Changes in clinical and biochemical characteristics of polycystic ovary syndrome with advancing age

Anthropometric, Metabolic, and Endocrine Parameters as Predictors of Estimated Average Glucose and Other Biomarkers of Dysglycemia in Women with Different Phenotypes of Polycystic Ovary Syndrome

The aim of the study was to evaluate the efficacy of anthropometric, metabolic, and endocrine abnormalities as predictors of estimated average glucose and other biomarkers of dysglycemia in women with different phenotypes of polycystic ovary syndrome (PCOS). This cross-sectional study included 648 women with PCOS and 330 controls. A single protocol of investigation was applied for all subjects. PCOS women were divided by phenotypes according to the Rotterdam criteria. Biomarkers of dysglycemia were considered dependent variables and anthropometric, lipid, and hormone alterations as independent variables using univariate and multivariate logistic regressions. Univariate logistic regression analysis, controlled for age and BMI, showed that many biomarkers of dysglycemia could be predicted by anthropometric, lipid, and endocrine variables. Multivariate logistic models showed that in non-PCOS women estimated average glucose (eAG) was predicted by lower TSH levels (OR=0.39; p=0.045); fasting glucose was predicted by increased T (OR=2.3). For PCOS, phenotype A, eAG was predicted by decreased HDL-C (OR=0.17, p=0.023) and high levels of free estradiol (OR=7.1, p<0.001). Otherwise, in PCOS, phenotype D, eAG was predicted by higher levels of HDL-C. The current study demonstrated that eAG was poorly predicted by anthropometric, lipid, and hormone parameters. Nevertheless, without adding significant benefits, it was comparable with other established markers of dysglycemia in women with different PCOS phenotypes.

Is polycystic ovary syndrome a risk factor for depression and anxiety?: a cross-sectional study

OBJECTIVE

The objective of this study was to learn more about the prevalence and pathophysiology of depression and anxiety that may be caused by polycystic ovary syndrome and to make plans for taking necessary precautions for this vulnerable group.

METHODS

This case-control study was conducted between January 2022 and October 2022. A total of 120 women with polycystic ovary syndrome and 143 controls were included in the study. All healthy volunteers and women with polycystic ovary syndrome were evaluated using self-administered questionnaires and physical examination. Anthropometric data such as weight and height and laboratory value were documented.

RESULTS

There was no significant difference between the groups in terms of demographic characteristics. When the Hospital Anxiety and Depression Scale scores of both groups were compared, both depression and anxiety scores were found to be significantly higher in women with polycystic ovary syndrome compared with the control group (OR: 3.319, 95%CI, 1.563-7.047, p<0.001 and OR: 3.238, 95%CI, 1.659-6.315, p<0.001). In the Hospital Anxiety and Depression Scale questionnaire, the rate of irregular menstruation and Ferriman-Gallwey score were statistically significant in women with polycystic ovary syndrome with high depression and anxiety scores. While serum LH levels and LH/FSH ratios were significantly different in women with polycystic ovary syndrome with high depression scores, serum LH, LH:FSH ratios, and serum total testosterone levels were found significant in women with polycystic ovary syndrome with high anxiety scores.

CONCLUSION

It is clear that depression and anxiety are more common in patients with polycystic ovary syndrome than in healthy women. Our findings support previous recommendations regarding routine screening for depression and anxiety in this population.

White-brown adipose tissue interplay in polycystic ovary syndrome: Therapeutic avenues

This study highlights the therapeutic potential of activating brown adipose tissue (BAT) for managing polycystic ovary syndrome (PCOS), a prevalent endocrine disorder associated with metabolic and reproductive abnormalities. BAT plays a crucial role in regulating energy expenditure and systemic insulin sensitivity, making it an attractive target for the treatment of obesity and metabolic diseases. Recent research suggests that impaired BAT function and mass may contribute to the link between metabolic disturbances and reproductive issues in PCOS. Additionally, abnormal white adipose tissue (WAT) can exacerbate these conditions by releasing adipokines and nonesterified fatty acids. In this review, we explored the impact of WAT changes on BAT function in PCOS and discussed the potential of BAT activation as a therapeutic strategy to improve PCOS symptoms. We propose that BAT activation holds promise for managing PCOS; however, further research is needed to confirm its efficacy and to develop clinically feasible methods for BAT activation.

Polycystic ovary syndrome: pathophysiology and therapeutic opportunities

Polycystic ovary syndrome is characterised by excessive levels of androgens and ovulatory dysfunction, and is a common endocrine disorder in women of reproductive age. Polycystic ovary syndrome arises as a result of polygenic susceptibility in combination with environmental influences that might include epigenetic alterations and in utero programming. In addition to the well recognised clinical manifestations of hyperandrogenism and ovulatory dysfunction, women with polycystic ovary syndrome have an increased risk of adverse mental health outcomes, pregnancy complications, and cardiometabolic disease. Unlicensed treatments have limited efficacy, mostly because drug development has been hampered by an incomplete understanding of the underlying pathophysiological processes. Advances in genetics, metabolomics, and adipocyte biology have improved our understanding of key changes in neuroendocrine, enteroendocrine, and steroidogenic pathways, including increased gonadotrophin releasing hormone pulsatility, androgen excess, insulin resistance, and changes in the gut microbiome. Many patients with polycystic ovary syndrome have high levels of 11-oxygenated androgens, with high androgenic potency, that might mediate metabolic risk. These advances have prompted the development of new treatments, including those that target the neurokinin-kisspeptin axis upstream of gonadotrophin releasing hormone, with the potential to lessen adverse clinical sequelae and improve patient outcomes.

Hormonal and Metabolic Factors Influence the Action of Progesterone on the Endometrium of Women with Polycystic Ovary Syndrome

Hormonal and metabolic factors may influence endometrial quality and interfere with the action of progesterone. Therefore, the aim of our study was to address this issue. Participants were recruited from an outpatient reproductive endocrinology clinic at an academic tertiary medical care centre. All subjects underwent endometrial biopsy (EB) in the follicular phase of the cycle prior to treatment. Thereafter, they were treated with micronized progesterone (400 mg/day × 10 days intravaginally) from days 14-28 of the next cycle. A second EB was performed between days 21-24 of the cycle (the second phase). The metabolic and hormonal serum levels were evaluated during the implantation window. EB samples were analysed using light microscopy for histomorphometric analysis. The endometrium of women with Polycystic Ovarian Syndrome (PCOS) in the second phase demonstrated a uniform surface epithelium with less leukocyte infiltration and an absence of apoptotic figures compared to the control group. (p < 0.021). The thickness of the surface epithelium in the second phase of the PCOS group correlated positively with free and bioavailable testosterone values. The number of stromal cells increases with increasing insulin levels. Our results suggest that histomorphometric abnormalities of the endometrium persist and are linked to androgen and insulin levels despite progesterone supplementation in PCOS.

Multi Interventional Strategies on physiological and biochemical parameters on Polycystic Ovarian Syndrome – A Pilot Report

Background: Polycystic ovarian syndrome (PCOS) is a heterogeneous, chronic endocrine disorder commonly diagnosed in women of reproductive age. It often manifests with some or all of the following symptoms: menstrual dysfunction, infertility, hirsutism, acne, and obesity. Polycystic ovarian syndrome has now become one of the major health problem among adolescent and adult women. Lifestyle modifications, including diet modifications, exercise, and behavioral modification, appear to alleviate the metabolic dysfunction and improve the reproductive disorders of girls with PCOS. Therefore, lifestyle modifications have been gradually acknowledged as the first-line management for PCOS. Methods: Quantitative experimental and control group pre and post test design was used in this study.A total of 152 young girls from different colleges in Chennai were screened based on Rotterdam criteria and among that 30 study participants were selected who met the inclusion criteria. Structured self-administered questionnaire was used to elicit the baseline data. Participants were divided into three groups, 10 in each group – control group (only education regarding PCOS), experimental group I with all three interventions (cinnamon tea, exercise program and anxiety reduction counselling) given for 3 months, experimental group 2 with exercise program and anxiety reduction counselling given for 3 months. Post test I is conducted after 45 days and post test II is conducted after 3 months. Non probability Purposive sampling technique was used. Prior permissions were obtained from all the college principals and dean. Informed consent was obtained from all the participants. Results: This study shows that there was significant decrease (P<0.001) in the Physiological parameters (BMI, Waist circumference) and biochemical parameters (Total testosterone level) of experimental 1 group with multi interventional strategies (cinnamon tea, exercise program and anxiety reduction counselling) when compared to experimental 2 group and control group. There was better reduction in the experimental 2 group (exercise program and anxiety reduction counselling) when compared to the control group. There is increase in BMI, Waist circumference and total testosterone level in the control group when compared to experimental 1 and 2 groups. Conclusion: The present study highlighted the beneficial role of multi interventional strategies (cinnamon tea, exercise program and anxiety reduction counselling) in reducing the BMI, waist circumference and total testosterone level of young girls with Polycystic ovarian syndrome. Hence, the study recommends multi interventional strategies for young girls with Polycystic ovarian syndrome.

A study on changes in hormonal disruption in polycystic ovary syndrome with advancing age and body mass index

Introduction and Aim: Polycystic ovary syndrome is a diverse condition that contributes to metabolic problems like insulin resistance and hyperandrogenism which women experience during their reproductive years, and it is closely related to the body mass index. The purpose of this study was to evaluate the clinical, biochemical, and hormonal profiles of PCOS patients and healthy women concerning age and BMI and to correlate insulin with other parameters.   Materials and Methods: The present case-control study was conducted from June 2019-April 2021. 180 PCOS women and 170 age-matched healthy women were enrolled from Mangalore, Karnataka. Anthropometric measurements, biochemical, hormonal profile, and the presence of IR were estimated in all patients and were further subdivided based on age and BMI.   Results: The mean age of patients with PCOS and controls was 25.9± 5.6 years vs 24.7 ± 6.8 years. BMI and WHR had statistical significance (p<0.01) between the groups. TG & HDL showed statistical significance (p<0.05) in both age groups who were underweight and had normal BMI. A significant difference (p<0.05) was also observed in plasma insulin and HOMA-IR in all groups except in women who were obese.   Conclusion: PCOS women were presented with hyperandrogenism and had metabolic risk factors like insulin resistance and low HDL-C levels at budding age and increased BMI. When comparing women with and without PCOS from the south Indian state of Karnataka, our findings revealed that changes in sex hormone levels had no significant impact on age or BMI.

Comparison of stromal thickness and doppler findings in polycystic ovary syndrome and healthy women with ultrasonographic evidence of polycystic ovaries? A cross-sectional study

The purpose of the study was to compare the ovarian stromal blood flow and stromal thickness (ST) of polycystic ovary syndrome (PCOS) patients, with healthy women with polycystic ovarian morphology (PCOM) and normal ovarian morphology (NOM). A total of 220 participants were recruited and the three study groups were determined by diagnostic criteria (PCOS n = 106, PCOM n = 68, NOM n = 46). Clinical, hormonal and ultrasonographic measurements of ovaries were assessed and compared. PCOS patients showed statistically higher androgen levels, insulin resistance, hirsutism score, ovarian ST and stromal blood flow compared to PCOM and NOM. The correlation between free androgen index (FAI) and ST was measured. FAI was significantly highly correlated with left ovarian ST (0.83; p < .001) and right ovarian ST (0.83; p < .001). According to the results of this study, the ovarian ST which can be considered as ultrasonographic indicator of FAI, can be used in PCOS diagnosis. Also, it can be suggested that there is no statistically significant difference in ovarian ST and doppler findings between healthy women with PCOM or NOM. ROC analysis was used to measure diagnostic utility of ST. Impact StatementWhat is already known on this subject? Although it is known that ovarian stromal blood flows and stromal thickness are increased in PCOS disease compared to healthy women, they are not included in the diagnostic criteria.What the results of this study add? In the results of this study, it was determined that ovarian stromal blood flow and stromal thickness were increased in PCOS patients, as previously reported in the literature. In addition, these ultrasound measurements were found to be increased in PCOS patients compared to healthy women with PCO morphology, and stromal thickness measurements were strongly correlated with the free androgen index in PCOS patients.What the implications are of these findings for clinical practice and/or further research? Ovarian ST and/or S/A ratio may be an ultrasonograpic indicator of FAI, and may be used in PCOS diagnostic criterias. In the future, it can be revealed whether they vary in patients with different components of the syndrome, by examining these parameters in different PCOS phenotypes.

The prevalence and phenotypic manifestations of polycystic ovary syndrome (PCOS) among infertile Sudanese women: a cross-sectional study

BACKGROUND

Polycystic ovary syndrome (PCOS) is a global health problem associated with significant morbidity during reproductive age. Only a few published studies that address the clinical manifestations and phenotypic presentation of the disease have been conducted in Africa, including Sudan. Thus, this study aimed to evaluate the clinical and biochemical presentation of the different PCOS phenotypes among infertile Sudanese women.

METHODS

A cross-sectional, descriptive study was conducted from January to December 2019. A total of 368 infertile women with PCOS (based on the Rotterdam criteria) were recruited from a fertility center in Khartoum, Sudan. Clinical, hormonal, and ultrasonographic characteristics were described and compared between the four phenotypes of PCOS.

RESULTS

Majority (321 [87.2%]) of the women had oligo/anovulation (OA). Polycystic ovary morphology on ultrasound appeared in 236 (64.1%) women, acne in 171 (46.5%) women, acanthosis nigricans in 81 (22.0%) women, and hirsutism in 101 (27.4%) women. Phenotype D was the most prevalent among infertile Sudanese women (51.6%), followed by phenotype B (22.6%), phenotype C (18.2%), and phenotype A (7.6%). No statistical differences in the body mass index and hormonal profile between the four phenotypes were noted. Women with phenotype A were older and had high mean blood pressure, and a higher waist/hip ratio was observed among women with phenotype D.

CONCLUSION

Unlike the global distribution of PCOS phenotypes, Sudanese women uniquely expressed phenotype D as the most prevalent. More epidemiological studies are needed in the region due to geographical, ethnic, and genetic variations.

Leukocyte telomere length in women with and without polycystic ovary syndrome: a systematic review and meta-analysis

AIM

To study the telomere length and the telomerase activity in women with and without polycystic ovary syndrome (PCOS).

METHODS

Relevant studies were searched from PubMed, Embase, and LILACS online databases and manual screening. The mean differences (MDs) or standardized MDs (SMDs) with their 95% confidence intervals (CIs) were calculated. The methodological quality of included studies was evaluated with the Newcastle-Ottawa Scale (NOS), and heterogeneity with the I² and Tau² statistics.

RESULTS

Six studies including 2109 non-pregnant women with (n = 1155) or without (n = 954) PCOS assessed leukocyte telomere length. There was a non-significant leukocyte telomere length difference (SMD = 0.25, 95% CI: -0.01, 0.51, p = .06, I² = 81%, Tau² = 0.08) comparing PCOS patients with the control group. Studied PCOS women were younger (MD = -1.39, 95% CI: -2.47, -0.31 years, I² = 83%), and had higher body mass index (BMI; MD = 3.66, 95% CI: 2.11, 5.20 kg/m², I² = 94%). There were significantly higher testosterone (SMD = 0.88, 95% CI: 0.65, 1.10) and luteinizing hormone levels (SMD = 0.60, 95% CI: 0.12, 1.08) in women with PCOS as compared to controls. There was a low risk of bias and there were not sufficient studies to meta-analyze other cell types.

CONCLUSIONS

Leukocyte telomere length did not differ between women with and without PCOS. Further studies with large sample sizes and including other outcomes are warranted to further substantiate the reported evidence.

Polycystic ovary syndrome and risks for COVID-19 infection: A comprehensive review : PCOS and COVID-19 relationship

This comprehensive review aimed to evaluate the relationship between SARS-CoV-2 infection (the cause of coronavirus disease 2019, or COVID-19) and the metabolic and endocrine characteristics frequently found in women with polycystic ovary syndrome (PCOS). In the general population, COVID-19 is more severe in subjects with dyslipidemia, obesity, diabetes mellitus, and arterial hypertension. Because these conditions are comorbidities commonly associated with PCOS, it was hypothesized that women with PCOS would be at higher risk for acquiring COVID-19 and developing more severe clinical presentations. This hypothesis was confirmed in several epidemiological studies. The present review shows that women with PCOS are at 28%-50% higher risk of being infected with the SARS-CoV-2 virus at all ages and that, in these women, COVID-19 is associated with increased rates of hospitalization, morbidity, and mortality. We summarize the mechanisms of the higher risk of COVID-19 infection in women with PCOS, particularly in those with carbohydrate and lipid abnormal metabolism, hyperandrogenism, and central obesity.

Adrenal Androgen Predictive Effects on Clinical and Metabolic Abnormalities of Polycystic Ovary Syndrome

OBJECTIVE

 To examine the possible effects of adrenal prohormones in the prediction of clinical and metabolic abnormalities in women with polycystic ovary syndrome (PCOS).

METHODS

 The present study enrolled 299 normal cycling non-PCOS, 156 normoandrogenemic, and 474 hyperandrogenemic women with PCOS. Baseline characteristics were compared using a chi-squared test or analysis of variance (ANOVA) as appropriate. The roles of adrenal prohormones and their ratios with total testosterone in predicting co-occurring morbidities in women PCOS were evaluated using univariate and multivariate logistic regression analyses.

RESULTS

 Adrenal hyperandrogenism per dehydroepiandrosterone sulfate (DHEAS) levels were found in 32% of women with PCOS. In non-PCOS women, dehydroepiandrosterone (DHEA) and its sulfate had no predictive role concerning clinical, anthropometric, and metabolic parameters. In PCOS women, mainly in the hyperandrogenemic group, DHEA showed to be a significant predictor against most anthropometric-metabolic index abnormalities (odds ratio [OR] = 0.36-0.97; p < 0.05), and an increase in triglycerides (TG) levels (OR = 0.76; p = 0.006). Dehydroepiandrosterone sulfate presented a few predictive effects regarding PCOS-associated disorders. In controls, DHEAS predicted against the increase in estimated average glucose (OR= 0.38; p = 0.036). In the normoandrogenic group, it predicted against elevation in the waist/hip ratio (WHR) (OR= 0.59; p = 0.042), and in hyperandrogenemic PCOS women, it predicted against abnormality in the conicity index (CI) (OR = 0.31; p = 0.028).

CONCLUSION

 Dehydroepiandrosterone was shown to be a better predictor of abnormal anthropometric and biochemical parameters in women with PCOS than DHEAS. Thus, regarding adrenal prohormones, DHEA measurement, instead of DHEAS, should be preferred in PCOS management. The effects of androgen prohormones on the prediction of PCOS abnormalities are weak.

The Lipid Profiles in Different Characteristics of Women with PCOS and the Interaction Between Dyslipidemia and Metabolic Disorder States: A Retrospective Study in Chinese Population

PURPOSE

To exhibit the lipid profiles in PCOS women with different characteristics and to access correlations between alternation of key lipid parameters and characteristics of PCOS.

DESIGN

A retrospective study.

PARTICIPANTS

A total of 700 PCOS women were included.

METHODS

Retrospective study on 700 women (age 24.6 ± 4.7 years), diagnosed with PCOS in the outpatient department of Obstetrics and Gynecology Hospital of Fudan University according to Rotterdam criteria. Anthropometric features, hormone levels, lipid levels, and metabolic parameters were measured and compared between PCOS patients with different characteristics.

RESULTS

There was a high prevalence of dyslipidemia among Chinese PCOS patients (41.3%), and the most common pattern was low HDL. Patients with clinical hyperandrogenism presented with significantly decreased HDL and Apo-A levels. The levels of TG, LDL, Apo-B, TG/HDL, and Apo-B/Apo-A were significantly increased in the insulin resistance subgroup. The levels of TC and TG were significantly increased in the dysglycemia and T2DM women. And in general, the levels of TG, and Apo-B had an increasing trend with BMI. Moreover, AI, TG/HDL, and Apo-B/Apo-A ratios were associated with some characteristics of PCOS, such as insulin resistance, and obesity.

CONCLUSION

The PCOS women with different characteristics presented with different lipid profiles, and there is a complex correlation between lipid metabolism and PCOS characteristics, which may explain the increased risk of long-term cardiovascular disease. Regular screening of blood lipids is essential for PCOS women. Identification of optimal subgroups in PCOS patients that need lipid-lowering treatment and therapeutic effectiveness is worth exploring.

Prevalence of polycystic ovary syndrome in patients with type 2 diabetes: A systematic review and meta-analysis

PURPOSE

With type 2 diabetes mellitus (T2DM) occurring at a younger age, a greater number of women with T2DM experience reproductive health problems. The prevalence of polycystic ovary syndrome (PCOS), a common reproductive disease associated with T2DM, remains unknown in women with T2DM. This systematic review and meta-analysis aimed to determine the prevalence of PCOS in women with T2DM.

METHODS

Stata 15.1 was used to perform a meta-analysis on the prevalence of PCOS in patients with T2DM included in this study. Additionally, a narrative review of the effects of different diagnostic methods, obesity, state, and other factors on the prevalence of PCOS was conducted.

RESULTS

Meta-analysis showed that the overall prevalence of PCOS in women with T2DM was approximately 21%. Subgroup analysis showed that the incidence of PCOS in female patients aged 25-45 years was higher than that in female patients aged < 25 years. The prevalence of PCOS in obese women was 14%, which was lower than that in normal weight women and normal weight or overweight or obese women. Women with T2DM in Oceania had the highest incidence of PCOS, followed by those in Europe and Asia; women with T2DM in North America had the lowest incidence. In terms of PCOS diagnostic standards, the prevalence of PCOS diagnosed by the National Institutes of Health was the lowest. The prevalence of PCOS diagnosed on the basis of clinical symptoms and biochemical characteristics was the highest, and the prevalence of PCOS diagnosed on the basis of medical records was 20%.

CONCLUSIONS

PCOS is a common disease in female patients with T2DM. The prevalence of PCOS in women with T2DM at childbearing age was higher than that in adolescent females. Women with T2DM at childbearing age should pay attention to the screening and prevention of PCOS to avoid the hazards of PCOS to reproductive health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD42022318657.

Effect of aging on clinical features and metabolic complications of women with polycystic ovary syndrome

PURPOSE

To assess the distribution of clinical features and metabolic abnormalities of polycystic ovary syndrome (PCOS) women according to their age.

METHODS

Retrospective study on 602 women (mean age 23.9 ± 6.2 years), diagnosed according to International PCOS Network Guidelines criteria as having PCOS in a University-based Hospital. Anthropometric features, hormonal and metabolic parameters were measured and compared between the different age groups (group A ≤ 20 years; group B 21-30 years; group C > 30 years).

RESULTS

Patients in group A were more often hyperandrogenic, while in group C hypertension, dyslipidemia, obesity, impaired fasting glucose, and insulin resistance (IR) were more prevalent. After adjusting for BMI, age correlated positively with sex hormone-binding globulin (SHBG), IR, total- and LDL-cholesterol, and negatively with DHEAS, insulin, and free androgen index (FAI). SHBG was significantly associated with IR and atherogenic dyslipidemia, while FAI levels were linked to hypertension, independently of other factors considered. Furthermore, the regression analysis showed a stronger relationship between BMI and metabolic outcomes, regardless of age.

CONCLUSION

Polycystic ovarian syndrome (PCOS) phenotype changes with age. Clinical and biochemical hyperandrogenism are a major concern in young PCOS women, while metabolic burden tends to increase with aging. Some of the cardiovascular risk factors are dependent on FAI and SHBG levels, whereas BMI confirms its key role in the genesis of most of the metabolic sequelae in PCOS, independently of age.

Serum asprosin level in different subtypes of polycystic ovary syndrome: a cross-sectional study

OBJECTIVE

Polycystic ovary syndrome can be divided into different subtypes, including insulin resistance and hyperandrogenism. The aim of this study was to investigate the relationship between serum asprosin levels and polycystic ovary syndrome subtypes.

METHODS

A total of 93 women with polycystic ovary syndrome and 77 healthy women as controls were selected for this study. The clinical and laboratory data were compared between the Polycystic ovary syndrome group and the control group. The Polycystic ovary syndrome group was further divided into subgroups: (1) women with or without hyperandrogenism (polycystic ovary syndrome hyperandrogenism and Polycystic ovary syndrome none-hyperandrogenism, respectively) and (2) women with or without insulin resistance (polycystic ovary syndrome insulin resistance and Polycystic ovary syndrome none-insulin resistance, respectively). Serum asprosin was measured by using enenzyme-linked immunosorbent assay.

RESULTS

Serum asprosin levels showed no significant difference between the polycystic ovary syndrome and control groups. However, it was significantly lower in the Polycystic ovary syndrome HA and insulin resistance groups compared with the respective Polycystic ovary syndrome none-hyperandrogenism and none-insulin resistance groups (p<0.05). In the Polycystic ovary syndrome group, serum asprosin was negatively correlated with body mass index, luteinizing hormone, testosterone, basal antral follicles, fasting insulin, homeostatic model assessment of insulin resistance, and triglycerides. After adjusting for body mass index, the correlations were not significant, and asprosin was only positively correlated with prolactin (prolactin; r=0.426, p<0.001).

CONCLUSION

Our study shows that women with polycystic ovary syndrome hyperandrogenism or insulin resistance exhibit significantly lower serum asprosin levels compared with controls, and the lower asprosin level directly correlated with prolactin level.

The importance of inflammation markers in polycystic ovary syndrome

OBJECTIVE

This study aimed to examine inflammation markers in patients with polycystic ovary syndrome (PCOS) and to compare them with healthy women.

METHODS

This prospective study was conducted by examining patients who applied to the Near East University Gynecology and Obstetrics Outpatient Clinic between January 2019 and January 2020. A total of 110 PCOS patients with 135 control groups were compared in terms of metabolism, hormonal factors, and inflammation markers.

RESULTS

The neutrophil count, neutrophil-lymphocyte ratio (NLR), platelet, platelet-lymphocyte ratio (PLR), platelecrit (PCT), erythrocyte cell distribution width, platelet distribution width, mean platelet volume, and C-reactive protein (CRP) values were found to be statistically significantly higher in patients with PCOS. There was a positive correlation between inflammation markers and serum androgens. Also, a positive correlation was observed between inflammation markers and cardiovascular risk parameters. In receiver operating characteristic curve analysis, the most valuable parameter in distinguishing PCOS patients from healthy controls was serum CRP levels [areas under the curve (AUC)=0.928, 95%CI 0.894-0.963, p<0.001, 92.6% sensitivity, and 82.7% specificity].

CONCLUSIONS

Serum CRP, neutrophil count, and PCT and NLR levels are valuable markers that show the inflammatory process in PCOS patients.

Polycystic ovary syndrome in adolescents with obesity

INTRODUCTION

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age with the prevalence from 5% to 15%, and the prevalence of PCOS in adolescents with obesity seems even higher. The weight status is significantly associated with the quality of life in adolescents with PCOS.

OBJECTIVE

This review aims to summarize the latest findings of pathogenesis, diagnosis, comorbidity, and management in PCOS adolescents with obesity.

METHODS

This is a narrative review of articles published in PubMed from June 2013 to June 2020 Data were searched using the key words of "polycystic ovary syndrome" AND "adolescent" AND "obesity."

RESULTS

Pubertal obesity, particularly central obesity, could have a negative impact on the pathophysiology of PCOS. In adolescents with obesity, a review of medical history and a long-term follow-up for PCOS symptoms are essential to avoid misdiagnosis. There is a link between obesity and comorbidities of PCOS in adolescents. Holistic treatment and concern for related comorbidities should ideally begin as early as possible in obese adolescents once the diagnosis of PCOS is confirmed.

CONCLUSION

Adolescents with PCOS and obesity need more attention from physicians and researchers, and the effective interventions in the early stage are critical to improve their life quality.

The connection of alpha-1 acid glycoprotein inflammatory marker with anthropometric, hormonal, and metabolic characteristic of women with polycystic ovary syndrome

AIM

To investigate the connection of alpha-1 acid glycoprotein inflammatory biomarker with clinical, hormonal, and metabolic characteristics in women with polycystic ovary syndrome (PCOS) and normal cycling controls.

METHODS

A cross-sectional study was conducted on 235 women with PCOS and 92 normal cycling controls attended between 2008 and 2018. Alpha-1 acid glycoprotein levels were correlated with clinical, anthropometric, anthropometric-metabolic indexes, and hormones of women with PCOS and controls. Simple and multivariate stepwise linear regression, matched for age and body mass index confounding variables, was performed.

RESULTS

Alpha-1 acid glycoprotein levels were higher in women with PCOS (p = 0.0016). In controls, it was positively correlated with waist circumference, fat mass, body adiposity index, and lipid accumulation product, and negatively correlated with sex hormone-binding globulin (p < 0.005 for all comparisons). In PCOS, it was positively correlated with testosterone, most biomarkers of central adiposity, homeostatic model assessment of insulin-resistant, erythrocyte sedimentation rate, and negatively correlated with sex hormone-binding globulin, high-density lipoprotein cholesterol, glucose/insulin ratio, and lymphocytes (p < 0.055 for all comparisons). After multivariate regression in women with PCOS, alpha-1 acid glycoprotein retained a significant positive correlation with erythrocyte sedimentation rate and C-reactive protein.

CONCLUSIONS

In PCOS, alpha-1 acid glycoprotein is correlated with biomarkers of adiposity, carbohydrate metabolism, and total testosterone. This inflammatory marker is also correlated with erythrocyte sedimentation rate, neutrophils, and lymphocytes, frequent markers of an inflammation state.

Differential Effects of Various Androgens on Polycystic Ovary Syndrome

The hyperandrogenism in polycystic ovary syndrome (PCOS) is associated with the risk for the future development of the cardiovascular disease. The objective of the study is to verify whether different androgens have the same harmful effect. This cross-sectional study enrolled 823 women with PCOS: 627 (76.2%) with biochemical hyperandrogenism and 196 (23.8%) with normal androgen levels. The role of individual androgen was evaluated using univariate and multivariate logistic regression. In normoandrogenemic PCOS (NA-PCOS), free androgen index (FAI) predicted significant abnormality in visceral adipose index (VAI, OR=9.2, p=0.002) and dehydroepiandrosterone (DHEA) predicted against alteration in β-cell function (OR=0.5, p=0.007). In hyperandrogenemic PCOS (HA-PCOS), FAI predicted derangements in waist triglyceride index (WTI), VAI, and lipid accumulation product (LAP) (OR ranging from 1.6 to 5.8, p<0.05). DHEA weakly predicted against VAI (OR 0.7, p=0.018), dehydroepiandrosterone sulfate (DHEAS) tended to predict against the conicity index (OR=0.7, p=0.037). After multiple regression, FAI retained significant strength to predict various anthropometric and metabolic abnormalities (OR ranging from 1.1 to 3.0, p<0.01), DHEA was kept as a protector factor against WTI, LAP, and VAI (OR ranging from 0.6 to 0.9; p<0.01) and DHEAS against the conicity index (OR=0.5, p<0.001). In conclusion, the free androgen index was the most powerful predictor of anthropometric and metabolic abnormalities of polycystic ovary syndrome. Conversely, DHEA and DHEAS demonstrated protective effects against disorders in some markers of obesity and abnormal metabolism.

Adipocyte and steroidogenic cell cross-talk in polycystic ovary syndrome

BACKGROUND

Metabolic and endocrine alterations in women with polycystic ovary syndrome (PCOS) affect adipose tissue mass and distribution. PCOS is characterised by hyperandrogenism, obesity and adipocyte dysfunction. Hyperandrogenism in PCOS drives dysfunctional adipocyte secretion of potentially harmful adipocytokines. Glucocorticoids and sex-steroids modulate adipocyte development and function. For their part, adipocyte products interact with adrenal and ovarian steroidogenic cells. Currently, the relationship between adipocyte and steroidogenic cells is not clear, and for these reasons, it is important to elucidate the interrelationship between these cells in women with and without PCOS.

OBJECTIVE AND RATIONALE

This comprehensive review aims to assess current knowledge regarding the interrelationship between adipocytes and adrenal and ovarian steroidogenic cells in animal models and humans with or without PCOS.

SEARCH METHODS

We searched for articles published in English and Portuguese in PubMed. Keywords were as follows: polycystic ovary syndrome, steroidogenesis, adrenal glands, theca cells, granulosa cells, adipocytes, adipocytokines, obesity, enzyme activation, and cytochrome P450 enzymes. We expanded the search into the references from the retrieved articles.

OUTCOMES

Glucocorticoids and sex-steroids modulate adipocyte differentiation and function. Dysfunctional adipocyte products play important roles in the metabolic and endocrine pathways in animals and women with PCOS. Most adipokines participate in the regulation of the hypothalamic-pituitary-adrenal and ovarian axes. In animal models of PCOS, hyperinsulinemia and poor fertility are common; various adipokines modulate ovarian steroidogenesis, depending on the species. Women with PCOS secrete unbalanced levels of adipocyte products, characterised by higher levels of leptin and lower levels of adiponectin. Leptin expression positively correlates with body mass index, waist/hip ratio and levels of total cholesterol, triglyceride, luteinising hormone, oestradiol and androgens. Leptin inhibits the production of oestradiol and, in granulosa cells, may modulate 17-hydroxylase and aromatase enzyme activities. Adiponectin levels negatively correlate with fat mass, body mass index, waist-hip ratio, glucose, insulin and triglycerides, and decrease androgen production by altering expression of luteinising hormone receptor, steroidogenic acute regulatory protein, cholesterol-side-chain cleavage enzyme and 17-hydroxylase. Resistin expression positively correlates with body mass index and testosterone, and promotes the expression of 17-hydroxylase enzyme in theca cells. The potential benefits of adipokines in the treatment of women with PCOS require more investigation.

WIDER IMPLICATIONS

The current data regarding the relationship between adipocyte products and steroidogenic cells are conflicting in animals and humans. Polycystic ovary syndrome is an excellent model to investigate the interrelationship among adipocyte and steroidogenic cells. Women with PCOS manifest some pathological conditions associated with hyperandrogenism and adipocyte products. In animals, cross-talk between cells may vary according to species, and the current review suggests opportunities to test new medications to prevent or even reverse several harmful sequelae of PCOS in humans. Further studies are required to investigate the possible therapeutic application of adipokines in women with obese and non-obese PCOS. Meanwhile, when appropriate, metformin use alone, or associated with flutamide, may be considered for therapeutic purposes.

Circulating steroids and mood disorders in patients with polycystic ovary syndrome

Aberrant androgen metabolism is a characteristic feature of polycystic ovary syndrome (PCOS). Various androgens as well as their precursors and metabolites can accumulate in the blood of PCOS patients. Although these steroids include neuroactive steroids, such as allopregnanolone and androstenedione (Δ4A), it remains unknown whether altered blood steroid levels contribute to the high risk of mood disorders in PCOS. In this study, we measured blood levels of 11 steroids in 25 PCOS patients using liquid chromatography-tandem mass spectrometry and chemiluminescent enzyme immunoassay, and assessed the psychological status of these patients using the Hospital Anxiety and Depression Scale (HADS) questionnaire. We also examined age and the degree of metabolic abnormalities of each patient. Steroid values of the patients were compared to our previous data from 31 eumenorrheic women. As a result, 20 patients exhibited aberrant blood levels of one or more of the 11 tested steroids. In most cases, Δ4A and allopregnanolone levels were within or close to the reference ranges. Levels of four steroids were negatively correlated with patients' age, while no correlation was observed between steroid values and metabolic conditions. Seven patients showed high HADS scores. HADS scores were correlated with blood Δ4A levels even after stratifying by body mass indexes, but not with the levels of other steroids or clinical data. These results indicate that the high frequency of anxiety and depression in PCOS patients cannot be ascribed to altered blood levels of a specific steroid, although there may be a weak association between circulating Δ4A levels and psychological conditions of the patients.

Comparison of metabolic and obesity biomarkers between adolescent and adult women with polycystic ovary syndrome

PURPOSE

Knowledge of adolescent and adult phenotypes of women with polycystic ovary syndrome (PCOS) might drive opportune management. The aim of this study was to compare metabolic and obesity biomarkers between adolescent and adult women with PCOS.

METHODS

This observational study compared biomarkers of obesity and metabolism derangements between adolescent (n = 62) and adult (n = 248) women with PCOS. Predictors of metabolic syndrome (MS) were investigated using univariate and multivariate binary logistic regression analysis.

RESULTS

The postmenarcheal age of adolescents was 4.9 ± 0.03 years. Systolic blood pressure was lower in adolescents than in adults (112.3 mmHg vs 117.0 mmHg, p = 0.001) Diastolic blood pressure was also lower in adolescents (70.7 mmHg vs 75.8 mmHg, p < 0.001). Glucose intolerance (12.0% vs 19.3%) and insulin resistance (18.2% vs 17.7%) were similar in both groups (p > 0.05, for comparisons). Impaired fasting glucose was lower in adolescents (1.8% vs 11.6%, p = 0.015). Total cholesterol and low-density lipoprotein cholesterol were lower in adolescents (p < 0.001). MS in adolescents and adults were found in 10.3% and 27.8%, respectively (p = 0.005). Visceral adiposity index (VAI) was a good predictor of MS in both adolescents (OR = 12.2), and adults (OR = 9.7).

CONCLUSIONS

Most biomarkers of glucose metabolism abnormalities were similar in adolescents and adults with PCOS. The prevalence of MS was lower in adolescents. VAI was a strong predictor of metabolic syndrome, both in adolescent and adult women with PCOS.

The Role of Visceral Adiposity Index as Predictor of Metabolic Syndrome in Obese and Nonobese Women with Polycystic Ovary Syndrome

Background: To evaluate anthropometric-metabolic biomarkers as predictors of metabolic syndrome (MS) in women with polycystic ovary syndrome (PCOS) with and without obesity. Methods: This was an observational cross-sectional study. Patients were classified as nonobese-PCOS (body mass index, BMI <30 kg/m², n = 385), and obese-PCOS (BMI ≥30 kg/m², n = 261). The anthropometric parameters waist circumference, waist/hip ratio, lean body mass, fat body mass, visceral adiposity index (VAI), lipid accumulating product, and biomarkers of glucose and lipid metabolisms were compared between groups. Binominal logistic regression analyses were performed to identify predictors of MS. Results: Obesity was diagnosed in 40% of all PCOS women (P < 0.001). Blood pressure and anthropometric abnormalities were significantly more frequent in obese-PCOS women (P < 0.001, for all comparisons). Glucose metabolism markers were higher in obese-PCOS compared with nonobese-PCOS (P < 0.001, for all comparisons). High-density lipoprotein cholesterol was lower in obese group than in nonobese group (1.26 mM vs. 1.08 mM, P < 0.001). MS was found in 23 of 385 (6%) nonobese-PCOS and in 116 of 261 (44.4%) obese-PCOS (P < 0.001). VAI was the best predictor of MS in both nonobese-PCOS (OR = 4.1, 95% CI 1.5-11.1) and obese-PCOS (OR = 12.9, 95% CI 5.7-29.0). Conclusions: MS is more prevalent in PCOS women with obesity. VAI was the strongest predictor of MS in both obese and nonobese PCOS women, and can be applied in clinical practice for early detection of risk for MS and precocious intervention in women with PCOS, particularly in obese women.