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Garcia-Beltran C, Malpique R, Andersen MS, Bas F, Bassols J, Darendeliler F, Díaz M, Dieris B, Fanelli F, Fröhlich-Reiterer E, Gambineri A, Glintborg D, López-Bermejo A, Mann C, Marin S, Obermayer-Pietsch B, Ødegård R, Ravn P, Reinehr T, Renzulli M, Salvador C, Singer V, Vanky E, Torres JV, Yildiz M, de Zegher F, Ibáñez L. SPIOMET4HEALTH-efficacy, tolerability and safety of lifestyle intervention plus a fixed dose combination of spironolactone, pioglitazone and metformin (SPIOMET) for adolescent girls and young women with polycystic ovary syndrome: study protocol for a multicentre, randomised, double-blind, placebo-controlled, four-arm, parallel-group, phase II clinical trial. Trials 2023; 24:589. [PMID: 37715279 PMCID: PMC10503102 DOI: 10.1186/s13063-023-07593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most prevalent, chronic endocrine-metabolic disorder of adolescents and young women (AYAs), affecting 5-10% of AYAs worldwide. There is no approved pharmacological therapy for PCOS. Standard off-label treatment with oral contraceptives (OCs) reverts neither the underlying pathophysiology nor the associated co-morbidities. Pilot studies have generated new insights into the pathogenesis of PCOS, leading to the development of a new treatment consisting of a fixed, low-dose combination of two so-called insulin sensitisers [pioglitazone (PIO), metformin (MET)] and one mixed anti-androgen and anti-mineralocorticoid also acting as an activator of brown adipose tissue [spironolactone (SPI)], within a single tablet (SPIOMET). The present trial will evaluate the efficacy, tolerability and safety of SPIOMET, on top of lifestyle measures, for the treatment of PCOS in AYAs. METHODS In this multicentre, randomised, double-blind, placebo-controlled, four-arm, parallel-group, phase II clinical trial, AYAs with PCOS will be recruited from 7 clinical centres across Europe. Intention is to randomise a total of 364 eligible patients into four arms (1:1:1:1): Placebo, PIO, SPI + PIO (SPIO) and SPI + PIO + MET (SPIOMET). Active treatment over 12 months will consist of lifestyle guidance plus the ingestion of one tablet daily (at dinner time); post-treatment follow-up will span 6 months. Primary endpoint is on- and post-treatment ovulation rate. Secondary endpoints are clinical features (hirsutism, menstrual regularity); endocrine-metabolic variables (androgens, lipids, insulin, inflammatory markers); epigenetic markers; imaging data (carotid intima-media thickness, body composition, abdominal fat partitioning, hepatic fat); safety profile; adherence, tolerability and acceptability of the medication; and quality of life in the study participants. Superiority (in this order) of SPIOMET, SPIO and PIO will be tested over placebo, and if present, subsequently the superiority of SPIOMET versus PIO, and if still present, finally versus SPIO. DISCUSSION The present study will be the first to evaluate-in a randomised, double-blind, placebo-controlled way-the efficacy, tolerability and safety of SPIOMET treatment for early PCOS, on top of a lifestyle intervention. TRIAL REGISTRATION EudraCT 2021-003177-58. Registered on 22 December 2021. https://www.clinicaltrialsregister.eu/ctr-search/search?query=%092021-003177-58 .
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Affiliation(s)
- Cristina Garcia-Beltran
- Paediatric Endocrinology, Paediatric Research Institute Sant Joan de Déu, University of Barcelona, 08950, Esplugues, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, 28029, Spain
| | - Rita Malpique
- Paediatric Endocrinology, Paediatric Research Institute Sant Joan de Déu, University of Barcelona, 08950, Esplugues, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, 28029, Spain
| | - Marianne S Andersen
- Department of Gynaecology and Obstetrics and Department of Endocrinology, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Firdevs Bas
- Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Institute for Biomedical Research (IDIBGI), Girona, Spain
| | | | - Marta Díaz
- Paediatric Endocrinology, Paediatric Research Institute Sant Joan de Déu, University of Barcelona, 08950, Esplugues, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, 28029, Spain
| | - Barbara Dieris
- Department of Paediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten-Herdecke, Datteln, Germany
| | - Flaminia Fanelli
- Department of Medical and Surgical Science-DIMEC, Division of Endocrinology and Diabetes Prevention and Care, University of Bologna - S. Orsola-Hospital, Bologna, Italy
| | - Elke Fröhlich-Reiterer
- Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Alessandra Gambineri
- Department of Medical and Surgical Science-DIMEC, Division of Endocrinology and Diabetes Prevention and Care, University of Bologna - S. Orsola-Hospital, Bologna, Italy
| | - Dorte Glintborg
- Department of Gynaecology and Obstetrics and Department of Endocrinology, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Abel López-Bermejo
- Paediatric Endocrinology Research Group, Girona Institute for Biomedical Research (IDIBGI), Paediatrics, Dr. Josep Trueta Hospital, Department of Medical Sciences, University of Girona, Girona, Spain
| | | | - Silvia Marin
- Paediatric Endocrinology, Paediatric Research Institute Sant Joan de Déu, University of Barcelona, 08950, Esplugues, Barcelona, Spain
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Rønnaug Ødegård
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Centre for Obesity Research, St. Olavs Hospital, Trondheim University Hospital, Torgarden, Trondheim, Norway
| | - Pernille Ravn
- Department of Gynaecology and Obstetrics and Department of Endocrinology, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Thomas Reinehr
- Department of Paediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten-Herdecke, Datteln, Germany
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Cristina Salvador
- Paediatric Endocrinology, Paediatric Research Institute Sant Joan de Déu, University of Barcelona, 08950, Esplugues, Barcelona, Spain
| | - Viola Singer
- Department of Paediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten-Herdecke, Datteln, Germany
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway
| | | | - Melek Yildiz
- Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Francis de Zegher
- Leuven Research & Development, University of Leuven, 3000, Louvain, Belgium
| | - Lourdes Ibáñez
- Paediatric Endocrinology, Paediatric Research Institute Sant Joan de Déu, University of Barcelona, 08950, Esplugues, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, 28029, Spain.
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Saei Ghare Naz M, Ramezani Tehrani F, Ahmadi F, Alavi Majd H, Ozgoli G. Threats to Feminine Identity as the Main Concern of Iranian Adolescents with Polycystic Ovary Syndrome: A Qualitative Study. J Pediatr Nurs 2019; 49:e42-e47. [PMID: 31645273 DOI: 10.1016/j.pedn.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder in adolescents; this study seeks to elaborate the main concerns of adolescents with PCOS. DESIGN AND METHODS This qualitative content analysis was conducted on 15 adolescents with PCOS using purposive sampling in 2018. Semi-structured in-depth interviews were held for data collection, and data saturation occurred when no new data were being obtained. Data were analyzed concurrently with data collection. RESULTS Fifteen adolescents with PCOS aged 13-19 years were enrolled into the study. Thirteen were single and two were married. The data analysis led to the extraction of "threats to feminine identity" as the main theme of this research, which was then divided into two categories: 1) concerns about attractiveness, with subcategories including fashion-related stress and the loss of physical beauty 2) concerns about femininity, with subcategories including the underlying issues of worrying about future marriage prospects, anxiety about infertility in the future and stress about menstrual abnormalities. CONCLUSION According to the results of this study, attractiveness and threat to femininity is the main concern of adolescents with PCOS that should be further considered in the management of their treatment. IMPLICATIONS FOR PRACTICE Understanding the main concerns of adolescents with PCOS can help healthcare professionals better manage this disease in this population subgroup.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giti Ozgoli
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
PURPOSE OF REVIEW Polycystic ovarian syndrome (PCOS) is a common endocrinopathy which can be difficult to treat in adolescents. Fortunately, early identification and treatment can help mitigate some of the metabolic complications. In this review, we reflect on recent literature regarding PCOS diagnosis, associated complications, and treatment options. RECENT FINDINGS Although there are three well known criteria to diagnose PCOS, they can be difficult to translate to adolescence. Newer diagnostic tools under study include anti-Mullerian hormone and revised ultrasound criteria. More is known about the many complications associated with PCOS, and new treatment options are on the horizon. SUMMARY PCOS frequently will present during adolescence. These young women may already have symptoms of metabolic comorbidities. Providers caring for these patients must be aware of the many related complications and common treatment options. Newer diagnostic techniques and treatment options are under active study in adults, and may soon be translated to adolescence. A comprehensive approach allows treatment of patients' concerns, and also prevention of metabolic complications.
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Lundgren JA, Kim SH, Burt Solorzano CM, McCartney CR, Marshall JC. Progesterone Suppression of Luteinizing Hormone Pulse Frequency in Adolescent Girls With Hyperandrogenism: Effects of Metformin. J Clin Endocrinol Metab 2018; 103:263-270. [PMID: 29095983 PMCID: PMC5761484 DOI: 10.1210/jc.2017-02068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/23/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) and adolescent hyperandrogenism (HA) are characterized by rapid luteinizing hormone (LH) pulse frequency. This partly reflects impaired gonadotropin-releasing hormone pulse generator (hypothalamic) sensitivity to progesterone (P4) negative feedback. We assessed whether metformin may improve P4 sensitivity in adolescent HA, for which it is prescribed widely. OBJECTIVE To test the hypothesis that metformin improves hypothalamic P4 sensitivity in adolescent HA. DESIGN Nonrandomized, interventional trial. SETTING Academic clinical research unit. PARTICIPANTS Ten adolescent girls with HA. INTERVENTION The girls underwent LH sampling every 10 minutes for 11 hours, at study baseline and after 7 days of oral P4 and estradiol (E2). Participants then took metformin (1 g twice daily) for 9.4 to 13.7 weeks, after which participants again underwent frequent LH sampling before and after 7 days of oral P4 and E2 (while continuing metformin). Total and free testosterone (T) and fasting insulin were assessed at each admission. At admissions 1 and 3, 2-hour oral glucose tolerance tests were performed. MAIN OUTCOME MEASURE Metformin-related change in hypothalamic P4 sensitivity index [percent change in LH pulse frequency (before vs after P4 and E2) divided by day 7 P4 level]. RESULTS Free T levels decreased by 29% with metformin (P = 0.0137). Measures of hyperinsulinemia and P4 sensitivity index did not significantly change with metformin use. CONCLUSION Short-term metformin use improved biochemical hyperandrogenemia, but did not improve hypothalamic sensitivity to P4 suppression, in adolescent girls.
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Affiliation(s)
- Jessica A. Lundgren
- The Center for Research in Reproduction, University of Virginia Health System, Charlottesville, Virginia 22908
- Division of Endocrinology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908
| | - Su Hee Kim
- The Center for Research in Reproduction, University of Virginia Health System, Charlottesville, Virginia 22908
- Division of Endocrinology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908
| | - Christine M. Burt Solorzano
- The Center for Research in Reproduction, University of Virginia Health System, Charlottesville, Virginia 22908
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia 22908
| | - Christopher R. McCartney
- The Center for Research in Reproduction, University of Virginia Health System, Charlottesville, Virginia 22908
- Division of Endocrinology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908
| | - John C. Marshall
- The Center for Research in Reproduction, University of Virginia Health System, Charlottesville, Virginia 22908
- Division of Endocrinology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908
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Ibáñez L, Del Río L, Díaz M, Sebastiani G, Pozo ÓJ, López-Bermejo A, de Zegher F. Normalizing Ovulation Rate by Preferential Reduction of Hepato-Visceral Fat in Adolescent Girls With Polycystic Ovary Syndrome. J Adolesc Health 2017; 61:446-453. [PMID: 28712591 DOI: 10.1016/j.jadohealth.2017.04.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is an increasingly prevalent disorder in adolescent girls, commonly presenting with hirsutism/oligomenorrhea, commonly treated with an oral contraceptive (OC), and commonly followed by oligoanovulatory subfertility. We tested whether an intervention targeting the reduction of hepato-visceral adiposity is followed by a higher ovulation rate than OC treatment. METHODS This randomized, open-label, single-center, pilot proof-of-concept study (12 months on treatment, then 12 months off) was performed in adolescent girls with hirsutism and oligomenorrhea (PCOS by National Institutes of Health; no sexual activity; N = 36; mean age 16 years, body mass index 23.5 kg/m2; 94% study completion). Compared treatments were OC (ethinylestradiol-levonorgestrel) versus low-dose combination of spironolactone 50 mg/d, pioglitazone 7.5 mg/d, and metformin 850 mg/d (SPIOMET). Primary outcome was post-treatment ovulation rate inferred from menstrual diaries and salivary progesterone (12 + 12 weeks). Secondary outcomes included body composition (dual X-ray absorptiometry), abdominal fat (magnetic resonance imaging), insulinemia (oral glucose tolerance test), and androgenemia (liquid chromatography - tandem mass spectrometry). RESULTS SPIOMET was followed by a 2.5-fold higher ovulation rate than OC (p ≤ .001) and by a 6-fold higher normovulatory fraction (71% vs. 12%; p ≤ .001); oligoanovulation risk after SPIOMET was 65% lower (95% confidence interval, 40%-89%) than after OC. Higher post-treatment ovulation rates related to more on-treatment loss of hepatic fat (r2 = .27; p < .005). Visceral fat and insulinemia normalized only with SPIOMET; androgenemia normalized faster with OC but rebounded more thereafter. Body weight, lean mass, and abdominal subcutaneous fat mass remained stable in both groups. CONCLUSIONS Early SPIOMET treatment for PCOS normalized post-treatment ovulation rates more than OC. Focusing PCOS treatment on early reduction of hepato-visceral fat may prevent part of later oligoanovulatory subfertility.
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Affiliation(s)
- Lourdes Ibáñez
- Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain.
| | | | - Marta Díaz
- Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - Giorgia Sebastiani
- Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - Óscar J Pozo
- Bioanalysis Research Group, IMIM, Hospital del Mar, Barcelona, Spain
| | - Abel López-Bermejo
- Department of Pediatrics, Dr. Josep Trueta Hospital, Girona Institute for Biomedical Research, Girona, Spain
| | - Francis de Zegher
- Pediatric & Adolescent Endocrinology, Department of Development & Regeneration, University Hospital Gasthuisberg-University of Leuven, Leuven, Belgium
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Kim JY, Tfayli H, Michaliszyn SF, Lee S, Nasr A, Arslanian S. Anti-Müllerian Hormone in Obese Adolescent Girls With Polycystic Ovary Syndrome. J Adolesc Health 2017; 60:333-339. [PMID: 27998701 PMCID: PMC5326592 DOI: 10.1016/j.jadohealth.2016.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/10/2016] [Accepted: 10/21/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Anti-Müllerian hormone (AMH) is proposed as a biomarker of polycystic ovary syndrome (PCOS). This study investigated: (1) AMH concentrations in obese adolescents with PCOS versus without PCOS; (2) the relationship of AMH to sex steroid hormones, adiposity, and insulin resistance; and (3) the optimal AMH value and the multivariable prediction model to determine PCOS in obese adolescents. METHODS AMH levels were measured in 46 obese PCOS girls and 43 obese non-PCOS girls. Sex steroid hormones, clamp-measured insulin sensitivity and secretion, body composition, and abdominal adiposity were evaluated. Logistic regression and receiver-operating characteristic curve analyses were used, and multivariate prediction models were developed to test the utility of AMH for the diagnosis of PCOS. RESULTS AMH levels were higher in obese PCOS versus non-PCOS girls (8.3 ± .6 vs. 4.3 ± .4 ng/mL, p < .0001), of comparable age and puberty. AMH concentrations correlated positively with age in both groups, total and free testosterone in PCOS girls only, abdominal adipose tissue in non-PCOS girls, with no correlation to in vivo insulin sensitivity and secretion in either groups. A multivariate model including AMH (cutoff 6.26 ng/mL, area under the curve .788) together with sex hormone-binding globulin and total testosterone exhibited 93.4% predictive power for diagnosing PCOS. CONCLUSIONS AMH may be a useful biomarker for the diagnosis of PCOS in obese adolescent girls.
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Affiliation(s)
- Joon Young Kim
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara F Michaliszyn
- Human Performance and Exercise Science, Youngstown State University, Youngstown, Ohio
| | - SoJung Lee
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alexis Nasr
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Silva Arslanian
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges. Nutr Res Rev 2017; 30:97-105. [PMID: 28222828 DOI: 10.1017/s0954422416000287] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) have a considerable risk of metabolic dysfunction. This review aims to present contemporary knowledge on obesity, insulin resistance and PCOS with emphasis on the diagnostic and methodological challenges encountered in research and clinical practice. Variable diagnostic criteria for PCOS and associated phenotypes are frequently published. Targeted searches were conducted to identify all available data concerning the association of obesity and insulin resistance with PCOS up to September 2016. Articles were considered if they were peer reviewed, in English and included women with PCOS. Obesity is more prevalent in women with PCOS, but studies rarely reported accurate assessments of adiposity, nor split the study population by PCOS phenotypes. Many women with PCOS have insulin resistance, though there is considerable variation reported in part due to not distinguishing subgroups known to have an impact on insulin resistance as well as limited methodology to measure insulin resistance. Inflammatory markers are positively correlated with androgen levels, but detailed interactions need to be identified. Weight management is the primary therapy; specific advice to reduce the glycaemic load of the diet and reduce the intake of pro-inflammatory SFA and advanced glycation endproducts have provided promising results. It is important that women with PCOS are educated about their increased risk of metabolic complications in order to make timely and appropriate lifestyle modifications. Furthermore, well-designed robust studies are needed to evaluate the mechanisms behind the improvements observed with dietary interventions.
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Chakraborty TR, Donthireddy L, Adhikary D, Chakraborty S. Long-Term High Fat Diet Has a Profound Effect on Body Weight, Hormone Levels, and Estrous Cycle in Mice. Med Sci Monit 2016; 22:1601-8. [PMID: 27171231 PMCID: PMC4917314 DOI: 10.12659/msm.897628] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Obesity causes several health complications along with disruption of the reproductive system. The aim of the current study was to determine how long-term intake of very high fat diet (VHFD) changes the hormonal milieu, affecting the cellular morphology and reproductive cycle in female mice. Material/Methods Mice were fed on normal diet (ND) and VHFD for 2 weeks, 12 weeks, and 25–27 weeks. We assessed changes in body weight, food consumption, energy intake, cellular and tissue morphology, hormonal levels (leptin, insulin, and estradiol), and vaginal smears were performed at various time points to determine the length and cellularity at each stage of the estrous cycle. Results Mice fed on VHFD showed a significant increase in weight gain, reduction in food intake, and increase in energy intake compared to animals fed on ND, indicating that the caloric density of the diet is responsible for the differences in weight gain. Hormonal analysis showed hyperleptinemia, hyperinsulinemia, and increases in estrogen levels, along with increases in size of the islet of Langerhans and adipocytes. After 25–27 weeks, all animals fed on VHFD showed complete acyclicity; elongation of phases (e.g., diestrous), skipping of phases (e.g., metestrous), or a combination of both, indicating disruption in the reproductive cycle. Quantitative analysis showed that in the diestrous phase there was a 70% increase in cell count in VHFD compared to animals fed on ND. Conclusions The above results show that morphological and hormonal changes caused by VHFD probably act via negative feedback to the hypothalamic-pituitary axis to shut down reproduction, which has a direct effect on the estrous cycle, causing acyclicity in mice.
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Affiliation(s)
| | | | | | - Sanjoy Chakraborty
- Department of Biological Sciences, New York City College of Technology/CUNY, New York, NY, USA
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Ciresi A, Amato MC, Bianco J, Giordano C. Prevalence and clinical features of polycystic ovarian syndrome in adolescents with previous childhood growth hormone deficiency. J Pediatr Endocrinol Metab 2016; 29:571-8. [PMID: 26953707 DOI: 10.1515/jpem-2015-0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Growth hormone (GH) plays a role in the regulation of ovarian function but there are limited data in women with GH deficiency (GHD). Our aim was to evaluate the features of polycystic ovarian syndrome (PCOS) in women with previous GHD. METHODS Data of 22 adolescents previously GH-treated (group A) were compared with those of 22 women with classical PCOS (group B) and 20 controls (group C). RESULTS Group A showed higher testosterone (p=0.048) and prevalence of menstrual irregularities (p<0.001) than group C. Compared to the group B, group A showed lower diastolic blood pressure (p=0.004), degree of hirsutism (p=0.005), testosterone (p=0.003) and prevalence of polycsytic ovaries (POC) morphology (p=0.024), with higher HDL-cholesterol (p=0.035) and 17-β-estradiol (p=0.009). CONCLUSIONS Adolescents with previous GHD show a higher prevalence of PCOS than controls, but with milder metabolic and hormonal features than adolescents with classical PCOS. A careful long-term follow-up is advisable in these patients.
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Kim JY, Tfayli H, Michaliszyn SF, Lee S, Arslanian S. Distinguishing characteristics of metabolically healthy versus metabolically unhealthy obese adolescent girls with polycystic ovary syndrome. Fertil Steril 2016; 105:1603-11. [PMID: 26921624 DOI: 10.1016/j.fertnstert.2016.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/18/2016] [Accepted: 02/01/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the key physical, metabolic, hormonal and cardiovascular characteristics of metabolically healthy obese (MHO) versus unhealthy obese (MUHO) girls with polycystic ovary syndrome (PCOS). DESIGN Cross-sectional study. SETTING Research center. PATIENT(S) Seventy obese girls with PCOS were divided into 19 MHO and 51 MUHO based on cutoff points for in vivo insulin sensitivity (within and < 2 SDs of the mean of the insulin sensitivity of the normal-weight girls, respectively). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Body composition, abdominal fat, in vivo insulin sensitivity and secretion (hyperinsulinemic-euglycemic and hyperglycemic clamps respectively), hormonal profile, and cardiovascular disease risk markers. RESULT(S) MUHO-PCOS girls had higher waist circumference, visceral adipose tissue, leptin, and free testosterone, lower SHBG and E2, higher non-high-density lipoprotein (HDL) cholesterol and atherogenic lipoprotein particle concentrations, smaller HDL particle size, and higher high-sensitivity C-reactive protein compared with MHO-PCOS girls. Hepatic and peripheral insulin sensitivity were lower with higher first- and second-phase insulin secretion, but β-cell function relative to insulin sensitivity was lower in MUHO versus MHO. Pair matching of MHO and MUHO regarding age and body mass index revealed similar findings. MUHO-PCOS girls had larger visceral adiposity, lower insulin sensitivity and β-cell function, worse hormonal profile, and severely atherogenic lipoprotein concentrations compared with MHO-PCOS girls. CONCLUSION(S) MHO-PCOS girls have favorable physical, metabolic, hormonal, and cardiovascular disease (CVD) characteristics and lower risk biomarkers for type 2 diabetes compared with their MUHO-PCOS peers. A greater understanding of the contrast in this risk phenotype in obese girls with PCOS may have important implications for therapeutic interventions, their outcomes, and their durability.
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Affiliation(s)
- Joon Young Kim
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara F Michaliszyn
- Human Performance and Exercise Science, Youngstown State University, Pittsburgh, Pennsylvania
| | - Sojung Lee
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Silva Arslanian
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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