January 2013 and January 2016. Patientsundergoing IVF with GnRH-antagonist protocol and 150-225 UI/days of recombinant FSH; triggering was carried out using 250 mg of recombinant hCG or a GnRH analogous on the basis of the risk to OHSS. We observed that Phenotype B had a tendency to have a greater doses of gonadotropins used respect to all phenotypes. Phenotype A group showed a greater serum estrogen levels compared to all phenotypes groups, a greater number of follicles of diameter between 8-12 mm found by ultrasound on the day of triggering and a greater mean number of freeze embryo. Additionally serum AMH and antral follicles count (AFC) follow the same trend in the different phenotypes ad they were significantly higher in phenotype A and in phenotype D. In conclusion this study shows that the features of PCOS phenotypes reflect the variety of ovarian response to COH as well as the risks to develop OHSS. Serum AMH and AFC are related to the degree of ovulatory dysfunction making these 'added values' in identifying the different PCOS phenotypes. Phenotype A seems to be the phenotype with the higher risk to develop OHSS and the use of GnRH as a trigger seems to improve oocyte quality. To classify PCOS phenotype at diagnosis might help clinicians to identify patients at greater risk of OHSS, customize therapy and subsequently plan the trigger agent.
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Affiliation(s)
- Vito Cela
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Maria Elena Rosa Obino
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Ylenia Alberga
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Sara Pinelli
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Claudia Sergiampietri
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Elena Casarosa
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Giovanna Simi
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Francesca Papini
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
| | - Paolo Giovanni Artini
- a Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology , University of Pisa , Pisa , Italy
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21
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Giampaolino P, Della Corte L, De Rosa N, Mercorio A, Bruzzese D, Bifulco G. Ovarian volume and PCOS: a controversial issue. Gynecol Endocrinol 2018; 34:229-232. [PMID: 29043882 DOI: 10.1080/09513590.2017.1391205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Polycystic ovarian syndrome (PCOS) is a common endocrinopathy. The Rotterdam criteria indicate four distinct phenotypes. In phenotypes with the typical ovarian morphology (ovarian volume ≥10 ml) the sensibility to clomiphene citrate (CC) ovulation therapy was demonstrated inversely proportional to the ovarian volume. In this retrospective study we evaluated the influence of ovarian volume on the success rate of CC ovulation induction in women with anovulatory phenotype 2 characterized only by the presence of hyperandrogenism and anovulation (ANOV + HA). Statistical analysis was conducted by stratifying patients both on the basis of CC dose (Group 1: n = 37, 50 mg; Group 2: n = 9, 100 mg; and Group 3: n = 12, 150 mg) and on the basis of response to therapy. Eighty women were evaluated but overall only 58 women (72.5%) reached ovulation. In the phenotype studied, we didn't find any correlations between ovarian volume and the chance of ovulation with the gradient increase in CC; furthermore, ovarian volume was comparable in CC responders and non-responders. Our study has shown that in the phenotype 2 examined, ovarian volume did not have any predictive value of the dosage required to induce ovulation. The significance of this result is discussed.
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Affiliation(s)
| | - Luigi Della Corte
- b Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II , Naples , Italy
| | - Nicoletta De Rosa
- b Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II , Naples , Italy
| | - Antonio Mercorio
- b Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II , Naples , Italy
| | - Dario Bruzzese
- a Department of Public Health , University of Naples Federico II , Naples , Italy
| | - Giuseppe Bifulco
- b Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II , Naples , Italy
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22
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Sun Y, Wang W, Shen Q, Du S, Guo Y, He F, Zhang W. Waist Circumference Coupled with Either HDL-C or TG Can Be Used as a Diagnostic Marker for Metabolic Syndrome in Chinese Women with Polycystic Ovary Syndrome. Int J Endocrinol 2018; 2018:6102085. [PMID: 30275828 PMCID: PMC6151373 DOI: 10.1155/2018/6102085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/15/2018] [Indexed: 01/22/2023] Open
Abstract
Although quite a few polycystic ovary syndrome (PCOS) patients suffering from metabolic syndrome (MS) have been reported in previous studies, no reliable and early diagnostic biomarkers for MS in PCOS patients have yet been identified. To identify early and reliable diagnostic biomarkers for MS in Chinese women with PCOS, a total of 401 patients (200 PCOS patients and 201 controls) were enrolled in our present study. All of the subjects were examined for anthropometric (weight, waist circumference, blood pressure, etc.) and biochemical (fasting glucose, serum lipid indices, total testosterone, etc.) parameters. Our results showed that the prevalence of MS in the PCOS patients (20.50%) was 6.8-fold higher (P < 0.05) than that in the controls (2.99%). Nearly 71.0% of the PCOS patients had at least one component of MS, of which dyslipidemia was the most prevalent. Furthermore, within the PCOS group, the prevalence of MS increased with increasing age and body mass index (BMI). Logistic analysis indicated that BMI, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), hypertension, and fasting glucose were significantly associated with the presence of MS in PCOS patients. Analysis of the ability of the potential diagnostic biomarkers to indicate MS in PCOS patients showed that the PPV, NPV, specificity, sensitivity, and Youden's index for waist circumference (WC) coupled with HDL-C were 59.68%, 97.10%, 84.28%, 90.24%, and 74.52, respectively, and those for WC coupled with TG were 93.33%, 92.35%, 98.74%, 68.29%, and 67.03%, respectively. ROC curve analysis showed that the areas under the ROC curves (AUCs) for WC coupled with HDL-C and for WC coupled with TG were 0.882 and 0.901, respectively. Our present study demonstrates that WC coupled with either HDL-C or TG can be used as a relatively early and reliable diagnostic biomarker for MS in Chinese PCOS patients.
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Affiliation(s)
- Yan Sun
- Reproductive Medicine Center, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Province Key Laboratory of Environment and Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Wenxiang Wang
- Fujian Province Key Laboratory of Environment and Health, Fujian Medical University, Fuzhou, Fujian, China
- Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Qi Shen
- Fujian Province Key Laboratory of Environment and Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Shengrong Du
- Reproductive Medicine Center, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yiwei Guo
- Fujian Province Key Laboratory of Environment and Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Fei He
- Fujian Province Key Laboratory of Environment and Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Wenchang Zhang
- Fujian Province Key Laboratory of Environment and Health, Fujian Medical University, Fuzhou, Fujian, China
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Ashrafi M, Sheikhan F, Arabipoor A, Rouhana N, Hosseini R, Zolfaghari Z. Gestational Diabetes Mellitus and Metabolic Disorder Among the Different Phenotypes of Polycystic Ovary Syndrome. Oman Med J 2017; 32:214-220. [PMID: 28584602 DOI: 10.5001/omj.2017.40] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Polycystic ovary syndrome (PCOS) is a common endocrine disorder related to several metabolic consequences. However, there remains uncertainty regarding the metabolic features of various phenotypes. The aim of this study was to explore the relationship between the prevalence of gestational diabetes mellitus (GDM) and metabolic disorders among the four different phenotypes of PCOS. METHODS A cross-sectional study was performed in Royan Institute including 208 pregnant women with a history of infertility and PCOS. Using the diagnostic criteria of the American Diabetes Association (ADA), pregnant women with a documented diagnoses of PCOS were further categorized into four different phenotypes (A, B, C, and D) as defined by the Rotterdam criteria. RESULTS The prevalence of GDM failed to demonstrate a significant relationship among the four phenotypes of PCOS. The mean levels of fasting blood sugar, plasma glucose concentrations at three hours (following the 100 g oral glucose tolerance test) and triglyceride levels were significantly higher in phenotype B compared to the remaining phenotypes (p < 0.050). There was a statistically significant difference between the mean free testosterone level and phenotypes A and C groups (1.8±1.6 vs. 1.1±1.0, p = 0.003). CONCLUSIONS Women with a known diagnosis of PCOS who exhibited oligo/anovulation and hyperandrogenism demonstrated an increase of metabolic disorders. These results suggest that metabolic screening, before conception or in the early stages of pregnancy, can be beneficial particularly in women with PCOS phenotypes A and B. Early screening and identification may justify enhanced maternal fetal surveillance to improve maternal and fetal morbidity among women affected with PCOS.
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Affiliation(s)
- Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Acadmic Center for Education, Culture, and Research, Tehran, Iran
| | - Fatemeh Sheikhan
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Acadmic Center for Education, Culture, and Research, Tehran, Iran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Acadmic Center for Education, Culture, and Research, Tehran, Iran
| | - Nicole Rouhana
- Director of Graduate Programs, Decker School of Nursing, Binghamton, USA
| | - Roya Hosseini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Acadmic Center for Education, Culture, and Research, Tehran, Iran
| | - Zahra Zolfaghari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Acadmic Center for Education, Culture, and Research, Tehran, Iran
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Lizneva D, Kirubakaran R, Mykhalchenko K, Suturina L, Chernukha G, Diamond MP, Azziz R. Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis. Fertil Steril 2016; 106:1510-1520.e2. [DOI: 10.1016/j.fertnstert.2016.07.1121] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/15/2022]
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Yang R, Yang S, Li R, Liu P, Qiao J, Zhang Y. Effects of hyperandrogenism on metabolic abnormalities in patients with polycystic ovary syndrome: a meta-analysis. Reprod Biol Endocrinol 2016; 14:67. [PMID: 27756332 PMCID: PMC5069996 DOI: 10.1186/s12958-016-0203-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study evaluated the effect of hyperandrogenism (HA) in polycystic ovary syndrome (PCOS) on metabolic parameters. METHODS We searched PubMed, EMBASE, Cochrane, Web of Science, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang data and VIP for clinical observational studies. The study evaluated PCOS patients with or without HA on metabolic parameters was included. Prevalence of metabolic syndrome, indexes of insulin resistance (IR) including homeostasis model assessment IR index (HOMA-IR), incidence of IR, biomarkers of serum lipid metabolism such as total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). RESULTS Of 4457 identified trials, 32 observational studies were included for the final analysis comprising 9556 female with PCOS. 6482 cases were having HA, and the others were negative. There were significant differences in the incidence of metabolic syndrome, HOMA-IR, rate of IR, TC level and HDL level between PCOS patients with or without HA, except for LDL level. No significant publication bias was found as P value of Egger's test was 0.82. CONCLUSIONS HA play an important role in metabolic disorders in PCOS patients. The incidence of metabolic syndrome, IR indexes, and most biomarkers of serum lipid metabolism were significantly different between patients with and without HA.
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Affiliation(s)
- Rui Yang
- Reproductive Medical Center, Peking University Third Hospital, No 49, North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Shuo Yang
- Reproductive Medical Center, Peking University Third Hospital, No 49, North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Rong Li
- Reproductive Medical Center, Peking University Third Hospital, No 49, North Huayuan Road, Haidian District, Beijing, 100191, China.
| | - Ping Liu
- Reproductive Medical Center, Peking University Third Hospital, No 49, North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Jie Qiao
- Reproductive Medical Center, Peking University Third Hospital, No 49, North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Yanwu Zhang
- Institute of Medical Information (IMI) & Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril 2016; 106:6-15. [PMID: 27233760 DOI: 10.1016/j.fertnstert.2016.05.003] [Citation(s) in RCA: 624] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 12/28/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a highly prevalent disorder effecting reproductive-aged women worldwide. This article addresses the evolution of the criteria used to diagnosis PCOS; reviews recent advances in the phenotypic approach, specifically in the context of the extended Rotterdam criteria; discusses limitations of the current criteria used to diagnosis, particularly when studying adolescents and women in the peri- and postmenopause; and describes significant strides made in understanding the epidemiology of PCOS. This review recognizes that although there is a high prevalence of PCOS, there is increased variability when using Rotterdam 2003 criteria, owing to limitations in population sampling and approaches used to define PCOS phenotypes. Last, we discuss the distribution of PCOS phenotypes, their morbidity, and the role that referral bias plays in the epidemiology of this syndrome.
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Jędrzejuk D, Lwow F, Kuliczkowska-Płaksej J, Hirnle L, Trzmiel-Bira A, Lenarcik-Kabza A, Kolackov K, Łaczmański Ł, Milewicz A. Association of serum glypican-4 levels with cardiovascular risk predictors in women with polycystic ovary syndrome - a pilot study. Gynecol Endocrinol 2016; 32:223-6. [PMID: 26486309 DOI: 10.3109/09513590.2015.1110137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Glypican-4 (Gpc4) is an adipokine which interacts with the insulin receptor and affects insulin sensitivity in proteoglycans. Insulin resistance plays a crucial role in the etiology of polycystic ovary syndrome (PCOS). PCOS is associated with metabolic disturbances such as abdominal obesity, dyslipidemia and type 2 diabetes. Thus, higher levels of Gpc4 released from visceral adipose tissue in women with PCOS may suggest an increased risk of cardiovascular disease (CVD). DESIGN The aim of this pilot study was to determine whether the serum Gpc4 level is associated with cardiovascular risk predictors in women with PCOS. METHODS Sixty-two women with PCOS according to the Rotterdam criteria (20-35 years old) and 43 healthy controls were studied. Cardiovascular risk predictors such as obesity indices, fat deposits according to dual-energy X-ray absorptiometry, biochemical lipid profile parameters and Homeostasis Model Assessment were estimated. RESULTS The serum Gpc4 level in PCOS women was significantly higher (2.61 ± 1.17 ng/ml) than in the control group (1.55 ± 0.47 ng/ml) and correlated with waist circumference, waist-to-hip ratio, total fat and android fat deposit to gynoid fat deposit ratio only in the PCOS group. CONCLUSION The Gpc4 level was higher in the PCOS group and correlated with CVD risk predictors, especially fat distribution.
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Affiliation(s)
- Diana Jędrzejuk
- a Department of Endocrinology , Diabetology and Isotope Therapy, Wroclaw Medical University , Wroclaw , Poland
| | - Felicja Lwow
- b Department of Health Promotion , Faculty of Physiotherapy, University School of Physical Education , Wroclaw , Poland , and
| | | | - Lidia Hirnle
- c First Department of Gynecology and Obstetrics, Wroclaw Medical University , Wroclaw , Poland
| | - Anna Trzmiel-Bira
- a Department of Endocrinology , Diabetology and Isotope Therapy, Wroclaw Medical University , Wroclaw , Poland
| | - Agnieszka Lenarcik-Kabza
- a Department of Endocrinology , Diabetology and Isotope Therapy, Wroclaw Medical University , Wroclaw , Poland
| | - Katarzyna Kolackov
- a Department of Endocrinology , Diabetology and Isotope Therapy, Wroclaw Medical University , Wroclaw , Poland
| | - Łukasz Łaczmański
- a Department of Endocrinology , Diabetology and Isotope Therapy, Wroclaw Medical University , Wroclaw , Poland
| | - Andrzej Milewicz
- b Department of Health Promotion , Faculty of Physiotherapy, University School of Physical Education , Wroclaw , Poland , and
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Romualdi D, Di Florio C, Tagliaferri V, De Cicco S, Gagliano D, Immediata V, Lanzone A, Guido M. The Role of Anti-Müllerian Hormone in the Characterization of the Different Polycystic Ovary Syndrome Phenotypes. Reprod Sci 2015; 23:655-61. [DOI: 10.1177/1933719115611751] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniela Romualdi
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
| | - C. Di Florio
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
| | - V. Tagliaferri
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
| | - S. De Cicco
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
| | - D. Gagliano
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
| | - V. Immediata
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
| | - A. Lanzone
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
- OASI Institute for Research, Troina, Italia
| | - M. Guido
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italia
- Ospedale Generale Regionale “F. Miulli,” Acquaviva delle Fonti, Italia
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Ellakwa HE, Sanad ZF, Hamza HA, Emara MA, Elsayed MA. Predictors of patient responses to ovulation induction with clomiphene citrate in patients with polycystic ovary syndrome experiencing infertility. Int J Gynaecol Obstet 2015; 133:59-63. [DOI: 10.1016/j.ijgo.2015.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 09/14/2015] [Accepted: 12/02/2015] [Indexed: 12/12/2022]
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Comparison of clinical and hormonal characteristics among four phenotypes of polycystic ovary syndrome based on the Rotterdam criteria. Arch Gynecol Obstet 2015; 293:447-56. [DOI: 10.1007/s00404-015-3889-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022]
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31
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Moro F, Tropea A, Scarinci E, Federico A, De Simone C, Caldarola G, Leoncini E, Boccia S, Lanzone A, Apa R. Psoriasis and polycystic ovary syndrome: a new link in different phenotypes. Eur J Obstet Gynecol Reprod Biol 2015; 191:101-5. [PMID: 26115053 DOI: 10.1016/j.ejogrb.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/14/2015] [Accepted: 06/03/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Women affected by PCOS and psoriasis are more likely to have insulin-resistance, hyperinsulinemia, reduced HDL cholesterol levels and a more severe degree of skin disease than those with psoriasis alone. The mechanism underlying this association between PCOS and psoriasis is currently unknown. The aim of the present study was to evaluate the features of psoriasis and the psoriasis severity scores in the different PCOS phenotypes and in age and body mass index (BMI)-matched psoriatic control patients. STUDY DESIGN A cross-sectional study was performed on 150 psoriatic patients: 94 PCOS and 56 age- and BMI-matched controls. PCOS patients were diagnosed and divided into four phenotypes according to Rotterdam criteria: A - patients with complete phenotype with hyperandrogenism (H) plus oligoamenorrhea (O) plus polycystic ovary (PCO) on ultrasound examination; B - patients with H plus O (without PCO); C - patients with H plus PCO (ovulatory phenotype); D - patients with O plus PCO (without H). The patient's Psoriasis Area and Severity Index (PASI) as well as the Physician's Global Assessment (PGA) were calculated. A PASI score ≥10 was correlated with common indicator of severe disease. A PGA ≥4 was considered as a condition of moderate to severe disease. RESULTS Among the four phenotypes investigated, the group with complete phenotype (H plus O plus PCO) had a higher prevalence of patients with patient's PASI ≥10 compared to controls (Odds Ratio (OR) 4.71, 95% confidence intervals (CI) 1.59-13.95). The group with O plus PCO had a higher prevalence of patients with PGA ≥4 compared to controls (OR 26.79, 95% CI 3.40-211.02) while the ovulatory group had a lower prevalence of patients with PGA ≥4 (OR 0.06, 95% CI 0.01-0.51). CONCLUSIONS The ovulatory phenotype displays a milder psoriasis form than other phenotypes while the phenotypes with oligoamenorrhea presented higher severity scores of disease than other phenotypes and control group.
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Affiliation(s)
- Francesca Moro
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Anna Tropea
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Scarinci
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alex Federico
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clara De Simone
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Caldarola
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Leoncini
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosanna Apa
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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Jamil AS, Alalaf SK, Al-Tawil NG, Al-Shawaf T. A case-control observational study of insulin resistance and metabolic syndrome among the four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. Reprod Health 2015; 12:7. [PMID: 25595199 PMCID: PMC4417246 DOI: 10.1186/1742-4755-12-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/09/2015] [Indexed: 01/08/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is associated with an increased risk of insulin resistance (IR), metabolic syndrome (MetS), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). Metabolic aspects of the four PCOS phenotypes remain to be fully defined. The aim of this study was to compare metabolic parameters and insulin resistance among the four PCOS phenotypes defined according to the Rotterdam criteria and to determine predictors of these complications. Methods A total of 526 reproductive-aged women were included in this observational case–control study. Of these, 263 were diagnosed as a PCOS based on Rotterdam criteria and 263 infertile women with no evidence of PCOS were recruited as controls. Biochemical, metabolic and insulin resistance parameters were compared in the two groups and the frequency of MetS and IR were compared among the four phenotypes. Data were analyzed for statistical significance using Student’s t-test and one way analysis of variance followed by a post-hoc test (least significant difference). Chi-square tests were used to compare proportions. Univariate and multivariate logistic regression analyses were also applied. Results IR was identified in 112 (42.6%) of the PCOS women and 45 (17.1%) of the control (P <0.001). There were no significant differences in the frequency of IR and MetS between the four PCOS phenotypes. Homeostatic model assessment for IR (HOMA-IR) ≥3.8 was the most common IR parameter in PCOS and control groups. Women with oligo-anovulation (O) and PCO morphology (P) had a significantly lower level of 2-h postprandial insulin compared to women with O, P and hyperandrogenism (H) phenotypes. Logistic regression analysis showed that body mass index, waist circumference, triglyceride/high-density lipoprotein ratio (cardiovascular risk), HOMA-IR and glucose abnormalities (T2DM) were associated with increased risk of having MetS (P < 0.05). Conclusions PCOS women with (O + P) show milder endocrine and metabolic abnormalities. Although, there were no significant differences in IR, MetS and glucose intolerance between the four PCOS phenotypes, women with PCOS are at higher risk of impaired glucose tolerance and undiagnosed diabetes.
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Affiliation(s)
- Avin S Jamil
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, P.O. Box 383-65, Erbil, Iraq.
| | - Shahla K Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, P.O. Box 383-65, Erbil, Iraq.
| | - Namir G Al-Tawil
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
| | - Talha Al-Shawaf
- Women's Health Research Unit, Centre for Primary Care and Public Health, Barts and The London Medical College, Queen Mary University, London, UK. .,Department of Primary Care and Public Health, Imperial College, London, UK.
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Jedrzejuk D, Łaczmański Ł, Milewicz A, Kuliczkowska-Płaksej J, Lenarcik-Kabza A, Hirnle L, Zaleska-Dorobisz U, Lwow F. Classic PCOS phenotype is not associated with deficiency of endogenous vitamin D and VDR gene polymorphisms rs731236 (TaqI), rs7975232 (ApaI), rs1544410 (BsmI), rs10735810 (FokI): a case-control study of lower Silesian women. Gynecol Endocrinol 2015; 31:976-9. [PMID: 26422783 DOI: 10.3109/09513590.2015.1062865] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT The role of endogenous vitamin D and vitamin D receptor (VDR) gene polymorphism in polycystic ovary syndrome (PCOS) is still controversial. OBJECTIVE The objective of this study was to investigate for the first time in women with "classic" PCOS phenotype and healthy controls the role of the serum endogenous vitamin D level and VDR gene polymorphisms in PCOS etiology. DESIGN Ninety-two women with "classic" PCOS phenotype and 85 controls from lower Silesia with comparable body mass index (BMI) were studied. In all women the waist circumference, android/gynoid fat deposit, parameters of lipid and glucose metabolism, testosterone, free androgen index, sex hormone binding globulin (SHBG) and vitamin D were evaluated. Also, VDR gene polymorphisms rs731236, rs7975232, rs1544410 and rs10735810 were assessed. RESULTS Serum vitamin D levels in both groups were comparable. Also high, comparable frequencies of hypovitaminosis and vitamin D deficiency in both groups were observed. Women with "classic" PCOS phenotype had statistically significantly higher values of all measured parameters, except serum SHBG and high-density lipoprotein (HDL)-cholesterol, which were lower. The frequency of VDR genotype polymorphism was also comparable in both groups. CONCLUSIONS For the first time, we show that endogenous vitamin D deficiency and VDR polymorphisms are not associated with homogeneous "classic" PCOS phenotype.
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Affiliation(s)
- Diana Jedrzejuk
- a Department and Clinic of Endocrinology , Diabetology and Isotope Treatment
| | - Łukasz Łaczmański
- a Department and Clinic of Endocrinology , Diabetology and Isotope Treatment
| | - Andrzej Milewicz
- a Department and Clinic of Endocrinology , Diabetology and Isotope Treatment
| | | | | | - Lidia Hirnle
- b Department and Clinic of Gynecology and Obstetrics , and
| | | | - Felicja Lwow
- d Department of Health Promotion , Faculty of Physiotherapy, University School of Physical Education , Wroclaw , Poland
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Daan NM, Louwers YV, Koster MP, Eijkemans MJ, de Rijke YB, Lentjes EW, Fauser BC, Laven JS. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertil Steril 2014; 102:1444-1451.e3. [DOI: 10.1016/j.fertnstert.2014.08.001] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/03/2014] [Accepted: 08/01/2014] [Indexed: 11/16/2022]
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Lin AW, Lujan ME. Comparison of dietary intake and physical activity between women with and without polycystic ovary syndrome: a review. Adv Nutr 2014; 5:486-96. [PMID: 25469380 PMCID: PMC4188220 DOI: 10.3945/an.113.005561] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age worldwide. In addition to deleterious effects on fertility imparted by PCOS, women with PCOS are at increased risk of obesity, diabetes, cardiovascular disease, depression, and certain cancers. Hormonal and metabolic aberrations in PCOS have the potential to influence dietary intake and physical activity levels. There are emerging global data that women with PCOS have different baseline dietary energy intakes compared with women without PCOS. These alterations in diet may exacerbate clinical symptoms and compound risk of chronic disease in patients. Few studies have compared baseline physical activity levels between women with and without PCOS. Although comparisons between studies are confounded by several factors, the data point to no differences in activity levels among PCOS and non-PCOS groups. This review provides an assessment of the current literature on baseline dietary intake and physical activity levels in women with PCOS. Future recommendations to strengthen research in this area are provided, given the implications to aid in the development of effective nutrition-focused interventions for PCOS.
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Prevalence of metabolic syndrome is higher among non-obese PCOS women with hyperandrogenism and menstrual irregularity in Korea. PLoS One 2014; 9:e99252. [PMID: 24901345 PMCID: PMC4047097 DOI: 10.1371/journal.pone.0099252] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/12/2014] [Indexed: 11/25/2022] Open
Abstract
Background Hyperandrogenism (HA) has been linked with several components of metabolic syndrome (MetS). Few studies in Asian women have evaluated the important risk factors for and prevalence of MetS according to PCOS subtype. In this study, we investigated differences in metabolic parameters and the prevalence of MetS in two major phenotypic subgroups of PCOS in Korea. Furthermore, we investigated the relationship between HA-associated parameters and MetS. Materials and Methods This cross-sectional observational study was conducted from May 2010 to December 2011 in Korea. A total of 837 females with PCOS, aged 15–40, were recruited from Departments of Obstetrics and Gynecology at 13 hospitals. Of those, 700 subjects with either polycystic ovaries (PCO)+HA+oligomenorrhea/amenorrhea (O) or PCO+O were eligible for this study. MetS was diagnosed according to the modified National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines and the International Diabetes Federation (IDF) criteria. Results MetS was more prevalent in the PCO+HA+O group (19.7%) than in the PCO+O (11.9%) group. There were statistically significant trends for an increased risk of MetS in the PCO+HA+O group compared to the PCO+O group. After adjustment for age, the odds ratio of MetS was 2.192 in non-obese subjects with PCO+HA+O compared to those with PCO+O, whereas the risk of MetS was not different in obese patients. Multivariate logistic regression analysis showed that high free androgen index and low sex hormone-binding globulin were significantly associated with MetS in non-obese women with PCOS, with odds ratios of 4.234 (95% CI, 1.893–9.474) and 4.612 (95% CI, 1.978–10.750), respectively. However, no associations were detected between MetS and SHBG and FAI in obese PCOS subjects. Conclusions Our results indicate that HA and its associated parameters (FAI and SHBG) are significantly associated with MetS in non-obese PCOS subjects, whereas this association was not observed in obese subjects.
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Georgopoulos NA, Papadakis E, Armeni AK, Katsikis I, Roupas ND, Panidis D. Elevated serum androstenedione is associated with a more severe phenotype in women with polycystic ovary syndrome (PCOS). Hormones (Athens) 2014; 13:213-21. [PMID: 24776621 DOI: 10.1007/bf03401335] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of elevated serum Δ4A levels on the hormonal and metabolic features of the different phenotypes of PCOS. DESIGN 1276 women with PCOS according to the Rotterdam criteria were included, in whom serum hormonal levels were determined. RESULTS In PCOS women as a whole, as well as in patients presenting clinical and/or biochemical hyperandrogenemia (phenotypes I and II), Δ4A levels >3.8 ng/ml were positively related to LH, LH/FSH ratio, T, DHEAS, 17 OH progesterone and FAI and negatively related to T/Δ4A ratio. In the milder phenotype III, a positive correlation between Δ4A levels >3.8 ng/ml and T, DHEAS, 17 OH progesterone and FAI and a negative one between increased Δ4A and T/Δ4A ratio were reported. In the whole PCOS group with androstenedione >3.8 ng/ml, an increased ovarian volume was observed, while a greater mean follicular number was found only in phenotypes I and II. CONCLUSIONS Increased serum Δ4A levels, which are associated with more severe PCOS phenotypes, possibly contribute to the worsening of PCOS features and therefore could be a valuable marker of biochemical hyperandrogenemia.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology; University of Patras Medical School; Patras (N.A.G., A.K.A., N.D.R); Greece
| | - Efstathios Papadakis
- Division of Endocrinology and Human Reproduction, 2nd Department of Obstetrics and Gynecology; Aristotle University of Thessaloniki; Thessaloniki (E.P., I.K., D.P.); Greece
| | - Anastasia K Armeni
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology; University of Patras Medical School; Patras (N.A.G., A.K.A., N.D.R); Greece
| | - Ilias Katsikis
- Division of Endocrinology and Human Reproduction, 2nd Department of Obstetrics and Gynecology; Aristotle University of Thessaloniki; Thessaloniki (E.P., I.K., D.P.); Greece
| | - Nikolaos D Roupas
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology; University of Patras Medical School; Patras (N.A.G., A.K.A., N.D.R); Greece
| | - Dimitrios Panidis
- Division of Endocrinology and Human Reproduction, 2nd Department of Obstetrics and Gynecology; Aristotle University of Thessaloniki; Thessaloniki (E.P., I.K., D.P.); Greece
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Clark NM, Podolski AJ, Brooks ED, Chizen DR, Pierson RA, Lehotay DC, Lujan ME. Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology: An Assessment of Over 100 Consecutive Women Self-reporting Features of Polycystic Ovary Syndrome. Reprod Sci 2014; 21:1034-1043. [PMID: 24520081 DOI: 10.1177/1933719114522525] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The prevalence of polycystic ovary syndrome (PCOS) and its distinct clinical phenotypes were assessed using 3 sets of international diagnostic criteria in women self-reporting concerns over outward features of PCOS. Revised ultrasonographic criteria for polycystic ovaries (PCO) based on modern ultrasound technology were used. Of the participants, 53%, 62%, and 70% were diagnosed with PCOS using National Institutes of Health, Androgen Excess and PCOS Society, and Rotterdam criteria, respectively. Prevalence of Frank, Ovulatory, Normoandrogenic, and Non-PCO PCOS were 66%, 13%, 11%, and 9%, respectively. Frank PCOS was associated with the severest metabolic disturbances whereas metabolic profiles in Normoandrogenic PCOS did not differ from controls, supporting reduced health risks in women without androgen excess. Metabolic disturbances and hyperandrogenism were linked to excess adiposity across all the groups. Using updated criteria for PCO, the prevalence of Non-PCO PCOS and PCO alone in healthy women recruited from the general population was reduced compared to the previous reports.
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Affiliation(s)
- Nina M Clark
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Amanda J Podolski
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Eric D Brooks
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Donna R Chizen
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Roger A Pierson
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Denis C Lehotay
- Department of Pathology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marla E Lujan
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
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Kar S. Anthropometric, clinical, and metabolic comparisons of the four Rotterdam PCOS phenotypes: A prospective study of PCOS women. J Hum Reprod Sci 2013; 6:194-200. [PMID: 24347934 PMCID: PMC3853876 DOI: 10.4103/0974-1208.121422] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/10/2013] [Accepted: 09/14/2013] [Indexed: 11/05/2022] Open
Abstract
AIMS: 1. To study the distribution of various Rotterdam classified phenotypes of polycystic ovarian syndrome (PCOS) women, in our population. 2. To compare the four phenotypes with respect to anthropometric, clinical, and metabolic parameters. 3. To report the prevalence of insulin resistance (IR) and metabolic syndrome in these women. SETTINGS AND DESIGN: Private practice, Prospective cross-sectional comparative study. MATERIALS AND METHODS: Women attending gynecology outpatient with the primary complains of irregular menses and/or infertility were evaluated. Each of them underwent detailed clinical examination, transvaginal sonography, and biochemical and hormonal assays. Four hundred and ten women with a clinical diagnosis of PCOS based on Rotterdam criteria were included in the study. The four phenotypes were 1) PCO complete, that is oligo/anovulation (O) + polycystic ovaries (P) + hyperandrogenism (H) 2) P + O, 3) P + H, and 4) O + H. All women were also evaluated for metabolic syndrome (American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), modified Adult Treatment Panel (ATP) III 2005 guidelines) and IR (homeostatic model assessment-IR (HOMA-IR)). STATISTICAL ANALYSIS: Statistical Package for Social Sciences (SPSS) version 18. RESULTS: Largest group was PCOS complete (65.6%) followed by P + O (22.2%); H + O (11.2%); and P + H (0.9%). Overall prevalence of metabolic syndrome was 35.07%. Hyperandrogenic phenotyptes; H + O (50%) and P + H + O (37.04%), had significantly higher prevalence of metabolic syndrome than normoandrogenic P + O phenotype (10%) (P ≤ 0.001). Body mass index (BMI) ≥ 25 (P = 0.0004; odds ratio (OR) = 3.07 (1.6574–5.7108, 95% CI)), waist circumference (WC) ≥ 80 cm (P = 0.001; OR = 3.68 (1.6807–8.0737, 95% CI)) and family history of diabetes (P = 0.019; OR 1.82 (1.1008–3.0194, 95% CI)), were strongly associated with the presence of metabolic syndrome. The overall prevalence of IR in PCOS women was 30.44% (HOMA-IR cutoff ≥ 3.8) and 34.94% (HOMA-IR cutoff ≥ 3.5). CONCLUSIONS: The prevalence of metabolic syndrome and IR was 35.07 and 30.44%, respectively. The hyperandrogenic phenotypes have significantly higher metabolic morbidity compared to normoandrgenic phenotype. BMI > 25, WC ≥ 80 cm, and family history of diabetes carry the highest risk for developing metabolic syndrome.
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Affiliation(s)
- Sujata Kar
- Department of Obstetrics and Gynaecology, Kar Clinic and Hospital Pvt. Ltd, Bhubaneswar, Orissa, India
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Ezeh U, Yildiz BO, Azziz R. Referral bias in defining the phenotype and prevalence of obesity in polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:E1088-96. [PMID: 23539721 PMCID: PMC3667270 DOI: 10.1210/jc.2013-1295] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The described phenotype of the polycystic ovary syndrome (PCOS) has been primarily based on findings in a referred (self or otherwise) population. It is possible that the phenotype of PCOS would be different if the disorder were to be detected and studied in its natural (unbiased) state. OBJECTIVE Our objective was to compare the phenotype of PCOS detected in an unselected population with that identified in a referral population. PARTICIPANTS Participants included 292 PCOS patients identified at a tertiary care outpatient facility (referral PCOS) and 64 PCOS women (unselected PCOS) identified through the screening of a population of 668 seeking a pre-employment physical. Among the women undergoing a pre-employment physical, 563 did not demonstrate features of the disorder (unselected controls). All PCOS subjects met the National Institutes of Health 1990 criteria for the disorder. MAIN OUTCOME MEASURES We estimated prevalence of obesity and severity of disease burden. RESULTS Referral PCOS subjects had greater mean body mass index and hirsutism score and higher degrees of hyperandrogenemia, were more likely to be non-Hispanic White (83.90%), and demonstrated a more severe PCOS subphenotype than unselected PCOS or unselected controls. The prevalence of obesity and severe obesity in referral PCOS was 2.3 and 2.5 times greater than estimates of the same in unselected PCOS and 2.2 and 3.8 times greater than estimates in unselected controls, respectively. Alternatively, unselected PCOS subjects had a prevalence of obesity and severe obesity and a mean body mass index similar to those of the general population from which they were derived. CONCLUSION The phenotype of PCOS, including the racial/ethnic mix, severity of presentation, and rate of obesity, is affected significantly by whether the PCOS subject arises from a referral population or through unselected screening, likely reflecting the degree of patient concern and awareness and access to healthcare.
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Affiliation(s)
- Uche Ezeh
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Moghetti P, Tosi F, Bonin C, Di Sarra D, Fiers T, Kaufman JM, Giagulli VA, Signori C, Zambotti F, Dall'Alda M, Spiazzi G, Zanolin ME, Bonora E. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:E628-37. [PMID: 23476073 DOI: 10.1210/jc.2012-3908] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT/OBJECTIVE Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women. PATIENTS/DESIGN A total of 137 consecutive Caucasian women with PCOS, diagnosed by the Rotterdam criteria, underwent accurate assessment of diagnostic and metabolic features. Insulin sensitivity was measured by the glucose clamp technique. RESULTS Among women with PCOS, 84.7% had hyperandrogenism, 84.7% had chronic oligoanovulation, and 89% had polycystic ovaries. According to the individual combinations of these features, 69.4% of women had the classic phenotype, 15.3% had the ovulatory phenotype, and 15.3% had the normoandrogenic phenotype. Most subjects (71.4%) were insulin resistant. However, insulin resistance frequency differed among phenotypes, being 80.4%, 65.0%, and 38.1%, respectively, in the 3 subgroups (P < .001). Although none of the PCOS diagnostic features per se was associated with the impairment in insulin action, after adjustment for covariates, the classic phenotype and, to a lesser extent, the ovulatory phenotype were independently associated with insulin resistance, whereas the normoandrogenic phenotype was not. Metabolic syndrome frequency was also different among phenotypes (P = .030). CONCLUSIONS There is a scale of metabolic risk among women with PCOS. Although no single diagnostic features of PCOS are independently associated with insulin resistance, their combinations, which define PCOS phenotypes, may allow physicians to establish which women should undergo metabolic screening. In metabolic terms, women belonging to the normoandrogenic phenotype behave as a separate group.
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Affiliation(s)
- Paolo Moghetti
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Piazzale Stefani, Verona, Italy.
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Zhu JP, Teng YC, Zhou J, Lu W, Tao MF, Jia WP. Increased mean glucose levels in patients with polycystic ovary syndrome and hyperandrogenemia as determined by continuous glucose monitoring. Acta Obstet Gynecol Scand 2012; 92:165-71. [PMID: 23072215 DOI: 10.1111/aogs.12031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Women with polycystic ovary syndrome are at risk of developing type 2 diabetes mellitus. This study aimed to evaluate the influence of hyperandrogenemia on glucose metabolism in polycystic ovarian syndrome patients. DESIGN Cohort study. SETTING Reproductive Endocrinology Clinic of the Shanghai Sixth People's Hospital. SAMPLE Fifty-three patients were recruited from June 2008 to December 2009, including 28 women with hyperandrogenism and 25 without hyperandrogenemia. METHODS Anthropometric parameters, including weight, height, body mass index and waist-to-hip ratio, as well as sex hormones, were measured. An oral glucose tolerance test, including fasting and two hour glucose and insulin levels, was recorded. Insulin resistance was evaluated by homeostatic model assessment of insulin resistance, and patients underwent continuous glucose monitoring. MAIN OUTCOME MEASURES Mean blood glucose level, mean amplitude of glycemic excursion, frequency of glycemic excursion and the percentage of time of hypoglycemia and hyperglycemia during a 48 h period. RESULTS No differences in age, body mass index, waist-to-hip ratio, fasting and two hour glucose and insulin concentrations were observed between the groups. The hyperandrogenism group had higher levels of luteinizing hormone and dehydroepiandrosterone sulfate (p < 0.05). However, continuous glucose monitoring showed that the minimal blood glucose and mean blood glucose were significantly higher in hyperandrogenemia group (p = 0.004). The percentage of time for hypoglycemia (≤70 mg/dL) was higher in the hyperandrogenemia group (p = 0.002). CONCLUSIONS Polycystic ovarian syndrome patients with hyperandrogenemia had an increased mean glucose value, which may place them at increased risk for developing type 2 diabetes.
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Affiliation(s)
- Jie-Ping Zhu
- Department of Obstetrics and Gynecology, the Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Cui L, Zhao H, Zhang B, Qu Z, Liu J, Liang X, Zhao X, Zhao J, Sun Y, Wang P, Li T, Shi Y, Chen ZJ. Genotype–phenotype correlations of PCOS susceptibility SNPs identified by GWAS in a large cohort of Han Chinese women. Hum Reprod 2012. [DOI: 10.1093/humrep/des424] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Moro F, Morciano A, Tropea A, Sagnella F, Palla C, Scarinci E, Cosentino N, Niccoli G, Liuzzo G, Crea F, Lanzone A, Apa R. CD4(+)CD28(null) T lymphocyte frequency, a new marker of cardiovascular risk: relationship with polycystic ovary syndrome phenotypes. Fertil Steril 2012; 98:1609-15. [PMID: 22963806 DOI: 10.1016/j.fertnstert.2012.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 08/10/2012] [Accepted: 08/10/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the frequency of CD4(+)CD28(null) T cells, which are aggressive T lymphocytes associated with recurrent coronary instability and type 2 diabetes mellitus, in different polycystic ovary syndrome (PCOS) phenotypes and in age- and body mass index-matched healthy women. DESIGN Retrospective cohort observational study. SETTING Unit of human reproductive pathophysiology, university hospital. PATIENT(S) A total of 167 PCOS patients and 102 control subjects. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) CD4(+)CD28(null) T cell frequency, high-sensitive C-reactive protein levels, and other glucose-metabolic parameters. RESULT(S) CD4(+)CD28(null) frequency was significantly higher in all PCOS groups than in control subjects. CD4(+)CD28(null) frequency was significantly higher in nonhyperandrogenic phenotype (5.7%, range 3.2-7.1) than in phenotypes with hyperandrogenism (H) + oligoamenorrhea (O) + polycystic ovary (PCO) (3.5%, range 1-5.8), H + O (3%, range 1.8-4.7), and H + PCO (2.63%, range 1.2-4.1). The relative risk of non-H phenotype for PCOS women in the highest quartile for CD4(+)CD28(null) frequency compared with PCOS women with the lowest quartile was 3.2 (95% confidence interval 1.9-5.8). CONCLUSION(S) Cardiovascular risk evaluation should be performed in all PCOS phenotypes. In particular, we demonstrated that the non-H phenotype has potentially increased cardiovascular risk in terms of CD4(+)CD28(null) frequency.
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Affiliation(s)
- Francesca Moro
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Maier PS, Spritzer PM. Aromatase gene polymorphism does not influence clinical phenotype and response to oral contraceptive pills in polycystic ovary syndrome women. Gynecol Obstet Invest 2012; 74:136-42. [PMID: 22889864 DOI: 10.1159/000339317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/03/2012] [Indexed: 11/19/2022]
Abstract
AIMS To assess whether a single nucleotide polymorphism (SNP50) of the aromatase gene (CYP19) is associated with polycystic ovary syndrome (PCOS) phenotypes and to investigate the influence of this polymorphism on the response of PCOS to treatment with oral contraceptive pills (OCP). METHODS 162 hirsute women were stratified into a classic PCOS group (hyperandrogenism, ovulatory dysfunction, c-PCOS) and an ovulatory PCOS group (hyperandrogenism, ovulatory cycles, polycystic ovaries, ov-PCOS). 51 women completed a 6-month OCP trial (20 µg ethinyl estradiol + 75 µg gestodene, 21/28 days per cycle, plus 100 mg spironolactone in 32 women with moderate to severe hirsutism). We considered the presence of the polymorphic allele A (AG+AA) in comparison to the absence of the polymorphism (GG) to express results and to perform the comparisons regarding clinical variables. RESULTS Mean age was 23.3 ± 6.9 years. Hirsutism score was similar in c-PCOS and ov-PCOS (15 (11-20) vs. 13 (11-20)). The differences in hormone and metabolic variables between phenotypes were independent of the presence of allele A. In the OCP trial subsample, no differences were observed between genotypes after 6 months' treatment. CONCLUSION The differences between c-PCOS and ov-PCOS cannot be explained by the genetic variation at SNP50 in the CYP19 gene.
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Affiliation(s)
- Polyana S Maier
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Capalbo A, Sagnella F, Apa R, Fulghesu AM, Lanzone A, Morciano A, Farcomeni A, Gangale MF, Moro F, Martinez D, Ciardulli A, Palla C, Uras ML, Spettu F, Cappai A, Carcassi C, Neri G, Tiziano FD. The 312N variant of the luteinizing hormone/choriogonadotropin receptor gene (LHCGR) confers up to 2·7-fold increased risk of polycystic ovary syndrome in a Sardinian population. Clin Endocrinol (Oxf) 2012; 77:113-9. [PMID: 22356187 DOI: 10.1111/j.1365-2265.2012.04372.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a frequent condition, affecting about 15% of women of reproductive age. Because of its familial occurrence, a multifactorial model of susceptibility, including both genetic and environmental factors, has been proposed. However, the identification of genetic factors has been elusive. DESIGN Case-control study aimed at evaluating possible associations between functionally relevant variants of the luteinizing hormone/choriogonadotrophin receptor gene (LHCGR) and PCOS phenotype. PATIENTS A total of 198 PCOS and 187 non-PCOS women, aged 14-35 years, of Sardinian origin, were referred to the outpatient clinic of the Department of Obstetrics and Gynaecology of the University of Cagliari (Sardinia). PCOS diagnosis was based on the Rotterdam criteria. MEASUREMENTS We determined the genotype of ins18LQ, S291N and S312N variants at the LHCGR locus. Genotype was related to the presence or absence of PCOS and to several clinical and biochemical characteristics. RESULTS The presence of at least one 312N allele was strongly associated with PCOS risk (OR, 2·04; 95% CI, 1·32-3·14; χ(2) , 10·47; P = 0·001). 312N homozygosity was associated with a further risk increase (OR, 2·73; 95% CI, 1·25-5·95; χ(2) , 6·65; P = 0·01). The number of ins18LQ alleles was associated with LH serum levels in controls (χ(2) , 8·04, P = 0·017). CONCLUSIONS For the first time, we have identified a genetic variant that is strongly associated with PCOS in an isolated population. These results, if confirmed in other cohorts, may provide the opportunity to test the S312N genotype at the LHCGR locus in fertile women to assess the risk of PCOS. The avoidance of triggering factors like weight increase may improve the reproductive outcome of potentially at-risk subjects.
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Affiliation(s)
- A Capalbo
- Istituto di Genetica Medica, Università Cattolica del Sacro Cuore, Roma, Italy
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Moran C, Arriaga M, Rodriguez G, Moran S. Obesity differentially affects phenotypes of polycystic ovary syndrome. Int J Endocrinol 2012; 2012:317241. [PMID: 22829818 PMCID: PMC3399368 DOI: 10.1155/2012/317241] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/13/2012] [Accepted: 04/17/2012] [Indexed: 11/17/2022] Open
Abstract
Obesity or overweight affect most of patients with polycystic ovary syndrome (PCOS). Phenotypes are the clinical characteristics produced by the interaction of heredity and environment in a disease or syndrome. Phenotypes of PCOS have been described on the presence of clinical hyperandrogenism, oligoovulation and polycystic ovaries. The insulin resistance is present in the majority of patients with obesity and/or PCOS and it is more frequent and of greater magnitude in obese than in non obese PCOS patients. Levels of sexual hormone binding globulin are decreased, and levels of free androgens are increased in obese PCOS patients. Weight loss treatment is important for overweight or obese PCOS patients, but not necessary for normal weight PCOS patients, who only need to avoid increasing their body weight. Obesity decreases or delays several infertility treatments. The differences in the hormonal and metabolic profile, as well as the different focus and response to treatment between obese and non obese PCOS patients suggest that obesity has to be considered as a characteristic for classification of PCOS phenotypes.
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Affiliation(s)
- Carlos Moran
- Direction of Health Research and Training, Medical Unit of High Specialty, Gynecology and Obstetrics Hospital No. 4 Luis Castelazo Ayala, Mexican Institute of Social Security, Mexico City, DF 01090, Mexico
- Health Research Council, Mexican Institute of Social Security, Mexico City, DF 06725, Mexico
- *Carlos Moran:
| | - Monica Arriaga
- Direction of Health Research and Training, Medical Unit of High Specialty, Gynecology and Obstetrics Hospital No. 4 Luis Castelazo Ayala, Mexican Institute of Social Security, Mexico City, DF 01090, Mexico
| | - Gustavo Rodriguez
- General Hospital of Zone No. 8, Mexican Institute of Social Security, Mexico City, DF 01090, Mexico
| | - Segundo Moran
- Health Research Council, Mexican Institute of Social Security, Mexico City, DF 06725, Mexico
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