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Li H, Tu Y, Xie W, Shi X, Zhang Q, Lin J, Zhong Y, Lin Z, Cai Z. In situ fabrication of covalent organic frameworks on solid-phase microextraction probes coupled with electrospray ionization mass spectrometry for enrichment and determination of androgens in biosamples. Mikrochim Acta 2024; 191:276. [PMID: 38644435 DOI: 10.1007/s00604-024-06355-8] [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: 02/13/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024]
Abstract
Solid-phase microextraction (SPME) coupled with electrospray ionization mass spectrometry (ESI-MS) was developed for rapid and sensitive determination of endogenous androgens. The SPME probe is coated with covalent organic frameworks (COFs) synthesized by reacting 1,3,5-tri(4-aminophenyl)benzene (TPB) with 2,5-dioctyloxybenzaldehyde (C8PDA). This COFs-SPME probe offers several advantages, including enhanced extraction efficiency and stability. The analytical method exhibited wide linearity (0.1-100.0 µg L-1), low limits of detection (0.03-0.07 µg L-1), high enrichment factors (37-154), and satisfactory relative standard deviations (RSDs) for both within one probe (4.0-14.8%) and between different probes (3.4-12.7%). These remarkable performance characteristics highlight the reliability and precision of the COFs-SPME-ESI-MS method. The developed method was successfully applied to detect five kinds of endogenous androgens in female serum samples, indicating that the developed analytical method has great potential for application in preliminary clinical diagnosis.
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Affiliation(s)
- Heming Li
- Ministry of Education Key Laboratory of Analytical Science for Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, College of Chemistry, Fuzhou University, 2 Xueyuan Road, Qishan Campus, Fuzhou, 350108, Fujian, China
| | - Yuxin Tu
- Ministry of Education Key Laboratory of Analytical Science for Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, College of Chemistry, Fuzhou University, 2 Xueyuan Road, Qishan Campus, Fuzhou, 350108, Fujian, China
| | - Wen Xie
- Ministry of Education Key Laboratory of Analytical Science for Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, College of Chemistry, Fuzhou University, 2 Xueyuan Road, Qishan Campus, Fuzhou, 350108, Fujian, China
| | - Xinye Shi
- Ministry of Education Key Laboratory of Analytical Science for Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, College of Chemistry, Fuzhou University, 2 Xueyuan Road, Qishan Campus, Fuzhou, 350108, Fujian, China
| | - Qiuting Zhang
- Ministry of Education Key Laboratory of Analytical Science for Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, College of Chemistry, Fuzhou University, 2 Xueyuan Road, Qishan Campus, Fuzhou, 350108, Fujian, China
| | - Juan Lin
- Department of Cardiology, Fujian Provincial Governmental Hospital, Fuzhou, 350003, China
| | - Yanhui Zhong
- Ministry of Education Key Laboratory of Analytical Science for Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, College of Chemistry, Fuzhou University, 2 Xueyuan Road, Qishan Campus, Fuzhou, 350108, Fujian, China
| | - Zian Lin
- Ministry of Education Key Laboratory of Analytical Science for Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, College of Chemistry, Fuzhou University, 2 Xueyuan Road, Qishan Campus, Fuzhou, 350108, Fujian, China.
| | - Zongwei Cai
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, 224 Waterloo Road, Kowloon Tong, Hong Kong, SAR, People's Republic of China.
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Zhu K, Chen Y, Sang Y, Chen Q, Wang G, Zhu B, Lin T, Mao L, Zhu Y. Serum steroid metabolome on the day of oocyte retrieval in women with polycystic ovarian syndrome and its association with pregnancy outcome of in vitro fertilization. J Steroid Biochem Mol Biol 2023; 231:106311. [PMID: 37060931 DOI: 10.1016/j.jsbmb.2023.106311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
Steroid hormone level is a crucial factor affecting the outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). The purpose of this study was to evaluate serum steroid metabolome on the day of oocyte retrieval in women with polycystic ovarian syndrome (PCOS) and explore whether specific steroids can be potential indicators to improve the prediction of pregnancy outcomes in PCOS patients undergoing IVF/ICSI. In this study, the serum levels of 21 steroids in 89 women with PCOS and 73 control women without PCOS on the day of oocyte retrieval of the first IVF/ICSI treatment cycle were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). All patients subsequently received good-quality embryo transfer, and the correlation between their steroid profiles and pregnancy outcomes of the first embryo transfer (ET) was retrospectively analyzed. We found PCOS patients had aberrant levels of 11 out of 21 steroid hormones compared to control individuals, with androgen steroid hormones being considerably enhanced. Enzyme activity evaluation indicated that PCOS women might have abnormal activity of CYP17A1, CYP21A2, CYP11B2, CYP19A1, HSD3B, HSD11B, and HSD17B. Additionally, the level of 18-hydroxycorticosterone (p = 0.014), corticosterone (p = 0.035), and 17-hydroxypregnenolone (p = 0.005) were markedly higher in live birth group than in non- live birth group for PCOS women following frozen embryo transfer (FET). Multiple logistic regressions indicated that 18-hydrocorticosterone and 17-hydroxypregnenolone were independently associated with live birth outcomes of PCOS women following FET. Receiver operating characteristic (ROC) curve analysis revealed that 0.595ng/mL for 18-hydrocorticosterone level (AUC: 0.6936, p = 0.014).and 2.829ng/mL for 17-hydroxypregnenolone level (AUC: 0.7215, p = 0.005) were the best cutoff values to predict live birth outcomes of PCOS. In conclusion, the blood steroid metabolome was closely related to the IVF/ICSI outcomes of PCOS patients. 18-hydroxycorticosterone and 17-hydroxypregnenolone might be potential indicators to predict pregnancy outcomes of PCOS undergoing IVF/ICSI treatment. AVAILABILITY OF DATA AND MATERIALS: The data used in the current study are available from the database of Women's Hospital, School of Medicine, Zhejiang University on reasonable request.
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Affiliation(s)
- Kai Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Yunwen Chen
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Yimiao Sang
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Qingqing Chen
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Guiquan Wang
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Bo Zhu
- Department of Clinical Laboratory, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Tingting Lin
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Luna Mao
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China.
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Zeng LH, Rana S, Hussain L, Asif M, Mehmood MH, Imran I, Younas A, Mahdy A, Al-Joufi FA, Abed SN. Polycystic Ovary Syndrome: A Disorder of Reproductive Age, Its Pathogenesis, and a Discussion on the Emerging Role of Herbal Remedies. Front Pharmacol 2022; 13:874914. [PMID: 35924049 PMCID: PMC9340349 DOI: 10.3389/fphar.2022.874914] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a very common, complex, and heterogeneous endocrine disorder of women that involves a combination of environmental and genetic factors. PCOS affects women of growing age particularly at the early to late reproductive stage (15-35 years). Currently, PCOS affects 1 in every 10 women worldwide. It is characterized majorly by a raised level of androgens such as testosterone and a large number of ovarian cysts (more than 10) that cause anovulation, infertility, and irregular menstrual cycle. PCOS is also related to other endocrine and metabolic abnormalities, such as obesity, hirsutism, acne, diabetes, insulin resistance, and glucose impairment. PCOS can be treated with allopathic, ayurvedic, and natural or herbal medications along with lifestyle modifications. Herbal medicines remained in demand for numerous reasons such as high cost and side effects associated with the use of allopathic medicine and our traditional norms, which have helped humans to use more herbal products for their health benefits. Estrogenic and nonestrogenic phytochemicals present in various plant species such as Glycyrrhiza glabra L. [Fabaceae], Aloe vera (L.) Burm. f. [Asphodelaceae], Silybum marianum (L.). Gaertn. [Asteraceae], Serenoa repens (W.Bartram) Small [Arecaceae], Actaea racemosa L. [Ranunculaceae], and Angelica sinensis (Oliv.) Diels [Apiaceae] are effective and harmless. Herbal medicines are found to be cost-effective, efficacious, and a highly esteemed source of management/treatment for PCOS than allopathic medicines. In this literature review, diagnosis, signs, and symptoms of PCOS; causes of hormonal imbalance; and risk factors associated with PCOS and their management are discussed briefly, and the focus was to find out the role of herbal remedies in PCOS management.
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Affiliation(s)
- Ling-Hui Zeng
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
| | - Saba Rana
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Liaqat Hussain
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Asif
- Department of Pharmacology, Faculty of Pharmacy, Islamia University Bahawalpur, Bahawalpur, Pakistan
| | - Malik Hassan Mehmood
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anam Younas
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Amina Mahdy
- Medical Pharmacology Department, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Fakhria A. Al-Joufi
- Department of Pharmacology, College of Pharmacy, Jouf University, Aljouf, Saudi Arabia
| | - Shaymaa Najm Abed
- Nursing Department, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
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Benjamin JJ, K. M, Koshy T, K. N. M, R. P. DHEA and polycystic ovarian syndrome: Meta-analysis of case-control studies. PLoS One 2021; 16:e0261552. [PMID: 34932604 PMCID: PMC8691613 DOI: 10.1371/journal.pone.0261552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Polycystic ovarian syndrome is a heterogenous endocrine disorder characterized by irregular menstrual cycles, hirsuitism and polycystic ovaries. It is further complicated by metabolic syndrome, infertility and psychological stress. Although the etiopathogenesis is unclear, many studies have pointed out the role of stress in this syndrome. DHEA, being a stress marker is being used by scientists to compare the stress levels between polycystic ovarian cases and healthy controls. However, the results obtained from previous studies are equivocal. OBJECTIVE To perform meta-analysis and find the association between stress and the syndrome. DATA SOURCES Relevant data till January 2021 were retrieved from PubMed, Scopus, Embase and Web of Science using MeSH terms. STUDY SELECTION Case-control studies having PCOS subjects as cases and healthy women as controls were selected provided; their basal DHEA levels were mentioned in the published articles. DATA EXTRACTION Two authors independently extracted the articles and qualified the final studies. DATA SYNTHESI Pooled meta-analysis was done using random effect model and showed level of DHEA statistically significant in PCOS compared to healthy controls (SMD = 1.15, 95% CI = 0.59-1.71).Heterogeneity was statistically significant as well (I2 = 95%). CONCLUSION Thismeta-analysis on DHEA and PCOS has helped in generating evidence regarding the involvement of stress in the pathogenesis of PCOS.
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Affiliation(s)
- Jiby Jolly Benjamin
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - MaheshKumar K.
- Department of Physiology, Government Yoga and Naturopathy Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Teena Koshy
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Maruthy K. N.
- Department of Physiology, Narayana Medical College and Hospital, Nellore, Andra Pradesh, India
| | - Padmavathi R.
- Department of Physiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
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Barber TM, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2021; 95:531-541. [PMID: 33460482 DOI: 10.1111/cen.14421] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/02/2020] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Abstract
The increased global prevalence of obesity over the last 40-years has driven a rise in prevalence of obesity-related co-morbidities, including polycystic ovary syndrome (PCOS). On a background of genetic susceptibility, PCOS often becomes clinically manifest following weight gain, commonly during adolescence. A common endocrinopathy affecting between 6%-10% of reproductive-age women, PCOS presents with the cardinal features of hyperandrogenism, reproductive and metabolic dysfunction. PCOS associates with insulin resistance, independently of (but amplified by) obesity. Insulin resistance in PCOS is characterized by abnormal post-receptor signalling within the phosphatidylinositol-kinase (PI3-K) pathway. Multiple factors (including most notably, weight gain) contribute towards the severity of insulin resistance in PCOS. Compensatory hyperinsulinaemia ensues, resulting in over-stimulation of the (intact) post-receptor mitogen-activated protein kinase (MAP-K) insulin pathway, with consequent implications for steroidogenesis and ovarian function. In this concise review, we explore the effects of weight gain and obesity on the pathogenesis of PCOS from the perspective of its three cardinal features of hyperandrogenism, reproductive and metabolic dysfunction, with a focus on the central mediating role of the insulin pathway. We also consider key lifestyle strategies for the effective management of obese and overweight women with PCOS.
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Affiliation(s)
- Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Franks
- Institute of Reproductive & Developmental Biology, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
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Association Between Dry Eye and Polycystic Ovary Syndrome: Subclinical Inflammation May Be Part of the Process. Eye Contact Lens 2021; 47:27-31. [PMID: 32496281 DOI: 10.1097/icl.0000000000000716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the changes in tear function in patients with polycystic ovary syndrome (PCOS) and establish whether there is a correlation between hormonal levels, novel hematologic biomarkers, and dry eye parameters. MATERIAL AND METHOD Forty-seven patients with PCOS and 43 age-matched patients with unexplained infertility were included in the control group. Follicle-stimulating hormone, luteinizing hormone, estradiol, thyroid-stimulating hormone, prolactin, dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, fasting and postprandial glucose, fasting insulin, and cholesterol metabolites were evaluated in both groups. In addition, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio were obtained from a complete blood count. The Ocular Surface Disease Index (OSDI) questionnaire was administered, and all patients underwent tear break-up time (BUT) and Schirmer I tests. Bivariate correlations were investigated using Spearman correlation coefficient analysis. RESULTS The mean age of the PCOS group and the control group was 27.66±3.96 years and 29.28±6.83 years, respectively. Schirmer I test scores and BUT values were significantly lower and OSDI results were significantly higher in the PCOS group (P=0.003, P<0.001, and P=0.004). An inverse correlation was found between DHEA-S and BUT values in the PCOS group (r=-0.296, P=0.043). Similarly, a negative correlation was also present between NLR and BUT values in the PCOS group (r=-0.322, P=0.027). CONCLUSIONS Dry eye can be well established by sensitive tests in patients with PCOS. The severity of dry eye may be correlated with the level of inflammation and hyperandrogenism.
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D Prabhu Y, Valsala Gopalakrishnan A. Can polyunsaturated fatty acids regulate Polycystic Ovary Syndrome via TGF-β signalling? Life Sci 2021; 276:119416. [PMID: 33774033 DOI: 10.1016/j.lfs.2021.119416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022]
Abstract
Polycystic Ovary Syndrome (PCOS) is a metabolic condition that affects women in their reproductive age by altering the ovarian hormone levels, leading to infertility. Increased inflammation, insulin resistance, hyperandrogenism, irregular menses, and infertility are the causes of morbidity when PCOS is the disease in question. PCOS is considered a multifactorial disease resulting from the disruption of multiple signalling pathways. Hence, the mono-targeted drugs are hardly adequate and conventional therapeutic strategies provide only palliative care. Studies show that the consumption of polyunsaturated fatty acids (PUFAs) regulates menstrual cycle, decrease testosterone and insulin levels, and improve metabolic health. This could favourably affect diabetes and infertility. In recent years, the fibrillin-3 gene has been linked to PCOS. Fibrillins along with the molecules in the extracellular matrix modulate the Transforming Growth Factor-β (TGF-β) signalling. So, mutations in the fibrillin-3 gene could cause TGF-β dysregulation, which might further contribute to PCOS pathogenesis. Therefore, the current study aimed to understand whether PUFAs could manage PCOS via the TGF-β pathway and function as a therapeutic agent for PCOS and its complications. To understand this, we have focused on the involvement of TGF-β in PCOS pathogenesis, discussed the effect of PUFA on hormones, insulin resistance, inflammation, obesity, adiponectin, and cardiovascular conditions. Using PUFAs to target TGF-β or its receptor molecules to modulate the TGF-β production might function as a treatment option for PCOS. PUFA therapy could be a good alternative, supportive medication for PCOS.
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Affiliation(s)
- Yogamaya D Prabhu
- Department of Biomedical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu 632014, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu 632014, India.
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Nikolaou N, Hodson L, Tomlinson JW. The role of 5-reduction in physiology and metabolic disease: evidence from cellular, pre-clinical and human studies. J Steroid Biochem Mol Biol 2021; 207:105808. [PMID: 33418075 DOI: 10.1016/j.jsbmb.2021.105808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 01/01/2023]
Abstract
The 5-reductases (5α-reductase types 1, 2 and 3 [5αR1-3], 5β-reductase [5βR]) are steroid hormone metabolising enzymes that hold fundamental roles in human physiology and pathology. They possess broad substrate specificity converting many steroid hormones to their 5α- and 5β-reduced metabolites, as well as catalysing crucial steps in bile acid synthesis. 5αRs are fundamentally important in urogenital development by converting testosterone to the more potent androgen 5α-dihydrotestosterone (5αDHT); inactivating mutations in 5αR2 lead to disorders of sexual development. Due to the ability of the 5αRs to generate 5αDHT, they are an established drug target, and 5αR inhibitors are widely used for the treatment of androgen-dependent benign or malignant prostatic diseases. There is an emerging body of evidence to suggest that the 5-reductases can impact upon aspects of health and disease (other than urogenital development); alterations in their expression and activity have been associated with metabolic disease, polycystic ovarian syndrome, inflammation and bone metabolism. This review will outline the evidence base for the extra-urogenital role of 5-reductases from in vitro cell systems, pre-clinical models and human studies, and highlight the potential adverse effects of 5αR inhibition in human health and disease.
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Affiliation(s)
- Nikolaos Nikolaou
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Leanne Hodson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK.
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Steroid hormone analysis of adolescents and young women with polycystic ovarian syndrome and adrenocortical dysfunction using UPC 2-MS/MS. Pediatr Res 2021; 89:118-126. [PMID: 32247282 PMCID: PMC7541460 DOI: 10.1038/s41390-020-0870-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 01/07/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND We recently identified 35 women with polycystic ovarian syndrome (PCOS) who exhibited features of micronodular adrenocortical hyperplasia. Steroid hormone analysis can be more accurate using state-of-the-art ultra-performance convergence chromatography-tandem mass spectrometry (UPC2-MS/MS). We hypothesized that UPC2-MS/MS may be used to better define hormonally this distinct subgroup of patients with PCOS. METHODS Plasma from PCOS patients (n = 35) and healthy volunteers (HVs, n = 19) who all received dexamethasone testing was analyzed. Samples were grouped per dexamethasone responses and followed by UPC2-MS/MS analysis. When insufficient, samples were pooled from patients with similar responses to allow quantification over the low end of the assay. RESULTS The C11-oxy C19 (11β-hydroxyandrostenedione, 11keto-androstenedione, 11β-hydroxytestosterone, 11keto-testosterone):C19 (androstenedione, testosterone) steroid ratio was decreased by 1.75-fold in PCOS patients compared to HVs. Downstream steroid metabolites 11β-hydroxyandrosterone and 11keto-androsterone were also measurable. The C11-oxy C21 steroids, 11-hydroxyprogesterone and 11keto-dihydroprogesterone levels, were 1.2- and 1.7-fold higher in PCOS patients compared to HVs, respectively. CONCLUSIONS We hypothesized that UPC2-MS/MS may accurately quantify steroids, in vivo, and identify novel metabolites in a subgroup of patients with PCOS and adrenal abnormalities. Indeed, it appears that adrenal C11-oxy steroids have the potential of being used diagnostically to identify younger women and adolescents with PCOS who also have some evidence of micronodular adrenocortical hyperplasia. IMPACT Adrenal C11-oxy steroids may be clinically important in identifying young patients with PCOS and adrenal abnormalities. The steroids presented in our manuscript have not yet been considered in the clinical setting so far, and we believe that this study could represent a first focused step towards the characterization of a distinct subgroup of women with PCOS who may in fact be treated differently than the average patient with PCOS. This paper can change the understanding of PCOS as one disorder: it is in fact a heterogeneous condition. In addition, for the subgroup of patients with PCOS associated with adrenocortical dysfunction, our paper provides novel hormonal markers that can be used diagnostically. Finally, the paper also adds to the basic pathophysiological understanding of adrenocortical-ovarian interactions in steroidogenesis of young women and adolescent girls with PCOS.
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Burger LL, Wagenmaker ER, Phumsatitpong C, Olson DP, Moenter SM. Prenatal Androgenization Alters the Development of GnRH Neuron and Preoptic Area RNA Transcripts in Female Mice. Endocrinology 2020; 161:bqaa166. [PMID: 33095238 PMCID: PMC7583650 DOI: 10.1210/endocr/bqaa166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/14/2020] [Indexed: 01/27/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common form of infertility in women. The causes of PCOS are not yet understood and both genetics and early-life exposure have been considered as candidates. With regard to the latter, circulating androgens are elevated in mid-late gestation in women with PCOS, potentially exposing offspring to elevated androgens in utero; daughters of women with PCOS are at increased risk for developing this disorder. Consistent with these clinical observations, prenatal androgenization (PNA) of several species recapitulates many phenotypes observed in PCOS. There is increasing evidence that symptoms associated with PCOS, including elevated luteinizing hormone (LH) (and presumably gonadotropin-releasing hormone [GnRH]) pulse frequency emerge during the pubertal transition. We utilized translating ribosome affinity purification coupled with ribonucleic acid (RNA) sequencing to examine GnRH neuron messenger RNAs from prepubertal (3 weeks) and adult female control and PNA mice. Prominent in GnRH neurons were transcripts associated with protein synthesis and cellular energetics, in particular oxidative phosphorylation. The GnRH neuron transcript profile was affected more by the transition from prepuberty to adulthood than by PNA treatment; however, PNA did change the developmental trajectory of GnRH neurons. This included families of transcripts related to both protein synthesis and oxidative phosphorylation, which were more prevalent in adults than in prepubertal mice but were blunted in PNA adults. These findings suggest that prenatal androgen exposure can program alterations in the translatome of GnRH neurons, providing a mechanism independent of changes in the genetic code for altered expression.
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Affiliation(s)
- Laura L Burger
- Department of Molecular and Integrative Physiology, Ann Arbor, Michigan
| | | | | | - David P Olson
- Department of Molecular and Integrative Physiology, Ann Arbor, Michigan
- Department of Pediatrics, Ann Arbor, Michigan
| | - Suzanne M Moenter
- Department of Molecular and Integrative Physiology, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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11
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Dineen R, Behan LA, Kelleher G, Hannon MJ, Brady JJ, Rogers B, Keevil BG, Tormey W, Smith D, Thompson CJ, McKenna MJ, Arlt W, Stewart PM, Agha A, Sherlock M. The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy. BMC Endocr Disord 2020; 20:154. [PMID: 33036588 PMCID: PMC7547490 DOI: 10.1186/s12902-020-00633-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Glucocorticoid therapy is the most common cause of iatrogenic osteoporosis. Less is known regarding the effect of glucocorticoids when used as replacement therapy on bone remodelling in patients with adrenal insufficiency. Enhanced intracellular conversion of inactive cortisone to active cortisol, by 11 beta-hydroxysteroid dehydrogenase type 1(11β-HSD1) and other enzymes leading to alterations in glucocorticoid metabolism, may contribute to a deleterious effect on bone health in this patient group. METHODS Study design: An open crossover prospective study randomizing ten hypopituitary men, with severe ACTH deficiency, to three commonly used hydrocortisone dose regimens. MEASUREMENTS Following 6 weeks of each regimen, patients underwent 24-h serum cortisol/cortisone sampling, measurement of bone turnover markers, and a 24-h urine collection for measurement of urinary steroid metabolites by gas chromatography-mass spectrometry (GC-MS). Serum cortisone and cortisol were analysed by liquid chromatography-mass spectrometry (LC-MS). RESULTS Dose-related and circadian variations in serum cortisone were seen to parallel those for cortisol, indicating conversion of ingested hydrocortisone to cortisone. The median area under the curve (AUC) of serum cortisone was significantly higher in patients on dose A (20 mg/10 mg) [670.5 (IQR 621-809.2)] compared to those on dose C (10 mg/5 mg) [562.8 (IQR 520.1-619.6), p = 0.01]. A negative correlation was observed between serum cortisone and bone formation markers, OC [1-49] (r = - 0.42, p = 0.03), and PINP (r = - 0.49, p = 0.01). There was a negative correlation between the AUC of night-time serum cortisone levels with the bone formation marker, OC [1-49] (r = - 0.41, p = 0.03) but there were no significant correlations between day-time serum cortisone or cortisol with bone turnover markers. There was a negative correlation between total urinary cortisol metabolites and the bone formation markers, PINP (r = - 0.39, p = 0.04), and OC [1-49] (r = - 0.35, p = 0.06). CONCLUSION Serum cortisol and cortisone and total urinary corticosteroid metabolites are negatively associated with bone turnover markers in patients receiving replacement doses of hydrocortisone, with nocturnal glucocorticoid exposure having a potentially greater influence on bone turnover. TRIAL REGISTRATION Irish Medicines Board Clinical Trial Number - CT900/459/1 and EudraCT Number - 2007-005018-37 . Registration date: 07-09-2007.
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Affiliation(s)
- Rosemary Dineen
- Department of Endocrinology, Tallaght University Hospital, Dublin, Ireland.
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Lucy-Ann Behan
- Department of Endocrinology, Tallaght University Hospital, Dublin, Ireland
| | - Grainne Kelleher
- Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland
| | - Mark J Hannon
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer J Brady
- Metabolism Laboratory, St Vincent's University Hospital, Dublin, Ireland
| | - Bairbre Rogers
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian G Keevil
- Manchester Academic Health Science Centre, University Hospital of South Manchester, The University of Manchester, Manchester, UK
- Biochemistry Department, University Hospital of South Manchester, Manchester, UK
| | - William Tormey
- Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland
| | - Diarmuid Smith
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christopher J Thompson
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Malachi J McKenna
- Metabolism Laboratory, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | | | - Amar Agha
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
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12
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Nasiadek M, Stragierowicz J, Klimczak M, Kilanowicz A. The Role of Zinc in Selected Female Reproductive System Disorders. Nutrients 2020; 12:E2464. [PMID: 32824334 PMCID: PMC7468694 DOI: 10.3390/nu12082464] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Zinc is an essential microelement that plays many important functions in the body. It is crucial for the regulation of cell growth, hormone release, immunological response and reproduction. This review focuses on its importance in the reproductive system of women of reproductive and postmenopausal ages, not including its well described role in pregnancy. Only recently, attention has been drawn to the potential role of zinc in polycystic ovary syndrome (PCOS), dysmenorrhea, or endometriosis. This review is mainly based on 36 randomized, controlled studies on reproductive, pre- and post-menopausal populations of women and on research trying to explain the potential impact of zinc and its supplementation in the etiology of selected female reproductive system disorders. In women with PCOS, zinc supplementation has a positive effect on many parameters, especially those related to insulin resistance and lipid balance. In primary dysmenorrhea, zinc supplementation before and during each menstrual cycle seems to be an important factor reducing the intensity of menstrual pain. On the other hand, little is known of the role of zinc in endometriosis and in postmenopausal women. Therefore, further studies explaining the potential impact of zinc and its supplementation on female reproductive system would be highly advisable and valuable.
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Affiliation(s)
- Marzenna Nasiadek
- Department of Toxicology, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (J.S.); (M.K.)
| | | | | | - Anna Kilanowicz
- Department of Toxicology, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (J.S.); (M.K.)
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13
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Liu X, Wei D, Jiang J, Liu X, Tu R, Luo Z, Wang Y, Dong X, Qiao D, Shen F, Li R, Wang Y, Jin Y, Yu S, Huo W, Li L, Li W, Jing T, Wang C, Mao Z. Associations of SRD5A1 gene variants and testosterone with dysglycemia: Henan Rural Cohort study. Nutr Metab Cardiovasc Dis 2020; 30:599-607. [PMID: 31870594 DOI: 10.1016/j.numecd.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Multiple studies support a complex relationship between testosterone and type 2 diabetes mellitus (T2DM) and the transformation of testosterone is affected by several reductases. Thus, we aimed to explore the associations of steroid-5α-reductase type 1 (SRD5A1) gene polymorphism with impaired fasting glucose (IFG) and T2DM and the interactive effects of testosterone and genotypes on glycometabolism. METHODS AND RESULTS A case-control study including 2365 participants was performed. Genomic DNA was extracted from the whole blood and genotyped for the SRD5A1 single nucleotide polymorphisms (SNP) rs1691053. Multivariable logistic regression and linear regression were performed to estimate the associations of SRD5A1 rs1691053 alleles and genotypes with glycometabolism. Generalized linear models were used to investigate the modulatory effects of serum testosterone on glycometabolism indexes in males. After multivariable adjustment, the odds ratio (OR) of homozygous CC genotypes in male carriers was 2.62 (95%CI: 1.11-6.18) for IFG. Furthermore, significant associations of SRD5A1 rs1691053 polymorphisms with adverse indices of glycometabolism were observed in males. Interestingly, the opposite associations in females were observed. The interactive associations of SNP and testosterone were found and mutations were more likely to lead unfavorable metabolic phenotypes. CONCLUSION These results showed that SRD5A1 rs1691053 gene polymorphism was independently associated with glycometabolism. The interaction between a genetic polymorphism from SRD5A1 and testosterone involved glycometabolism was identified in males. Although this preliminary data should be replicated with other rigorous researches, it highlighted the importance of the SNP-testosterone interaction over the present of glycometabolism.
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Affiliation(s)
- Xue Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jingjing Jiang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhicheng Luo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Dou Qiao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Fang Shen
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yikang Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yuxi Jin
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, PR China; Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, PR China.
| | - Songcheng Yu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenjie Li
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Tao Jing
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, PR China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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14
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Kempegowda P, Melson E, Manolopoulos KN, Arlt W, O’Reilly MW. Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome. Ther Adv Endocrinol Metab 2020; 11:2042018820934319. [PMID: 32637065 PMCID: PMC7315669 DOI: 10.1177/2042018820934319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) has been traditionally perceived as a reproductive disorder due to its most common presentation with menstrual dysfunction and infertility. However, it is now clear that women with PCOS are at increased risk of metabolic dysfunction, from impaired glucose tolerance and type 2 diabetes mellitus to nonalcoholic fatty liver disease and cardiovascular disease. PCOS is characterised by androgen excess, with cross-sectional data showing that hyperandrogenism is directly complicit in the development of metabolic complications. Recent studies have also shown that C11-oxy C19 androgens are emerging to be clinically and biochemically significant in PCOS, thus emphasising the importance of understanding the impact of both classic and C11-oxy C19 androgens on women's health. Here we discuss androgen metabolism in the context of PCOS, and dissect the role played by androgens in the development of metabolic disease through their effects on metabolic target tissues in women.
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Affiliation(s)
- Punith Kempegowda
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Eka Melson
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Konstantinos N. Manolopoulos
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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15
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Ilie IR. Neurotransmitter, neuropeptide and gut peptide profile in PCOS-pathways contributing to the pathophysiology, food intake and psychiatric manifestations of PCOS. Adv Clin Chem 2019; 96:85-135. [PMID: 32362321 DOI: 10.1016/bs.acc.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a major health problem with a heterogeneous hormone-imbalance and clinical presentation across the lifespan of women. Increased androgen production and abnormal gonadotropin-releasing hormone (GnRH) release and gonadotropin secretion, resulting in chronic anovulation are well-known features of the PCOS. The brain is both at the top of the neuroendocrine axis regulating ovarian function and a sensitive target of peripheral gonadal hormones and peptides. Current literature illustrates that neurotransmitters regulate various functions of the body, including reproduction, mood and body weight. Neurotransmitter alteration could be one of the reasons for disturbed GnRH release, consequently directing the ovarian dysfunction in PCOS, since there is plenty evidence for altered catecholamine metabolism and brain serotonin or opioid activity described in PCOS. Further, the dysregulated neurotransmitter and neuropeptide profile in PCOS could also be the reason for low self-esteem, anxiety, mood swings and depression or obesity, features closely associated with PCOS women. Can these altered central brain circuits, or the disrupted gut-brain axis be the tie that would both explain and link the pathogenesis of this disorder, the occurrence of depression, anxiety and other mood disorders as well as of obesity, insulin resistance and abnormal appetite in PCOS? This review intends to provide the reader with a comprehensive overview of what is known about the relatively understudied, but very complex role that neurotransmitters, neuropeptides and gut peptides play in PCOS. The answer to the above question may help the development of drugs to specifically target these central and peripheral circuits, thereby providing a valuable treatment for PCOS patients that present to the clinic with GnRH/LH hypersecretion, obesity or psychiatric manifestations.
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Affiliation(s)
- Ioana R Ilie
- Department of Endocrinology, University of Medicine and Pharmacy 'Iuliu-Hatieganu', Cluj-Napoca, Romania.
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16
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Barber TM, Hanson P, Weickert MO, Franks S. Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119874042. [PMID: 31523137 PMCID: PMC6734597 DOI: 10.1177/1179558119874042] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/05/2019] [Indexed: 01/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common female condition typified by reproductive, hyperandrogenic, and metabolic features. Polycystic ovary syndrome is a genetic condition, exacerbated by obesity. There is a close link between obesity and PCOS based on epidemiological data, and more recently corroborated through genetic studies. There are many mechanisms mediating the effects of weight-gain and obesity on the development of PCOS. The metabolic effects of insulin resistance and steroidogenic and reproductive effects of hyperinsulinaemia are important mechanisms. Adipokine production by subcutaneous and visceral fat appears to play a part in metabolic function. However, given the complexity of PCOS pathogenesis, it is important also to consider possible effects of PCOS on further weight-gain, or at least on hampering attempts at weight-loss and maintenance through lifestyle changes. Possible mediators of these effects include changes in energy expenditure, mental ill health, or physical inactivity. In this brief review, we discuss the main mechanisms that underlie the association between obesity and PCOS, from divergent perspectives of weight-gain contributing to development of PCOS and vice versa. We also consider novel management options for women with obesity and PCOS.
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Affiliation(s)
- Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Petra Hanson
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin O Weickert
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK.,Centre of Applied Biological and Exercise Sciences, Coventry University, Coventry, UK
| | - Stephen Franks
- Institute of Reproductive Medicine, Imperial College London, London, UK
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17
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Perturbed ovarian and uterine glucocorticoid receptor signaling accompanies the balanced regulation of mitochondrial function and NFκB-mediated inflammation under conditions of hyperandrogenism and insulin resistance. Life Sci 2019; 232:116681. [PMID: 31344428 DOI: 10.1016/j.lfs.2019.116681] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022]
Abstract
AIM This study aimed to determine whether glucocorticoid receptor (GR) signaling, mitochondrial function, and local inflammation in the ovary and uterus are intrinsically different in rats with hyperandrogenism and insulin resistance compared to controls. MAIN METHODS Female Sprague Dawley rats were exposed to daily injections of human chorionic gonadotropin and/or insulin. KEY FINDINGS In both the ovary and the uterus, decreased expression of the two GR isoforms was concurrent with increased expression of Fkbp51 but not Fkbp52 mRNA in hCG + insulin-treated rats. However, these rats exhibited contrasting regulation of Hsd11b1 and Hsd11b2 mRNAs in the two tissues. Further, the expression of several oxidative phosphorylation-related proteins decreased in the ovary and uterus following hCG and insulin stimulation, in contrast to increased expression of many genes involved in mitochondrial function and homeostasis. Additionally, hCG + insulin-treated rats showed increased expression of ovarian and uterine NFκB signaling proteins and Tnfaip3 mRNA. The mRNA expression of Il1b, Il6, and Mmp2 was decreased in both tissues, while the mRNA expression of Tnfa, Ccl2, Ccl5, and Mmp3 was increased in the uterus. Ovaries and uteri from animals co-treated with hCG and insulin showed increased collagen deposition compared to controls. SIGNIFICANCE Our observations suggest that hyperandrogenism and insulin resistance disrupt ovarian and uterine GR activation and trigger compensatory or adaptive effects for mitochondrial homeostasis, allowing tissue-level maintenance of mitochondrial function in order to limit ovarian and uterine dysfunction. Our study also suggests that hyperandrogenism and insulin resistance activate NFκB signaling resulting in aberrant regulation of inflammation-related gene expression.
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18
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Peecher DL, Binder AK, Gabriel KI. Rodent models of mental illness in polycystic ovary syndrome: the potential role of hypothalamic-pituitary-adrenal dysregulation and lessons for behavioral researchers. Biol Reprod 2019; 100:590-600. [PMID: 30388193 DOI: 10.1093/biolre/ioy233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/04/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most commonly diagnosed endocrine disorder in women of reproductive age, with phenotypes including ovarian and metabolic dysfunctions. Women with PCOS also show increased rates of mental illness, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and altered responsiveness to stressors that may contribute to the higher rates of mental illness, specifically depression and anxiety. Animal models of PCOS have provided insight into the ovarian and metabolic mechanisms that underlie the syndrome, and several models have been used to study the behavioral consequences associated with PCOS in the laboratory. Several studies in rodent models of PCOS demonstrate changes in anxiety-like behavior, but researchers often neglect to report procedural details or behavioral data crucial to interpreting the differences observed in those studies. Additionally, the impact of potential HPA dysregulation in animal models of PCOS may influence behavioral findings, although only three studies to date have examined this. As such, researchers should consider and report stress-associated variables (e.g., time of day, light/dark cycle, light intensity, housing, and procedures to control experimenter and litter effects) that may influence depression- and anxiety-like behaviors in rodents. This review will summarize the behavioral and HPA-related studies in women with PCOS and rodent models of the disease, and provide considerations for future studies.
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Affiliation(s)
- Danielle L Peecher
- Department of Psychology, Central Washington University, Ellensburg, Washington, USA.,Center for Reproductive Biology, Washington State University, Pullman, Washington, USA
| | - April K Binder
- Center for Reproductive Biology, Washington State University, Pullman, Washington, USA.,Department of Biological Sciences, Central Washington University, Ellensburg, Washington, USA
| | - Kara I Gabriel
- Department of Psychology, Central Washington University, Ellensburg, Washington, USA
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19
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Polycystic Ovary Syndrome as a systemic disease with multiple molecular pathways: a narrative review. Endocr Regul 2018; 52:208-221. [DOI: 10.2478/enr-2018-0026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract
Polycystic Ovary Syndrome (PCOS) is characterized by hyperandrogenism, amenorrhea, and polycystic ovaries. This endocrinopathy is associated with many metabolic disorders such as dyslipidemia and insulin resistance, with increased risk of type 2 diabetes mellitus, metabolic syndrome, and cardiovascular complications. Inflammation is likely to play an important role in the promoting these metabolic imbalances, while prothrombotic and pro-oxidative mechanisms further contribute to the cardiovascular risk of these patients. The etiology of PCOS is still not fully understood, but there is evidence of genetic and environmental components. This review aims to discuss some molecular pathways associated with PCOS that could contribute to the better understanding about this syndrome. Recent evidence suggests that intrauterine exposure of female mice to an excess of anti-Müllerian hormone may induce PCOS features in their post-natal life. High cytokine levels and cytokine gene polymorphisms also appear to be associated with the pathophysiology of PCOS. Furthermore, high levels of microparticles may contribute to the altered hemostasis and enhanced inflammation in PCOS. All these mechanisms may be relevant to clarify some aspects of PCOS pathogenesis and inspire new strategies to prevent the syndrome as well as treat its symptoms and mitigate the risk of long-term complications.
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20
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Kosicka K, Siemiątkowska A, Szpera-Goździewicz A, Krzyścin M, Bręborowicz GH, Główka FK. Increased cortisol metabolism in women with pregnancy-related hypertension. Endocrine 2018; 61:125-133. [PMID: 29611097 PMCID: PMC5997110 DOI: 10.1007/s12020-018-1586-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/17/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE The diminished function of 11β-hydroxysteroid dehydrogenase 2 (11β-HSD2) was found in placentae from preeclamptic pregnancies. Here, we examine the overall maternal glucocorticoid balance in pregnancy-related hypertension. We aim to answer the question if the functions of primary enzymes involved in cortisol metabolism: 11β-HSD1 and 11β-HSD2 and 5-reductases (both 5α- and 5β) are altered in the course of hypertensive pregnancy. METHODS We determined plasma and urinary cortisol and cortisone as well as their urinary tetrahydro- and allo-tetrahydrometabolites, both in free and conjugated forms in samples obtained from 181 Polish women in the third trimester of pregnancy. We compared steroid profiles in women with preeclampsia (PE), gestational hypertension (GH), chronic hypertension (CH) and in normotensives (controls). RESULTS We found significant differences in glucocorticoid balance in pregnancy-related hypertension. Plasma cortisol to cortisone was significantly lower in PE than in controls (3.00 vs. 4.79; p < 0.001). Increased function of renal 11β-HSD2 in PE and GH was manifested by significantly lower urinary free cortisol to cortisone ratio (0.169 and 0.206 vs. 0.277 in controls; p < 0.005). Markedly enhanced metabolism of cortisol was observed in pregnancy-related hypertension, with no significant alterations in CH, and the changes were more clearly expressed in PE than in GH. CONCLUSIONS The glucocorticoid balance in PE and GH is shifted towards decreasing cortisol concentration either due to intensified conversion to cortisone or enhanced production of tetrahydro and allo-tetrahydrometabolites.
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Affiliation(s)
- Katarzyna Kosicka
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 6 Święcickiego Street, Poznań, 60-781, Poland.
| | - Anna Siemiątkowska
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 6 Święcickiego Street, Poznań, 60-781, Poland
| | - Agata Szpera-Goździewicz
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 33 Polna Street, Poznań, 60-535, Poland
| | - Mariola Krzyścin
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 33 Polna Street, Poznań, 60-535, Poland
| | - Grzegorz H Bręborowicz
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 33 Polna Street, Poznań, 60-535, Poland
| | - Franciszek K Główka
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 6 Święcickiego Street, Poznań, 60-781, Poland
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21
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Schiffer L, Arlt W, Storbeck KH. Intracrine androgen biosynthesis, metabolism and action revisited. Mol Cell Endocrinol 2018; 465:4-26. [PMID: 28865807 PMCID: PMC6565845 DOI: 10.1016/j.mce.2017.08.016] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 12/19/2022]
Abstract
Androgens play an important role in metabolic homeostasis and reproductive health in both men and women. Androgen signalling is dependent on androgen receptor activation, mostly by testosterone and 5α-dihydrotestosterone. However, the intracellular or intracrine activation of C19 androgen precursors to active androgens in peripheral target tissues of androgen action is of equal importance. Intracrine androgen synthesis is often not reflected by circulating androgens but rather by androgen metabolites and conjugates. In this review we provide an overview of human C19 steroid biosynthesis including the production of 11-oxygenated androgens, their transport in circulation and uptake into peripheral tissues. We conceptualise the mechanisms of intracrinology and review the intracrine pathways of activation and inactivation in selected human tissues. The contribution of liver and kidney as organs driving androgen inactivation and renal excretion are also highlighted. Finally, the importance of quantifying androgen metabolites and conjugates to assess intracrine androgen production is discussed.
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Affiliation(s)
- Lina Schiffer
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Karl-Heinz Storbeck
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Department of Biochemistry, Stellenbosch University, Stellenbosch 7600, South Africa
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22
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van Rooyen D, Gent R, Barnard L, Swart AC. The in vitro metabolism of 11β-hydroxyprogesterone and 11-ketoprogesterone to 11-ketodihydrotestosterone in the backdoor pathway. J Steroid Biochem Mol Biol 2018; 178:203-212. [PMID: 29277707 DOI: 10.1016/j.jsbmb.2017.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/17/2017] [Accepted: 12/19/2017] [Indexed: 01/24/2023]
Abstract
Increased circulating 11β-hydroxyprogesterone (11OHP4), biosynthesised in the human adrenal, is associated with 21-hydroxylase deficiency in congenital adrenal hyperplasia. 17α-hydroxyprogesterone levels are also increased, with the steroid's metabolism to dihydrotestosterone in the backdoor pathway contributing to hyperandrogenic clinical conditions. In this study we investigated the in vitro biosynthesis and downstream metabolism of 11OHP4. Both cytochrome P450 11β-hydroxylase and aldosterone synthase catalyse the biosynthesis of 11OHP4 from progesterone (P4) which is converted to 11-ketoprogesterone (11KP4) by 11β-hydroxysteroid dehydrogenase type 2, while type 1 readily catalysed the reverse reaction. We showed in HEK-293 cells that these C11-oxy C21 steroids were metabolised by steroidogenic enzymes in the backdoor pathway-5α-reductase (SRD5A) and 3α-hydroxysteroid type 3 (AKR1C2) converted 11OHP4 to 5α-pregnan-11β-ol,3,20-dione and 5α-pregnan-3α,11β-diol-20-one, while 11KP4 was converted to 5α-pregnan-3,11,20-trione and 5α-pregnan-3α-ol-11,20-dione (alfaxalone), respectively. Cytochrome P450 17α-hydroxylase/17,20-lyase catalysed the hydroxylase and lyase reaction to produce the C11-oxy C19 steroids demonstrated in the conversion of alfaxalone to 11-oxy steroids demonstrated in the conversion of alfaxalone to 11ketoandrosterone. In LNCaP cells, a prostate cancer cell model endogenously expressing the relevant enzymes, 11OHP4 and 11KP4 were metabolised to the potent androgen, 11-ketodihydrotestosterone (11KDHT), thus suggesting the C11-oxy C21 steroids contribute to the pool of validating the in vitro biosynthesis of C11-oxy C19 steroids from C11-oxy C21 steroids. The in vitro reduction of 11KP4 at C3 and C5 by AKR1C2 and SRD5A has confirmed the metabolic route of the urinary metabolite, 3α,20α-dihydroxy-5β-pregnan-11-one. Although our assays have demonstrated the conversion of 11OHP4 and 11KP4 by steroidogenic enzymes in the backdoor pathway yielding 11KDHT, thus suggesting the C11-oxy C21 steroids contribute to the pool of potent androgens, the in vivo confirmation of this metabolic route remains challenging.
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Affiliation(s)
- Desmaré van Rooyen
- Biochemistry Department, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Rachelle Gent
- Biochemistry Department, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Lise Barnard
- Biochemistry Department, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Amanda C Swart
- Biochemistry Department, Stellenbosch University, Stellenbosch 7600, South Africa.
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23
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Manti M, Fornes R, Qi X, Folmerz E, Lindén Hirschberg A, de Castro Barbosa T, Maliqueo M, Benrick A, Stener-Victorin E. Maternal androgen excess and obesity induce sexually dimorphic anxiety-like behavior in the offspring. FASEB J 2018; 32:4158-4171. [PMID: 29565738 DOI: 10.1096/fj.201701263rr] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal polycystic ovary syndrome (PCOS), a condition associated with hyperandrogenism, is suggested to increase anxiety-like behavior in the offspring. Because PCOS is closely linked to obesity, we investigated the impact of an adverse hormonal or metabolic maternal environment and offspring obesity on anxiety in the offspring. The obese PCOS phenotype was induced by chronic high-fat-high-sucrose (HFHS) consumption together with prenatal dihydrotestosterone exposure in mouse dams. Anxiety-like behavior was assessed in adult offspring with the elevated-plus maze and open-field tests. The influence of maternal androgens and maternal and offspring diet on genes implicated in anxiety were analyzed in the amygdala and hypothalamus with real-time PCR ( n = 47). Independent of diet, female offspring exposed to maternal androgens were more anxious and displayed up-regulation of adrenoceptor α 1B in the amygdala and up-regulation of hypothalamic corticotropin-releasing hormone ( Crh). By contrast, male offspring exposed to a HFHS maternal diet had increased anxiety-like behavior and showed up-regulation of epigenetic markers in the amygdala and up-regulation of hypothalamic Crh. Overall, there were substantial sex differences in gene expression in the brain. These findings provide novel insight into how maternal androgens and obesity exert sex-specific effects on behavior and gene expression in the offspring of a PCOS mouse model.-Manti, M., Fornes, R., Qi, X., Folmerz, E., Lindén Hirschberg, A., de Castro Barbosa, T., Maliqueo, M., Benrick, A., Stener-Victorin, E. Maternal androgen excess and obesity induce sexually dimorphic anxiety-like behavior in the offspring.
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Affiliation(s)
- Maria Manti
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Romina Fornes
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Xiaojuan Qi
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Physiology, Qiqihar Medical University, Qiqihar, China
| | - Elin Folmerz
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Manuel Maliqueo
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,West Division, Endocrinology and Metabolism Laboratory, School of Medicine, University of Chile, Santiago, Chile
| | - Anna Benrick
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Health and Education, University of Skövde, Skövde, Sweden
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24
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Association of HSD11B1 rs12086634 and HSD11B1 rs846910 gene polymorphisms with polycystic ovary syndrome in South Indian women. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0596-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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25
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Sominsky L, Hodgson DM, McLaughlin EA, Smith R, Wall HM, Spencer SJ. Linking Stress and Infertility: A Novel Role for Ghrelin. Endocr Rev 2017; 38:432-467. [PMID: 28938425 DOI: 10.1210/er.2016-1133] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/24/2017] [Indexed: 12/23/2022]
Abstract
Infertility affects a remarkable one in four couples in developing countries. Psychological stress is a ubiquitous facet of life, and although stress affects us all at some point, prolonged or unmanageable stress may become harmful for some individuals, negatively impacting on their health, including fertility. For instance, women who struggle to conceive are twice as likely to suffer from emotional distress than fertile women. Assisted reproductive technology treatments place an additional physical, emotional, and financial burden of stress, particularly on women, who are often exposed to invasive techniques associated with treatment. Stress-reduction interventions can reduce negative affect and in some cases to improve in vitro fertilization outcomes. Although it has been well-established that stress negatively affects fertility in animal models, human research remains inconsistent due to individual differences and methodological flaws. Attempts to isolate single causal links between stress and infertility have not yet been successful due to their multifaceted etiologies. In this review, we will discuss the current literature in the field of stress-induced reproductive dysfunction based on animal and human models, and introduce a recently unexplored link between stress and infertility, the gut-derived hormone, ghrelin. We also present evidence from recent seminal studies demonstrating that ghrelin has a principal role in the stress response and reward processing, as well as in regulating reproductive function, and that these roles are tightly interlinked. Collectively, these data support the hypothesis that stress may negatively impact upon fertility at least in part by stimulating a dysregulation in ghrelin signaling.
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Affiliation(s)
- Luba Sominsky
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - Deborah M Hodgson
- School of Psychology, Faculty of Science and IT, The University of Newcastle, New South Wales 2308, Australia
| | - Eileen A McLaughlin
- School of Biological Sciences, Faculty of Science, The University of Auckland, Auckland 1010, New Zealand.,School of Environmental & Life Sciences, Faculty of Science and IT, The University of Newcastle, New South Wales 2308, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales 2305, Australia.,Priority Research Centre in Reproductive Science, The University of Newcastle, New South Wales 2308, Australia
| | - Hannah M Wall
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
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26
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Schiffer L, Kempegowda P, Arlt W, O’Reilly MW. MECHANISMS IN ENDOCRINOLOGY: The sexually dimorphic role of androgens in human metabolic disease. Eur J Endocrinol 2017; 177:R125-R143. [PMID: 28566439 PMCID: PMC5510573 DOI: 10.1530/eje-17-0124] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/12/2017] [Accepted: 05/03/2017] [Indexed: 12/22/2022]
Abstract
Female androgen excess and male androgen deficiency manifest with an overlapping adverse metabolic phenotype, including abdominal obesity, insulin resistance, type 2 diabetes mellitus, non-alcoholic fatty liver disease and an increased risk of cardiovascular disease. Here, we review the impact of androgens on metabolic target tissues in an attempt to unravel the complex mechanistic links with metabolic dysfunction; we also evaluate clinical studies examining the associations between metabolic disease and disorders of androgen metabolism in men and women. We conceptualise that an equilibrium between androgen effects on adipose tissue and skeletal muscle underpins the metabolic phenotype observed in female androgen excess and male androgen deficiency. Androgens induce adipose tissue dysfunction, with effects on lipid metabolism, insulin resistance and fat mass expansion, while anabolic effects on skeletal muscle may confer metabolic benefits. We hypothesise that serum androgen concentrations observed in female androgen excess and male hypogonadism are metabolically disadvantageous, promoting adipose and liver lipid accumulation, central fat mass expansion and insulin resistance.
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Affiliation(s)
- Lina Schiffer
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
| | - Punith Kempegowda
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Michael W O’Reilly
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
- Correspondence should be addressed to M W O’Reilly;
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27
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Moore AM, Campbell RE. Polycystic ovary syndrome: Understanding the role of the brain. Front Neuroendocrinol 2017; 46:1-14. [PMID: 28551304 DOI: 10.1016/j.yfrne.2017.05.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/19/2017] [Accepted: 05/20/2017] [Indexed: 01/09/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder and the leading cause of anovulatory infertility. Characterised by hyperandrogenism, menstrual dysfunction and polycystic ovaries, PCOS is a broad-spectrum disorder unlikely to stem from a single common origin. Although commonly considered an ovarian disease, the brain is now a prime suspect in both the ontogeny and pathology of PCOS. We discuss here the neuroendocrine impairments present in PCOS that implicate involvement of the brain and review evidence gained from pre-clinical models of the syndrome about the specific brain circuitry involved. In particular, we focus on the impact that developmental androgen excess and adult hyperandrogenemia have in programming and regulating brain circuits important in the central regulation of fertility. The studies discussed here provide compelling support for the importance of the brain in PCOS ontogeny and pathophysiology and highlight the need for a better understanding of the underlying mechanisms involved.
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Affiliation(s)
- Aleisha M Moore
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Rebecca E Campbell
- Centre for Neuroendocrinology and Department of Physiology, Biomedical Sciences, University of Otago, Dunedin 9054, New Zealand.
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28
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Münzker J, Lindheim L, Adaway J, Trummer C, Lerchbaum E, Pieber TR, Keevil B, Obermayer-Pietsch B. High salivary testosterone-to-androstenedione ratio and adverse metabolic phenotypes in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2017; 86:567-575. [PMID: 28039871 DOI: 10.1111/cen.13299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/13/2016] [Accepted: 12/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is characterized by a combination of hormonal and metabolic disturbances, such as insulin resistance, glucose intolerance, anovulation and hyperandrogenism. Clinical phenotypes of PCOS show different patterns of steroid hormones that have been investigated to some extent. This study aimed to establish a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of salivary testosterone and androstenedione and to describe the salivary testosterone-to-androstenedione (T/A4) ratio as a new tool for the assessment of hyperandrogenism and metabolic health. MATERIAL AND METHODS Saliva and serum samples of 274 patients with PCOS and 51 healthy women were used for the quantification of steroid hormones. A comprehensive clinical and metabolic assessment was performed. Salivary testosterone and androstenedione were measured via LC-MS/MS. The salivary T/A4 ratio was calculated and correlated with hormones and metabolic parameters. RESULTS Salivary testosterone (P < 0·001), androstenedione (P < 0·001) and the salivary T/A4 ratio (P < 0·001) were significantly higher in patients with patients compared to healthy women. In patients with PCOS, a high salivary T/A4 ratio was associated with an adverse metabolic phenotype, that is glucose intolerance (P = 0·019), insulin resistance (P < 0·001), metabolic syndrome (P < 0·001), obesity (P < 0·001) and oligo-/anovulation (P = 0·001). Significant correlations of the salivary T/A4 ratio with adverse metabolic parameters were found. CONCLUSION Quantification of salivary androgens provides an attractive alternative to serum analysis and helps in characterizing metabolic health in women with PCOS. Our data show a strong link between a high salivary T/A4 ratio and an adverse metabolic phenotype in patients with PCOS.
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Affiliation(s)
- J Münzker
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - L Lindheim
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - J Adaway
- Manchester Academic Health Science Centre, Department of Clinical Chemistry, University Hospital South Manchester, Manchester, UK
| | - C Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - E Lerchbaum
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - T R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - B Keevil
- Manchester Academic Health Science Centre, Department of Clinical Chemistry, University Hospital South Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
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29
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Wu C, Wei K, Jiang Z. 5α-reductase activity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol 2017; 15:21. [PMID: 28347315 PMCID: PMC5369013 DOI: 10.1186/s12958-017-0242-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/20/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND 5α-reductase activity might be important during the development of polycystic ovary syndrome (PCOS). However, the changes of 5α-reductase activity in PCOS subjects and the relationship between 5α-reductase activity and body mass index (BMI), insulin resistance (IR) remain largely unknown. METHODS We performed a meta-analysis to examine 5α-reductase activity in women with PCOS; exploratory subgroup analyses were also performed. RESULTS Five articles (with 356 cases and 236 controls) reporting 5α-reductase activity in patients with PCOS were selected for the meta-analysis. We observed significantly higher ratios of 5αTHF/THF (5α-reduced tetrahydrocortisol to 5β-reduced tetrahydrocortisol) and An/Et (androsteroneto/etiocholanolone) levels, which were used to assess 5α-reductase activity, among the patients with PCOS, [standardized mean differences (SMD) =0.43, 95%confidence intervals (95%CI) =0.25-0.61, P < 0.00001; SMD = 0.86, 95% CI = 0.29-1.44, P = 0.003]. We observed significant heterogeneity between studies for An/Et (I2 = 89% and P < 0.00001). According to the group analysis, women with PCOS exhibited increased 5α-reductase activity which was significantly associated with homeostasis model assessment of insulin resistance (HOMA-IR) regardless of obesity. CONCLUSIONS 5α-reductase activity was enhanced in women with PCOS. Increased 5α-reductase activity in patients with PCOS was related to IR.
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Affiliation(s)
- Chuyan Wu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke Wei
- Medical Service Section, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongli Jiang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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30
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O’Reilly MW, Kempegowda P, Jenkinson C, Taylor AE, Quanson JL, Storbeck KH, Arlt W. 11-Oxygenated C19 Steroids Are the Predominant Androgens in Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2017; 102:840-848. [PMID: 27901631 PMCID: PMC5460696 DOI: 10.1210/jc.2016-3285] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/29/2016] [Indexed: 12/27/2022]
Abstract
CONTEXT Androgen excess is a defining feature of polycystic ovary syndrome (PCOS), but the exact origin of hyperandrogenemia remains a matter of debate. Recent studies have highlighted the importance of the 11-oxygenated C19 steroid pathway to androgen metabolism in humans. In this study, we analyzed the contribution of 11-oxygenated androgens to androgen excess in women with PCOS. METHODS One hundred fourteen women with PCOS and 49 healthy control subjects underwent measurement of serum androgens by liquid chromatography-tandem mass spectrometry. Twenty-four-hour urinary androgen excretion was analyzed by gas chromatography-mass spectrometry. Fasting plasma insulin and glucose were measured for homeostatic model assessment of insulin resistance. Baseline demographic data, including body mass index, were recorded. RESULTS As expected, serum concentrations of the classic androgens testosterone (P < 0.001), androstenedione (P < 0.001), and dehydroepiandrosterone (P < 0.01) were significantly increased in PCOS. Mirroring this, serum 11-oxygenated androgens 11β-hydroxyandrostenedione, 11-ketoandrostenedione, 11β-hydroxytestosterone, and 11-ketotestosterone were significantly higher in PCOS than in control subjects, as was the urinary 11-oxygenated androgen metabolite 11β-hydroxyandrosterone. The proportionate contribution of 11-oxygenated to total serum androgens was significantly higher in patients with PCOS compared with control subjects [53.0% (interquartile range, 48.7 to 60.3) vs 44.0% (interquartile range, 32.9 to 54.9); P < 0.0001]. Obese (n = 51) and nonobese (n = 63) patients with PCOS had significantly increased 11-oxygenated androgens. Serum 11β-hydroxyandrostenedione and 11-ketoandrostenedione correlated significantly with markers of insulin resistance. CONCLUSIONS We show that 11-oxygenated androgens represent the majority of circulating androgens in women with PCOS, with close correlation to markers of metabolic risk.
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Affiliation(s)
- Michael W. O’Reilly
- Institute of Metabolism and Systems Research,
University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom;
- Centre for Endocrinology, Diabetes and Metabolism,
Birmingham Health Partners, Edgbaston, Birmingham B15 2TH, United Kingdom;
| | - Punith Kempegowda
- Institute of Metabolism and Systems Research,
University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom;
- Centre for Endocrinology, Diabetes and Metabolism,
Birmingham Health Partners, Edgbaston, Birmingham B15 2TH, United Kingdom;
| | - Carl Jenkinson
- Institute of Metabolism and Systems Research,
University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom;
- Centre for Endocrinology, Diabetes and Metabolism,
Birmingham Health Partners, Edgbaston, Birmingham B15 2TH, United Kingdom;
| | - Angela E. Taylor
- Institute of Metabolism and Systems Research,
University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom;
- Centre for Endocrinology, Diabetes and Metabolism,
Birmingham Health Partners, Edgbaston, Birmingham B15 2TH, United Kingdom;
| | - Jonathan L. Quanson
- Department of Biochemistry, Stellenbosch University,
Stellenbosch 7600, South Africa; and
| | - Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University,
Stellenbosch 7600, South Africa; and
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research,
University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom;
- Centre for Endocrinology, Diabetes and Metabolism,
Birmingham Health Partners, Edgbaston, Birmingham B15 2TH, United Kingdom;
- National Institute of Health Research (NIHR)
Birmingham Liver Biomedical Research Unit, University Hospital Birmingham, NHS
Foundation Trust, Birmingham B15 2GW, United Kingdom
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31
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Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev 2016; 37:467-520. [PMID: 27459230 PMCID: PMC5045492 DOI: 10.1210/er.2015-1104] [Citation(s) in RCA: 714] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/20/2016] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) was hypothesized to result from functional ovarian hyperandrogenism (FOH) due to dysregulation of androgen secretion in 1989-1995. Subsequent studies have supported and amplified this hypothesis. When defined as otherwise unexplained hyperandrogenic oligoanovulation, two-thirds of PCOS cases have functionally typical FOH, characterized by 17-hydroxyprogesterone hyperresponsiveness to gonadotropin stimulation. Two-thirds of the remaining PCOS have FOH detectable by testosterone elevation after suppression of adrenal androgen production. About 3% of PCOS have a related isolated functional adrenal hyperandrogenism. The remaining PCOS cases are mild and lack evidence of steroid secretory abnormalities; most of these are obese, which we postulate to account for their atypical PCOS. Approximately half of normal women with polycystic ovarian morphology (PCOM) have subclinical FOH-related steroidogenic defects. Theca cells from polycystic ovaries of classic PCOS patients in long-term culture have an intrinsic steroidogenic dysregulation that can account for the steroidogenic abnormalities typical of FOH. These cells overexpress most steroidogenic enzymes, particularly cytochrome P450c17. Overexpression of a protein identified by genome-wide association screening, differentially expressed in normal and neoplastic development 1A.V2, in normal theca cells has reproduced this PCOS phenotype in vitro. A metabolic syndrome of obesity-related and/or intrinsic insulin resistance occurs in about half of PCOS patients, and the compensatory hyperinsulinism has tissue-selective effects, which include aggravation of hyperandrogenism. PCOS seems to arise as a complex trait that results from the interaction of diverse genetic and environmental factors. Heritable factors include PCOM, hyperandrogenemia, insulin resistance, and insulin secretory defects. Environmental factors include prenatal androgen exposure and poor fetal growth, whereas acquired obesity is a major postnatal factor. The variety of pathways involved and lack of a common thread attests to the multifactorial nature and heterogeneity of the syndrome. Further research into the fundamental basis of the disorder will be necessary to optimally correct androgen levels, ovulation, and metabolic homeostasis.
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Affiliation(s)
- Robert L Rosenfield
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
| | - David A Ehrmann
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
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32
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Hawley JM, Keevil BG. Endogenous glucocorticoid analysis by liquid chromatography-tandem mass spectrometry in routine clinical laboratories. J Steroid Biochem Mol Biol 2016; 162:27-40. [PMID: 27208627 DOI: 10.1016/j.jsbmb.2016.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
Abstract
Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a powerful analytical technique that offers exceptional selectivity and sensitivity. Used optimally, LC-MS/MS provides accurate and precise results for a wide range of analytes at concentrations that are difficult to quantitate with other methodologies. Its implementation into routine clinical biochemistry laboratories has revolutionised our ability to analyse small molecules such as glucocorticoids. Whereas immunoassays can suffer from matrix effects and cross-reactivity due to interactions with structural analogues, the selectivity offered by LC-MS/MS has largely overcome these limitations. As many clinical guidelines are now beginning to acknowledge the importance of the methodology used to provide results, the advantages associated with LC-MS/MS are gaining wider recognition. With their integral role in both the diagnosis and management of hypo- and hyperadrenal disorders, coupled with their widespread pharmacological use, the accurate measurement of glucocorticoids is fundamental to effective patient care. Here, we provide an up-to-date review of the LC-MS/MS techniques used to successfully measure endogenous glucocorticoids, particular reference is made to serum, urine and salivary cortisol.
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Affiliation(s)
| | - Brian G Keevil
- University Hospital South Manchester, Manchester, UK; Manchester Healthcare Academy, Manchester, UK
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Dimitriadis GK, Barber TM. Obesity-related metabolic and reproductive dysfunction: variations between the sexes. Expert Rev Endocrinol Metab 2016; 11:387-393. [PMID: 30058907 DOI: 10.1080/17446651.2016.1220301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity prevalence remains at epidemic levels globally and is showing no signs of abating in either adult or child populations. Areas covered: Obesity-associated metabolic and reproductive diseases appear to be sexually dimorphic. Polycystic Ovary Syndrome (PCOS) and male obesity-associated secondary (hypogonadotrophic) hypogonadism (MOSH) represent two of the most common obesity associated endocrinopathies with sex-specific metabo-reproductive aberrations. These two diseases have entirely separate pathogeneses, with characteristic sex-specific clinico-pathological findings. These differences result from effects of sex-specific hormones, including estrogens and androgens. Such differences in sex-hormones also influence patterns of body-fat distribution. Expert commentary: This article focuses on sex-specific obesity-related metabolic and reproductive dysfunction. To illustrate key sex-related differences in the mechanisms by which obesity contributes towards metabolic and reproductive dysfunction, two common obesity-related conditions affecting women and men are considered: respectively, Polycystic Ovary Syndrome (PCOS) and Male Obesity-associated Secondary Hypogonadism (MOSH).
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Affiliation(s)
- Georgios K Dimitriadis
- a Division of Biomedical Sciences, Warwick Medical School , University of Warwick , Coventry , UK
- b Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism , University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
- c Division of Endocrinology and Investigative Medicine , Imperial College London , London , UK
| | - Thomas M Barber
- a Division of Biomedical Sciences, Warwick Medical School , University of Warwick , Coventry , UK
- b Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism , University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
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Barber TM, Dimitriadis GK, Andreou A, Franks S. Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance. Clin Med (Lond) 2016; 16:262-6. [PMID: 27251917 PMCID: PMC5922706 DOI: 10.7861/clinmedicine.16-3-262] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common condition that typically develops in reproductive-age women. The cardinal clinical and biochemical characteristics of PCOS include reproductive dysfunction and hyperandrogenic features. PCOS is also strongly associated with obesity based on data from epidemiological and genetic studies. Accordingly, PCOS often becomes manifest in those women who carry a genetic predisposition to its development, and who also gain weight. The role of weight gain and obesity in the development of PCOS is mediated at least in part, through worsening of insulin resistance. Compensatory hyperinsulinaemia that develops in this context disrupts ovarian function, with enhanced androgen production and arrest of ovarian follicular development. Insulin resistance also contributes to the strong association of PCOS with adverse metabolic risk, including dysglycaemia, dyslipidaemia and fatty liver. Conversely, modest weight loss of just 5% body weight with improvement in insulin sensitivity, frequently results in clinically meaningful improvements in hyperandrogenic, reproductive and metabolic features. Future developments of novel therapies for obese women with PCOS should focus on promotion of weight loss and improvement in insulin sensitivity. In this context, therapies that complement lifestyle changes such as dietary modification and exercise, particularly during the maintenance phase of weight loss are important. Putative novel targets for therapy in PCOS include human brown adipose tissue.
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Affiliation(s)
- Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, Coventry, UK, and Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - George K Dimitriadis
- Division of Biomedical Sciences, Warwick Medical School, Coventry, UK, and Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Avgi Andreou
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College, London, UK
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Idkowiak J, Taylor AE, Subtil S, O'Neil DM, Vijzelaar R, Dias RP, Amin R, Barrett TG, Shackleton CHL, Kirk JMW, Moss C, Arlt W. Steroid Sulfatase Deficiency and Androgen Activation Before and After Puberty. J Clin Endocrinol Metab 2016; 101:2545-53. [PMID: 27003302 PMCID: PMC4891801 DOI: 10.1210/jc.2015-4101] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Steroid sulfatase (STS) cleaves the sulfate moiety off steroid sulfates, including dehydroepiandrosterone (DHEA) sulfate (DHEAS), the inactive sulfate ester of the adrenal androgen precursor DHEA. Deficient DHEA sulfation, the opposite enzymatic reaction to that catalyzed by STS, results in androgen excess by increased conversion of DHEA to active androgens. STS deficiency (STSD) due to deletions or inactivating mutations in the X-linked STS gene manifests with ichthyosis, but androgen synthesis and metabolism in STSD have not been studied in detail yet. PATIENTS AND METHODS We carried out a cross-sectional study in 30 males with STSD (age 6-27 y; 13 prepubertal, 5 peripubertal, and 12 postpubertal) and 38 age-, sex-, and Tanner stage-matched healthy controls. Serum and 24-hour urine steroid metabolome analysis was performed by mass spectrometry and genetic analysis of the STS gene by multiplex ligation-dependent probe amplification and Sanger sequencing. RESULTS Genetic analysis showed STS mutations in all patients, comprising 27 complete gene deletions, 1 intragenic deletion and 2 missense mutations. STSD patients had apparently normal pubertal development. Serum and 24-hour urinary DHEAS were increased in STSD, whereas serum DHEA and testosterone were decreased. However, total 24-hour urinary androgen excretion was similar to controls, with evidence of increased 5α-reductase activity in STSD. Prepubertal healthy controls showed a marked increase in the serum DHEA to DHEAS ratio that was absent in postpubertal controls and in STSD patients of any pubertal stage. CONCLUSIONS In STSD patients, an increased 5α-reductase activity appears to compensate for a reduced rate of androgen generation by enhancing peripheral androgen activation in affected patients. In healthy controls, we discovered a prepubertal surge in the serum DHEA to DHEAS ratio that was absent in STSD, indicative of physiologically up-regulated STS activity before puberty. This may represent a fine tuning mechanism for tissue-specific androgen activation preparing for the major changes in androgen production during puberty.
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Affiliation(s)
- Jan Idkowiak
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Angela E Taylor
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Sandra Subtil
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Donna M O'Neil
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Raymon Vijzelaar
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Renuka P Dias
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Rakesh Amin
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Timothy G Barrett
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Cedric H L Shackleton
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Jeremy M W Kirk
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Celia Moss
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
| | - Wiebke Arlt
- Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609
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Nezi M, Christopoulos P, Paltoglou G, Gryparis A, Bakoulas V, Deligeoroglou E, Creatsas G, Mastorakos G. Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome. J Pediatr Endocrinol Metab 2016; 29:693-702. [PMID: 27089404 DOI: 10.1515/jpem-2015-0312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary amenorrhea, oligomenorrhea and secondary amenorrhea are diagnosed commonly during adolescence. Weight aberrations are associated with menstrual disorders. Autoimmune thyroiditis is frequent during adolescence. In this study, the commonest clinical and hormonal characteristics of amenorrhea or oligomenorrhea during adolescence were investigated. METHODS In this cross-sectional study, one hundred and thirty-eight consecutive young patients presenting with amenorrhea or oligomenorrhea referred to an adolescent endocrinology and gynecology university clinic were studied. Clinical examination and an abdominal ultrasound were performed. Testosterone, free-testosterone, estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, sex hormone binding globulin (SHBG), Δ4-androstenedione (Δ4A), free androgen index (FAI), insulin, glucose, thyroid stimulating hormone (TSH), total thyroxine (T4) (TT4), free T4 (FT4), total triiodothyronine (T3) (TT3) and free T3 (FT3). Concentrations were measured in blood samples. RESULTS Patients with primary and secondary amenorrhea presented more often with body mass index (BMI) <18.5 and BMI >25 kg/m2, respectively. BMI values correlated positively with insulin (r=0.742) and glucose (r=0.552) concentrations and negatively with glucose/insulin ratio values (r=-0.54); BMI values and insulin concentrations correlated positively with FAI values (r=0.629 and r=0.399, respectively). In all patients, BMI values correlated positively and negatively with free testosterone (r=0.249) and SHBG (r=-0.24) concentrations, respectively. In patients with secondary amenorrhea insulin concentrations correlated negatively with SHBG concentrations (r=-0.75). In patients with oligomenorrhea BMI values correlated positively with insulin (r=0.490) and TSH (r=0.325) concentrations, and negatively with SHBG (r=-0.33) concentrations. Seventy-two percent, 21% and 7% of patients presented with TSH concentrations <2.5 μIU/mL, between 2.5 μIU/mL, 4.5 μIU/mL and >4.5 μIU/mL (subclinical hypothyroidism), respectively. Following the definition of polycystic ovary syndrome (PCOS) according to either the National Institutes of Health (NIH) criteria or those proposed in the literature by Carmina and his team, patients presented mainly with oligomenorrhea or secondary amenorrhea. There was good agreement between patients with amenorrhea or oligomenorrhea fulfilling both of the PCOS definition criteria employed. CONCLUSIONS Among adolescent patients presenting with amenorrhea or oligomenorrhea for the first time those with low and high BMI present more often with primary and secondary amenorrhea, respectively. Obesity is involved in the development of hyperandrogenemia and hyperinsulinemia, particularly in PCOS patients. In these patients, subclinical hypothyroidism may be concealed and it should be investigated. These patients should be treated for abnormally increased or decreased BMI and be investigated for autoimmune thyroiditis.
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Torchen LC, Idkowiak J, Fogel NR, O'Neil DM, Shackleton CHL, Arlt W, Dunaif A. Evidence for Increased 5α-Reductase Activity During Early Childhood in Daughters of Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2016; 101:2069-75. [PMID: 26990942 PMCID: PMC4870855 DOI: 10.1210/jc.2015-3926] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a heritable, complex genetic disease. Animal models suggest that androgen exposure at critical developmental stages contributes to disease pathogenesis. We hypothesized that genetic variation resulting in increased androgen production produces the phenotypic features of PCOS by programming during critical developmental periods. Although we have not found evidence for increased in utero androgen levels in cord blood in the daughters of women with PCOS (PCOS-d), target tissue androgen production may be amplified by increased 5α-reductase activity analogous to findings in adult affected women. It is possible to noninvasively test this hypothesis by examining urinary steroid metabolites. OBJECTIVE We performed this study to investigate whether PCOS-d have altered androgen metabolism during early childhood. DESIGN, SETTING, AND PARTICIPANTS Twenty-one PCOS-d, 1-3 years old, and 36 control girls of comparable age were studied at an academic medical center. MAIN OUTCOME MEASURES Urinary steroid metabolites were measured by gas chromatography/mass spectrometry. Twenty-four hour steroid excretion rates and precursor to product ratios suggestive of 5α-reductase and 11β-hydroxysteroid dehydrogenase activities were calculated. RESULTS Age did not differ but weight for length Z-scores were higher in PCOS-d compared to control girls (P = .02). PCOS-d had increased 5α-tetrahydrocortisol:tetrahydrocortisol ratios (P = .04), suggesting increased global 5α-reductase activity. There was no evidence for differences in 11β-hydroxysteroid dehydrogenase activity. Steroid metabolite excretion was not correlated with weight. CONCLUSIONS Our findings suggest that differences in androgen metabolism are present in early childhood in PCOS-d. Increased 5α-reductase activity could contribute to the development of PCOS by amplifying target tissue androgen action.
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Affiliation(s)
- Laura C Torchen
- Division of Endocrinology, Metabolism, and Molecular Medicine (A.D.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Division of Pediatric Endocrinology (L.C.T., N.R.F.), Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Institute of Metabolism and Systems Research (J.I., D.M.O., C.H.L.S., W.A.), University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism (J.I., W.A.), Birmingham Health Partners, Birmingham B15 2TT, UK
| | - Jan Idkowiak
- Division of Endocrinology, Metabolism, and Molecular Medicine (A.D.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Division of Pediatric Endocrinology (L.C.T., N.R.F.), Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Institute of Metabolism and Systems Research (J.I., D.M.O., C.H.L.S., W.A.), University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism (J.I., W.A.), Birmingham Health Partners, Birmingham B15 2TT, UK
| | - Naomi R Fogel
- Division of Endocrinology, Metabolism, and Molecular Medicine (A.D.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Division of Pediatric Endocrinology (L.C.T., N.R.F.), Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Institute of Metabolism and Systems Research (J.I., D.M.O., C.H.L.S., W.A.), University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism (J.I., W.A.), Birmingham Health Partners, Birmingham B15 2TT, UK
| | - Donna M O'Neil
- Division of Endocrinology, Metabolism, and Molecular Medicine (A.D.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Division of Pediatric Endocrinology (L.C.T., N.R.F.), Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Institute of Metabolism and Systems Research (J.I., D.M.O., C.H.L.S., W.A.), University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism (J.I., W.A.), Birmingham Health Partners, Birmingham B15 2TT, UK
| | - Cedric H L Shackleton
- Division of Endocrinology, Metabolism, and Molecular Medicine (A.D.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Division of Pediatric Endocrinology (L.C.T., N.R.F.), Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Institute of Metabolism and Systems Research (J.I., D.M.O., C.H.L.S., W.A.), University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism (J.I., W.A.), Birmingham Health Partners, Birmingham B15 2TT, UK
| | - Wiebke Arlt
- Division of Endocrinology, Metabolism, and Molecular Medicine (A.D.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Division of Pediatric Endocrinology (L.C.T., N.R.F.), Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Institute of Metabolism and Systems Research (J.I., D.M.O., C.H.L.S., W.A.), University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism (J.I., W.A.), Birmingham Health Partners, Birmingham B15 2TT, UK
| | - Andrea Dunaif
- Division of Endocrinology, Metabolism, and Molecular Medicine (A.D.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Division of Pediatric Endocrinology (L.C.T., N.R.F.), Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611; Institute of Metabolism and Systems Research (J.I., D.M.O., C.H.L.S., W.A.), University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism (J.I., W.A.), Birmingham Health Partners, Birmingham B15 2TT, UK
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Barber TM, Dimitriadis GK, Andreou A, Franks S. Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance. Clin Med (Lond) 2015; 15 Suppl 6:s72-6. [PMID: 26634686 DOI: 10.7861/clinmedicine.15-6-s72] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common condition that typically develops in reproductive-age women. The cardinal clinical and biochemical characteristics of PCOS include reproductive dysfunction and hyperandrogenic features. PCOS is also strongly associated with obesity based on data from epidemiological and genetic studies. Accordingly, PCOS often becomes manifest in those women who carry a genetic predisposition to its development, and who also gain weight. The role of weight gain and obesity in the development of PCOS is mediated at least in part, through worsening of insulin resistance. Compensatory hyperinsulinaemia that develops in this context disrupts ovarian function, with enhanced androgen production and arrest of ovarian follicular development. Insulin resistance also contributes to the strong association of PCOS with adverse metabolic risk, including dysglycaemia, dyslipidaemia and fatty liver. Conversely, modest weight loss of just 5% body weight with improvement in insulin sensitivity, frequently results in clinically meaningful improvements in hyperandrogenic, reproductive and metabolic features. Future developments of novel therapies for obese women with PCOS should focus on promotion of weight loss and improvement in insulin sensitivity. In this context, therapies that complement lifestyle changes such as dietary modification and exercise, particularly during the maintenance phase of weight loss are important. Putative novel targets for therapy in PCOS include human brown adipose tissue.
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Affiliation(s)
- Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, Coventry, UK, and Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - George K Dimitriadis
- Division of Biomedical Sciences, Warwick Medical School, Coventry, UK, and Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Avgi Andreou
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College, London, UK
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Barber TM, Vojtechova P, Franks S. The impact of hyperandrogenism in female obesity and cardiometabolic diseases associated with polycystic ovary syndrome. Horm Mol Biol Clin Investig 2015; 15:91-103. [PMID: 25436736 DOI: 10.1515/hmbci-2013-0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/03/2013] [Indexed: 11/15/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common condition characterized by reproductive and hyperandrogenic features and is often associated with obesity and metabolic dysfunction. Overall, women with PCOS have a substantially greater prevalence of metabolic syndrome than women from the general population. Furthermore, PCOS per se (independent of its frequent association with obesity) often confers cardiometabolic risk (including insulin resistance), and its concurrence with obesity often represents a metabolic "double-whammy" from the adverse effects of PCOS and obesity. The introduction of the Rotterdam diagnostic criteria for PCOS in 2003 has broadened the scope of this condition. The Rotterdam diagnostic criteria have also introduced two new phenotypic subgroups (including normoandrogenemic women with PCOS) that have provided novel insights into a potential role for hyperandrogenism in the development of adverse cardiometabolic risk in women with PCOS. Based on evidence from cross-sectional and interventional studies, hyperandrogenism, obesity, and cardiometabolic risk in women appear to be linked through complex and multidirectional pathways. Furthermore, data from obese women without a formal diagnosis of PCOS also suggest that these interrelationships often exist in female obesity per se (in milder forms than occurs in PCOS). Data from female-to-male transsexuals are particularly informative because these show direct effects of hyperandrogenism (induced through exogenous use of androgenic therapies) on fat distribution and cardiometabolic risk in women. A challenge for the future will be to disentangle and improve our understanding of this complex pathogenic web, thereby facilitating novel and targeted therapies for the hyperandrogenic and adverse cardiometabolic manifestations of PCOS.
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Affiliation(s)
- Thomas M Barber
- Clinical Sciences Research Laboratories, Division of Metabolic and Vascular Health, University of Warwick, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
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Mantelli F, Moretti C, Macchi I, Massaro-Giordano G, Cozzupoli GM, Lambiase A, Bonini S. Effects of Sex Hormones on Ocular Surface Epithelia: Lessons Learned From Polycystic Ovary Syndrome. J Cell Physiol 2015; 231:971-5. [PMID: 26491950 DOI: 10.1002/jcp.25221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age. Although its clinical consequences have been known for a long time to extend beyond the reproductive system, with type-2 diabetes and obesity being the most common, the involvement of the ocular surface in PCOS has been described only more recently. The ocular surface is a morphofunctional unit comprising eyelid margin, tear film, cornea, and conjunctiva. Increasing evidence indicates that these structures are under a sex hormone control and relevant diseases such as ocular allergy and dry eye are often caused by alterations in circulating or local steroid hormones levels. Novel treatments targeting sex hormone receptors on ocular surface epithelial cells are also being developed. In this review we aim to describe the current knowledge on the effects of sex hormones at the ocular surface, with a special focus on the effects of androgen imbalance in PCOS.
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Affiliation(s)
- Flavio Mantelli
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania
| | - Costanzo Moretti
- Department of Endocrinology, Tor Vergata University of Rome, Rome, Italy
| | - Ilaria Macchi
- Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | | | - Stefano Bonini
- Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome, Italy
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Sherlock M, Behan LA, Hannon MJ, Alonso AA, Thompson CJ, Murray RD, Crabtree N, Hughes BA, Arlt W, Agha A, Toogood AA, Stewart PM. The modulation of corticosteroid metabolism by hydrocortisone therapy in patients with hypopituitarism increases tissue glucocorticoid exposure. Eur J Endocrinol 2015; 173:583-93. [PMID: 26264718 DOI: 10.1530/eje-15-0490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/10/2015] [Indexed: 11/08/2022]
Abstract
CONTEXT Patients with hypopituitarism have increased morbidity and mortality. There is ongoing debate about the optimum glucocorticoid (GC) replacement therapy. OBJECTIVE To assess the effect of GC replacement in hypopituitarism on corticosteroid metabolism and its impact on body composition. DESIGN AND PATIENTS We assessed the urinary corticosteroid metabolite profile (using gas chromatography/mass spectrometry) and body composition (clinical parameters and full body DXA) of 53 patients (19 female, median age 46 years) with hypopituitarism (33 ACTH-deficient/20 ACTH-replete) (study A). The corticosteroid metabolite profile of ten patients with ACTH deficiency was then assessed prospectively in a cross over study using three hydrocortisone (HC) dosing regimens (20/10 mg, 10/10 mg and 10/5 mg) (study B) each for 6 weeks. 11 beta-hydroxysteroid dehydrogenase 1 (11β-HSD1) activity was assessed by urinary THF+5α-THF/THE. SETTING Endocrine Centres within University Teaching Hospitals in the UK and Ireland. MAIN OUTCOME MEASURES Urinary corticosteroid metabolite profile and body composition assessment. RESULTS In study A, when patients were divided into three groups - patients not receiving HC and patients receiving HC≤20 mg/day or HC>20 mg/day - patients in the group receiving the highest daily dose of HC had significantly higher waist-to-hip ratio (WHR) than the ACTH replete group. They also had significantly elevated THF+5α-THF/THE (P=0.0002) and total cortisol metabolites (P=0.015). In study B, patients on the highest HC dose had significantly elevated total cortisol metabolites and all patients on HC had elevated THF+5α-THF/THE ratios when compared to controls. CONCLUSIONS In ACTH-deficient patients daily HC doses of >20 mg/day have increased WHR, THF+5α-THF/THE ratios and total cortisol metabolites. GC metabolism and induction of 11β-HSD1 may play a pivitol role in the development of the metabolically adverse hypopituitary phenotype.
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Affiliation(s)
- Mark Sherlock
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Lucy Ann Behan
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Mark J Hannon
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Aurora Aragon Alonso
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Christopher J Thompson
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Robert D Murray
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Nicola Crabtree
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Beverly A Hughes
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Wiebke Arlt
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Amar Agha
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Andrew A Toogood
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
| | - Paul M Stewart
- Centre for EndocrinologyDiabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Endocrinology and DiabetesAdelaide and Meath Hospitals, Incorporating the National Children's Hospital and Trinity College, Tallaght Hospital, Dublin 24, IrelandDepartment of EndocrinologyDiabetes and Metabolism, Beaumont Hospital and RCSI Medical School, Dublin, IrelandDepartment of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UKDepartment of Nuclear MedicineQueen Elizabeth Hospital, Birmingham, UKDepartment of Medicine and EndocrinologyUniversity of Leeds, Leeds, UK
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Association Analysis between the Polymorphisms of HSD11B1 and H6PD and Risk of Polycystic Ovary Syndrome in Chinese Population. PLoS One 2015; 10:e0140326. [PMID: 26452272 PMCID: PMC4599835 DOI: 10.1371/journal.pone.0140326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/24/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives To evaluate whether single nucleotide polymorphisms of HSD11B1 (rs846908) and H6PD (rs6688832 and rs17368528) are associated with polycystic ovary syndrome (PCOS) in Chinese population. Materials and Methods A case-control study was implemented to investigate the association between HSD11B1 and H6PD polymorphisms and PCOS. Patients with PCOS (n = 335) and controls (n = 354) were recruited in this study. Genetic variants of HSD11B1 (rs846908) and H6PD (rs6688832 and rs17368528) were analyzed by TaqMan method. Results We found a significantly 0.79-fold lower risk of G allele of rs6688832 in control group compared with the patients with PCOS (adjusted OR, 0.79; 95%CI = 0.63–0.99; P = 0.040). Additionally, significant difference in the levels of follicle stimulating hormone (FSH) was observed between AA and AG genotype in rs6688832. The rs6688832 AG genotype was associated with lower level of FSH (P = 0.039) and higher risk of hyperandrogenism (P = 0.016) in patients with PCOS. When all subjects were divided into different subgroups according to age and body mass index (BMI), we found that the frequency of G allele of rs6688832 was significantly higher in controls than that in PCOS patients in the subgroup of BMI > 23 (adjusted OR, 0.70; 95% CI = 0.50–0.98; P = 0.037). Conclusions Our findings showed a statistical association between H6PD rs6688832 and PCOS risk in Chinese population. The G allele of rs6688832 in H6PD might exert potential genetic protective role against the development of PCOS, especially in overweight women. PCOS patients with AG genotype of rs6688832 might confer risk to the phenotype of hyperandrogenemia of PCOS.
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Goodarzi MO, Carmina E, Azziz R. DHEA, DHEAS and PCOS. J Steroid Biochem Mol Biol 2015; 145:213-25. [PMID: 25008465 DOI: 10.1016/j.jsbmb.2014.06.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/16/2014] [Accepted: 06/05/2014] [Indexed: 11/17/2022]
Abstract
Approximately 20-30% of PCOS women demonstrate excess adrenal precursor androgen (APA) production, primarily using DHEAS as a marker of APA in general and more specifically DHEA, synthesis. The role of APA excess in determining or causing PCOS is unclear, although observations in patients with inherited APA excess (e.g., patients with 21-hydroxylase deficient congenital classic or non-classic adrenal hyperplasia) demonstrate that APA excess can result in a PCOS-like phenotype. Inherited defects of the enzymes responsible for steroid biosynthesis, or defects in cortisol metabolism, account for only a very small fraction of women suffering from hyperandrogenism or APA excess. Rather, women with PCOS and APA excess appear to have a generalized exaggeration in adrenal steroidogenesis in response to ACTH stimulation, although they do not have an overt hypothalamic-pituitary-adrenal axis dysfunction. In general, extra-adrenal factors, including obesity, insulin and glucose levels, and ovarian secretions, play a limited role in the increased APA production observed in PCOS. Substantial heritabilities of APAs, particularly DHEAS, have been found in the general population and in women with PCOS; however, the handful of SNPs discovered to date account only for a small portion of the inheritance of these traits. Paradoxically, and as in men, elevated levels of DHEAS appear to be protective against cardiovascular risk in women, although the role of DHEAS in modulating this risk in women with PCOS remains unknown. In summary, the exact cause of APA excess in PCOS remains unclear, although it may reflect a generalized and inherited exaggeration in androgen biosynthesis of an inherited nature.
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Affiliation(s)
| | | | - Ricardo Azziz
- Georgia Regents University, Office of the President, 120 15th St., AA 311, Augusta, GA 30912, USA.
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Crowley RK, Hughes B, Gray J, McCarthy T, Hughes S, Shackleton CHL, Crabtree N, Nightingale P, Stewart PM, Tomlinson JW. Longitudinal changes in glucocorticoid metabolism are associated with later development of adverse metabolic phenotype. Eur J Endocrinol 2014; 171:433-42. [PMID: 24986533 DOI: 10.1530/eje-14-0256] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Dysregulation of enzymes that control local tissue steroid metabolism has been implicated in the pathogenesis of obesity and insulin resistance; however, longitudinal changes in glucocorticoid metabolism have not been investigated. This study was performed to evaluate the role of glucocorticoid metabolism in the development of insulin resistance and obesity and to identify biomarkers for future development of metabolic disease. DESIGN This was a prospective longitudinal observation study conducted over 5 years. METHODS A 24-h collection was used to serially analyze urinary glucocorticoid and mineralocorticoid metabolites in 57 obese and overweight patients with no prior diagnosis of diabetes mellitus, recruited from the community. RESULTS Baseline higher 5α-reductase (5αR) activity, but not 11β-hydroxysteroid dehydrogenase type 1 activity, was predictive of increased fasting insulin at final visit (11.4 compared with 7.4 mU/l in subjects with lower 5αR activity, P<0.05), area under the curve insulin response to oral glucose tolerance test (176.7 compared with 89.1 mU/l.h, P<0.01), and homeostasis model assessment (HOMA2-IR; 1.3 compared with 0.8, P<0.01). Higher total glucocorticoid production was associated with abnormal glucose tolerance and increased BMI. During this study, systolic blood pressure increased (equivalent to ∼1 mmHg/year), as did plasma sodium levels; this evidence of increased mineralocorticoid activity was associated with increased aldosterone metabolites and decreased 11β-hydroxysteroid dehydrogenase type 2 activity. CONCLUSIONS Increased 5αR activity and glucocorticoid secretion rate over time are linked with the development of metabolic disease, and may represent targets for therapeutic intervention, which merits further study.
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Affiliation(s)
- Rachel K Crowley
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Beverly Hughes
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Joanna Gray
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Theresa McCarthy
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Susan Hughes
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Cedric H L Shackleton
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Nicola Crabtree
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Peter Nightingale
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Paul M Stewart
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Jeremy W Tomlinson
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
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Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, Kelestimur F, Macut D, Micic D, Pasquali R, Pfeifer M, Pignatelli D, Pugeat M, Yildiz BO. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2014; 171:P1-29. [PMID: 24849517 DOI: 10.1530/eje-14-0253] [Citation(s) in RCA: 364] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.
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Affiliation(s)
- Gerard Conway
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Didier Dewailly
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Evanthia Diamanti-Kandarakis
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Héctor F Escobar-Morreale
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Stephen Franks
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alessandra Gambineri
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Fahrettin Kelestimur
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Djuro Macut
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Dragan Micic
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Renato Pasquali
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marija Pfeifer
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Duarte Pignatelli
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Michel Pugeat
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent O Yildiz
- Department of EndocrinologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceEndocrine Unit3rd Department of Medicine, University of Athens Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, Medical Faculty, University Medical Centre, University of Ljubljana, Ljubljana, SloveniaDepartment of EndocrinologyFaculty of Medicine of Porto, Hospital S. Joao, Porto, PortugalInsermFédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, France andDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Gambineri A, Fanelli F, Tomassoni F, Munarini A, Pagotto U, Andrew R, Walker BR, Pasquali R. Tissue-specific dysregulation of 11β-hydroxysteroid dehydrogenase type 1 in overweight/obese women with polycystic ovary syndrome compared with weight-matched controls. Eur J Endocrinol 2014; 171:47-57. [PMID: 24743397 DOI: 10.1530/eje-13-1030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT Abnormal cortisol metabolism in polycystic ovary syndrome (PCOS) has been invoked as a cause of secondary activation of the hypothalamic-pituitary-adrenal axis and hence androgen excess. However, this is based on urinary excretion of cortisol metabolites, which cannot detect tissue-specific changes in metabolism and may be confounded by obesity. OBJECTIVE To assess cortisol clearance and whole-body and tissue-specific activities of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1 (HSD11B1)) in PCOS. DESIGN Case-control study. SETTING Medical center. PATIENTS A total of 20 overweight-obese unmedicated Caucasian women with PCOS, aged 18-45 years, and 20 Caucasian controls matched for age, BMI, body fat distribution, and HSD11B1 genotypes (rs846910 and rs12086634). MAIN OUTCOME MEASURES Cortisol metabolites were measured in 24 h urine. During steady-state 9,11,12,12-[(2)H]4-cortisol infusion, cortisol clearance was calculated and whole-body HSD11B1 activity was assessed as the rate of appearance of 9,12,12-(2)H3-cortisol (d3-cortisol). Hepatic HSD11B1 activity was quantified as the generation of plasma cortisol following an oral dose of cortisone. Subcutaneous adipose HSD11B1 activity and HSD11B1 mRNA were measured, ex vivo, in biopsies. RESULTS Urinary cortisol metabolite excretion, deuterated cortisol clearance, and the rate of appearance of d3-cortisol did not differ between patients with PCOS and controls. However, hepatic HSD11B1 conversion of oral cortisone to cortisol was impaired (P<0.05), whereas subcutaneous abdominal adipose tissue HSD11B1 mRNA levels and activity were increased (P<0.05) in women with PCOS when compared with controls. CONCLUSIONS Tissue-specific dysregulation of HSD11B1 is a feature of PCOS, over and above obesity, whereas increased clearance of cortisol may result from obesity rather than PCOS.
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Affiliation(s)
- Alessandra Gambineri
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Flaminia Fanelli
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Federica Tomassoni
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Alessandra Munarini
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Uberto Pagotto
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ruth Andrew
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Brian R Walker
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Renato Pasquali
- Division of EndocrinologyDepartment of Medical and Surgical Science, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyEndocrinology UnitQueen's Medical Research Institute, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
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Cuzzola A, Mazzini F, Petri A. A comprehensive study for the validation of a LC–MS/MS method for the determination of free and total forms of urinary cortisol and its metabolites. J Pharm Biomed Anal 2014; 94:203-9. [DOI: 10.1016/j.jpba.2014.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 02/07/2014] [Accepted: 02/09/2014] [Indexed: 11/28/2022]
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Keefe CC, Goldman MM, Zhang K, Clarke N, Reitz RE, Welt CK. Simultaneous measurement of thirteen steroid hormones in women with polycystic ovary syndrome and control women using liquid chromatography-tandem mass spectrometry. PLoS One 2014; 9:e93805. [PMID: 24713888 PMCID: PMC3979722 DOI: 10.1371/journal.pone.0093805] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/06/2014] [Indexed: 11/20/2022] Open
Abstract
Background The measurement of adrenal and ovarian androgens in women with PCOS has been difficult based on poor specificity and sensitivity of assays in the female range. Methods Women with PCOS (NIH criteria; n = 52) and control subjects with 25–35 day menstrual cycles, no evidence of hyperandrogenism and matched for BMI (n = 42) underwent morning blood sampling. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to simultaneously measure 13 steroids from a single blood sample to measure adrenal and ovarian steroids. Androgen and progesterone results were compared in the same samples using RIA. Results Testosterone, androstenedione, progesterone and 17OH progesterone levels were higher when measured using RIA compared to LC-MS/MS, although the testosterone RIA demonstrated the best agreement with the LC-MS/MS using a Bland-Altman analysis. Results using LC-MS/MS demonstrated that the concentration of androgens and their precursors were higher in women with PCOS than controls [median (2.5, 97.5th %ile); 1607 (638, 3085) vs. 1143 (511, 4784) ng/dL; p = 0.03]. Women with PCOS had higher testosterone [49 (16, 125) vs. 24 (10, 59) ng/dL], androstenedione [203 (98, 476) vs. 106 (69, 223) ng/dL] and 17OH progesterone levels [80 (17, 176) vs. 44 (17, 142) ng/dL] compared to controls (all P<0.02), but no differences in serum concentrations of the adrenal steroids DHEAS, cortisol, corticosterone and their 11 deoxy precursors. Women with PCOS also had an increase in the product:precursor ratio for 3β-hydroxysteroid dehydrogenase [22% (6, 92) vs. 20% (4, 43); p = 0.009]. Conclusion LC-MS/MS was superior to RIA in measuring androstenedione, progesterone and 17OH progesterone levels, while testosterone measurements were better matched in the two assays. Androgen levels were higher in women with PCOS in the absence of a difference in adrenal-predominant steroids. These data support previous findings that the ovary is an important source for the androgen excess in women with PCOS.
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Affiliation(s)
- Candace C. Keefe
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachussetts, United States of America
| | - Mildred M. Goldman
- Steroids Department, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Ke Zhang
- Steroids Department, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Nigel Clarke
- Steroids Department, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Richard E. Reitz
- Steroids Department, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Corrine K. Welt
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachussetts, United States of America
- * E-mail:
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Anderson AD, Solorzano CMB, McCartney CR. Childhood obesity and its impact on the development of adolescent PCOS. Semin Reprod Med 2014; 32:202-13. [PMID: 24715515 DOI: 10.1055/s-0034-1371092] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity exacerbates the reproductive and metabolic manifestations of polycystic ovary syndrome (PCOS). The symptoms of PCOS often begin in adolescence, and the rising prevalence of peripubertal obesity has prompted concern that the prevalence and severity of adolescent PCOS is increasing in parallel. Recent data have disclosed a high prevalence of hyperandrogenemia among peripubertal adolescents with obesity, suggesting that such girls are indeed at risk for developing PCOS. Obesity may impact the risk of PCOS via insulin resistance and compensatory hyperinsulinemia, which augments ovarian/adrenal androgen production and suppresses sex hormone-binding globulin (SHBG), thereby increasing androgen bioavailability. Altered luteinizing hormone (LH) secretion plays an important role in the pathophysiology of PCOS, and although obesity is generally associated with relative reductions of LH, higher LH appears to be the best predictor of increased free testosterone among peripubertal girls with obesity. Other potential mechanisms of obesity-associated hyperandrogenemia include enhanced androgen production in an expanded fat mass and potential effects of abnormal adipokine/cytokine levels. Adolescents with PCOS are at risk for comorbidities such as metabolic syndrome and impaired glucose tolerance, and concomitant obesity compounds these risks. For all of these reasons, weight loss represents an important therapeutic target in obese adolescents with PCOS.
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Affiliation(s)
- Amy D Anderson
- Center for Research in Reproduction, University of Virginia School of Medicine
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Becerra-Fernández A, Pérez-López G, Román MM, Martín-Lazaro JF, Lucio Pérez MJ, Asenjo Araque N, Rodríguez-Molina JM, Berrocal Sertucha MC, Aguilar Vilas MV. Prevalence of hyperandrogenism and polycystic ovary syndrome in female to male transsexuals. ACTA ACUST UNITED AC 2014; 61:351-8. [PMID: 24680383 DOI: 10.1016/j.endonu.2014.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Prevalence of hyperandrogenism (HA), including the polycystic ovary syndrome (PCOS), in female-to-male transsexuals (FMT) is high. This has been related to metabolic syndrome (MS), which appears to increase cardiovascular morbidity and mortality throughout cross-sex hormone (CSH) therapy. OBJECTIVES To assess the prevalence of HA and PCOS in FMT patients before the start of CSH therapy, and their association to MS and its components, insulin resistance (IR) and other cardiovascular risk (CVR) factors. MATERIALS AND METHODS Seventy-seven FMTs underwent clinical and biochemical assessment for HA before the start of CSH therapy. CVR, IR, and other MS parameters were also assessed. RESULTS Prevalence of HA was 49.4% (73.7% were cases of PCOS [Rotterdam criteria]), and prevalence of PCOS in the overall sample was 36.4%. Prevalence of MS was 38.4% and 51.7% according to ATP-III and IDF criteria respectively). MS (according to ATP-III and IDF criteria respectively) was found in 36.8% and 57.9% as compared to 25.6% and 41% of patients with and without HA respectively (p<0.0001 and P<0.01 respectively). Of total patients, 54.5% had normal weight (body mass index [BMI] 18.5-24.9 kg.m(-2)), 26% were overweight (BMI 25-29.9 kg.m(-2)), and 19.5% were obese (BMI ≥ 30 kg.m(-2)). After adjusting for BMI, the comparison of hormonal, metabolic, and anthropometric parameters showed statistically significant differences in plasma glucose, HOMA-IR, and abdominal circumference (P<0.001 for all), as well as HDL cholesterol (HDL) (P=0.033), but not in total testosterone or calculated free testosterone levels. In the total sample, 27.3% had HDL levels less than 50mg/dL. CONCLUSIONS Overall HA, and PCOS in particular, are highly prevalent in FMTs. HA and PCOS are related to early development of SM, IR, and other CVR factors with unknown consequences in adulthood.
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Affiliation(s)
- Antonio Becerra-Fernández
- Unidad de Identidad de Género, Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
| | | | - Miriam Menacho Román
- Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Juan F Martín-Lazaro
- Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Jesús Lucio Pérez
- Unidad de Identidad de Género, Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Nuria Asenjo Araque
- Unidad de Identidad de Género, Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España
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