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Zhao X, An X, Yang C, Sun W, Ji H, Lian F. The crucial role and mechanism of insulin resistance in metabolic disease. Front Endocrinol (Lausanne) 2023; 14:1149239. [PMID: 37056675 PMCID: PMC10086443 DOI: 10.3389/fendo.2023.1149239] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Insulin resistance (IR) plays a crucial role in the development and progression of metabolism-related diseases such as diabetes, hypertension, tumors, and nonalcoholic fatty liver disease, and provides the basis for a common understanding of these chronic diseases. In this study, we provide a systematic review of the causes, mechanisms, and treatments of IR. The pathogenesis of IR depends on genetics, obesity, age, disease, and drug effects. Mechanistically, any factor leading to abnormalities in the insulin signaling pathway leads to the development of IR in the host, including insulin receptor abnormalities, disturbances in the internal environment (regarding inflammation, hypoxia, lipotoxicity, and immunity), metabolic function of the liver and organelles, and other abnormalities. The available therapeutic strategies for IR are mainly exercise and dietary habit improvement, and chemotherapy based on biguanides and glucagon-like peptide-1, and traditional Chinese medicine treatments (e.g., herbs and acupuncture) can also be helpful. Based on the current understanding of IR mechanisms, there are still some vacancies to follow up and consider, and there is also a need to define more precise biomarkers for different chronic diseases and lifestyle interventions, and to explore natural or synthetic drugs targeting IR treatment. This could enable the treatment of patients with multiple combined metabolic diseases, with the aim of treating the disease holistically to reduce healthcare expenditures and to improve the quality of life of patients to some extent.
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Affiliation(s)
| | | | | | | | - Hangyu Ji
- *Correspondence: Fengmei Lian, ; Hangyu Ji,
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Correlation of Clinical, Hormonal, Biochemical and Ultrasound Parameters Between Adult and Adolescent Polycystic Ovarian Syndrome. J Obstet Gynaecol India 2021; 72:274-280. [PMID: 35928097 PMCID: PMC9343552 DOI: 10.1007/s13224-021-01557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To correlate the clinical, hormonal, biochemical and ultrasound parameters in adolescent patients with polycystic ovarian syndrome (PCOS) and to compare them with adult patients. Methods This was a prospective, correlational study. 50 adult (20-35 years) and 50 adolescent patients (15-19 years) who had features of PCOS (Rotterdam Criteria, 2003) were selected. The control group comprised of 50 women of same age in each group with normal parameters. Pelvic ultrasound was done in early follicular phase (3-5th day of menstrual cycle). Assessment of hormonal and biochemical parameters (LH/FSH ratio, free testosterone level, lipid profile and fasting glucose/insulin ratio) and grey-scale ultrasound was done. Results No significant difference was observed in menstrual pattern in adults and adolescents with PCOS. The mean values of serum LH/FSH ratio and free testosterone were significantly higher in both adult and adolescent PCOS patients as compared to their controls (p < 0.001). The mean value of serum insulin was significantly higher (p < 0.001) with positive correlation (adult: r = 0.655, p < 0.01; adolescent: r = 0.451, p < 0.01) of serum insulin with free testosterone. Hyperandrogenemia without hyperinsulinemia was found in 56% adolescent and 60% adult PCOS patients. 82% adolescent and 88% adult PCOS patients showed multiple follicles (> 5) on ultrasound. The ovarian morphology had positive correlation with serum LH and free testosterone. The mean ovarian volume was significantly higher in adult (10.48 ± 4.38 vs. 4.17 ± 0.91) and adolescent (11.08 ± 5.82 vs. 4.23 ± 0.89) PCOS patients, when compared with controls, respectively. Conclusion No statistically significant difference was noted in PCOS between adults and adolescents.
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Dube R. Does endothelial dysfunction correlate with endocrinal abnormalities in patients with polycystic ovary syndrome? Avicenna J Med 2021; 6:91-102. [PMID: 27843797 PMCID: PMC5054651 DOI: 10.4103/2231-0770.191445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To study and critically analyze the published evidence on correlation of hormonal abnormalities and endothelial dysfunction (ED) in polycystic ovary syndrome (PCOS) through a systematic review. The databases including MEDLINE, PubMed, Up-To-Date, and Science Direct were searched using Medical subject handling terms and free text term keywords such as endocrine abnormalities in PCOS, ED assessment in PCOS, ED in combination with insulin resistance (IR), hyperandrogenism (HA), increased free testosterone, free androgen index (FAI), gonadotrophin levels, luteinizing hormone (LH), prolactin, estrogen, adipocytokines to search trials, and observational studies published from January 1987 to September 2015. Authors of original studies were contacted for additional data when necessary. PCOS increases the risk of cardiovascular disease in women. ED, which is a reliable indicator of cardiovascular risk in general population, is seen in most (but not all) women with PCOS. IR, seen in 70% patients with PCOS, is associated with ED in these women, but patients can have normal endothelial function even in the presence of IR. Free testosterone and FAI are consistently associated with ED, but endothelial function can be normal despite HA. Estradiol (not estrone) appears to be protective against ED though estrone is the predominant estrogen produced in PCOS. Increased levels of adipocytokines (visfatin) are promising in predicting ED and cardiovascular risk. However, more studies are required focusing on direct correlation of levels of prolactin, LH, estrone, and visfatin with ED in PCOS.
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Affiliation(s)
- Rajani Dube
- Department of Obstetrics and Gynaecology, Ras al-Khaimah Medical and Health Sciences University, Al Qusaidat, Ras al-Khaimah, United Arab Emirates
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Dondi E, Tufano M, Vigone MC, Lucaccioni L, Pozzobon G, Ubertini G, Mozzillo E, Delvecchio M. Polycystic ovary syndrome in pediatric obesity and diabetes. Minerva Pediatr (Torino) 2021; 73:523-536. [PMID: 34286948 DOI: 10.23736/s2724-5276.21.06542-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome is characterized by anovulation (amenorrhea, oligomenorrhea, irregular menstrual cycles) combined with symptoms of androgen excess (hirsutism, acne, alopecia). The clear definition and diagnosis in adolescents could be challenging considering that most of symptoms occur as part of the expected physiological hormonal imbalance of puberty. Therefore, different diagnostic criteria have been elaborated. Polycystic ovary syndrome could be associated to obesity, diabetes mellitus, and metabolic syndrome. In adolescents with polycystic ovary syndrome, adiposity is associated with higher androgen concentrations and greater menstrual irregularity. Polycystic ovary syndrome in youth is considered a risk factor for type 2 diabetes mellitus in adulthood. On the other hand, increased prevalence of polycystic ovary syndrome has been shown in type 1 diabetes mellitus. EVIDENCE The treatment of polycystic ovary syndrome in adolescents is controversial considering that adequate trials are lacking. First line treatment comprises lifestyle modification (preferably multicomponent including diet, exercise and behavioural strategies) that should be recommended overall in the patients with polycystic ovary syndrome and overweight, central obesity and insulin resistance. Beyond non-pharmacological therapy, pharmacological agents include combined hormonal contraceptives, metformin and antiandrogens, used separately or in combination. The aim of therapy is to bring back ovulation, to normalize menses, to reduce hirsutism and acne, to reduce weight. Other important goal is the treatment of hyperlipidaemia and of hyperglycaemia. CONCLUSIONS This narrative review aims to review the most pertinent literature about polycystic ovary syndrome in adolescents with obesity or diabetes. We overviewed the diagnostic criteria, the pathophysiology and the possible treatment approaches.
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Affiliation(s)
- Elena Dondi
- Department of Pediatrics, S. Andrea Hospital, Vercelli, Italy
| | - Maria Tufano
- Department of Pediatrics and Neonatology, Usl Central Tuscany, Florence, Prato, Italy
| | - Maria C Vigone
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Departmente of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriella Pozzobon
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Maurizio Delvecchio
- Metabolic Disorders and Genetic Unit, Giovanni XXIII Children Hospital, Bari, Italy -
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de Medeiros SF, de Medeiros MAS, Barbosa BB, Yamamoto MMW, Maciel GAR. Comparison of metabolic and obesity biomarkers between adolescent and adult women with polycystic ovary syndrome. Arch Gynecol Obstet 2020; 303:739-749. [PMID: 33201375 DOI: 10.1007/s00404-020-05867-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/31/2020] [Indexed: 01/27/2023]
Abstract
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.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, Cuiabá, MT, 78 043 306, Brazil.
- Tropical Institute of Reproductive Medicine, Cuiabá, MT, Brazil.
| | | | | | | | - Gustavo Arantes Rosa Maciel
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Faculdade de Medicina de São Paulo, Hospital das Clínicas, São Paulo, Brazil
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Soliman A, De Sanctis V, Alaaraj N, Hamed N. The clinical application of metformin in children and adolescents: A short update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020086. [PMID: 32921782 PMCID: PMC7717009 DOI: 10.23750/abm.v91i3.10127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022]
Abstract
Metformin is a widely used drug that results in clear benefits in relation to glucose metabolism and diabetes-related complications. The global increase in the prevalence of obesity among children and adolescents is accompanied by the appearance and increasing prevalence of insulin resistance, prediabetes, and type 2 diabetes mellitus (T2DM). In addition, children, and adolescents with premature pubarche and polycystic ovary have considerable degree of insulin resistance. The insulin sensitizing actions of metformin encouraged many investigators and physician to use it as the key drug in these conditions for both prevention and treatment. However, long term-controlled studies are still required to assess the degree and duration of effectiveness and safety of using metformin. This review tries to update physicians about the main and the new therapeutic perspectives of this drug.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | - Nada Alaaraj
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
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Kostopoulou E, Anagnostis P, Bosdou JK, Spiliotis BE, Goulis DG. Polycystic ovary Syndrome in Adolescents: Pitfalls in Diagnosis and Management. Curr Obes Rep 2020; 9:193-203. [PMID: 32504286 DOI: 10.1007/s13679-020-00388-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder during a woman's reproductive lifespan, with well-documented diagnostic criteria and therapeutic strategies in adults; the same is not necessarily true for adolescents. The purpose of this review was to identify frequent pitfalls in PCOS diagnosis and management during adolescence. RECENT FINDINGS Although there is no global consensus on the definition, most experts converge to the presence of both oligo/amenorrhea and (clinical and/or biochemical) hyperandrogenism, as a prerequisite for diagnosis in adolescents. The former criterion includes: (a) consecutive menstrual intervals > 90 days even in the first year after menarche; (b) menstrual intervals persistently < 21 or > 45 days for ≥ 2 years after menarche; or (c) lack of menses by the age of 15 or 2-3 years after pubarche. However, these menstrual irregularity patterns may overlap with other common entities in adolescents, such as frequent or infrequent uterine bleeding or anovulation due to immaturity of the hypothalamic-pituitary-ovarian axis. Clinical signs of hyperandrogenism are obscure, without well-validated criteria. Finally, the criterion of polycystic morphology cannot be safely used in adolescents, mostly due to technical limitations of the transabdominal ultrasound. Except for the efficacy of lifestyle intervention in overweight and obese adolescents with PCOS, limited and low-quality data exist regarding the available medications, such as oral contraceptives, metformin, and anti-androgens. Individualized management, guided by clinical experience and research data and close monitoring appear the most effective approach in this PCOS population for optimal control of its reproductive and metabolic outcomes. Research focusing on PCOS genetic and molecular mechanisms may elucidate what diagnostic and therapeutic strategies will be most appropriate in adolescents with PCOS in the future.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, 265 00, Patras, Greece
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Julia K Bosdou
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bessie E Spiliotis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, 265 00, Patras, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Misitzis A, Cunha PR, Kroumpouzos G. Skin disease related to metabolic syndrome in women. Int J Womens Dermatol 2019; 5:205-212. [PMID: 31700973 PMCID: PMC6831757 DOI: 10.1016/j.ijwd.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
Sex hormones are involved in pathways of metabolic syndrome (MetS), an observation supported by animal studies. The relationships of sex hormones with components of MetS, such as insulin resistance and dyslipidemia, have been studied in pre- and postmenopausal women. High testosterone, low sex hormone-binding globulin, and low estrogen levels increase the risks of MetS and type 2 diabetes in women. Cutaneous diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance and increased risk for MetS. Furthermore, inflammatory skin conditions, such as hidradenitis suppurativa and psoriasis, increase the risk for MetS. Patients with such skin conditions should be followed for metabolic complications, and early lifestyle interventions toward these populations may be warranted.
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Affiliation(s)
- Angelica Misitzis
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paulo R Cunha
- Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts
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Kenawi MZ, Akl EM, Sabry JH, Mostafa ST. Evaluation of serum level of omentin-1 in females with hirsutism. J Cosmet Dermatol 2019; 19:535-539. [PMID: 31190433 DOI: 10.1111/jocd.13043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/03/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hirsutism is a common clinical condition encountered in day-to-day practice. The androgenic causes account for more than 80% of these patients and include polycystic ovary syndrome (PCOS), which affects about 70%-80% of hirsute women. The second most common cause is idiopathic hirsutism. Omentin-1 is an adipokine mainly produced by visceral adipose tissue. AIM The current study aimed at evaluating omentin-1 levels in hirsute females with PCOS and in idiopathic hirsutism. PATIENTS AND METHODS Eighty-five females were included in this study. They were classified into three groups: thirty hirsute patients with PCOS, thirty females with idiopathic hirsutism, and twenty-five healthy control females. The participants were subjected to history taking, physical and dermatological examination. A gynecological history and radiological examination of the ovary also were done. Serum testosterone and omentin-1 were measured by ELISA. RESULTS Serum testosterone was statistically elevated in PCOS than other groups. Serum omentin-1 in females with idiopathic hirsutism was statistically significantly higher than control and PCOS. There was a significant inverse correlation between serum testosterone level and serum omentin-1 level. CONCLUSION Omentin-1 may be involved in the pathogenic process of hirsutism.
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Affiliation(s)
- Mohammed Z Kenawi
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Essam M Akl
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Jehan H Sabry
- Department of Clinical Pathology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Sara T Mostafa
- Department of Obstetric & Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
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Tang L, Ye J, Shi Y, Zhu X. Association between CD16 ++ monocytes in peripheral blood and clinical features and short-term therapeutic effects of polycystic ovary syndrome. Int J Gynaecol Obstet 2019; 145:12-17. [PMID: 30710445 DOI: 10.1002/ijgo.12779] [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: 04/14/2018] [Revised: 09/22/2018] [Accepted: 01/31/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the association between CD16++ monocytes in peripheral blood and the clinical features and short-term therapeutic effects of polycystic ovary syndrome (PCOS). METHODS This prospective cross-sectional study included women diagnosed with PCOS at a University Hospital in Shanghai, China, between June 4 and November 28, 2016. Patients received Diane-35, metformin, or both combined for 3 months. We collected anthropometric measures and used flow cytometry to detect CD16++ monocytes. RESULTS The final analysis included 70 patients: 18 in the Diane-35 group, 30 in the metformin group, and 22 in the Diane-35 plus metformin group. The control group comprised 60 women without PCOS. The proportion of CD16++ monocytes was significantly higher in patients with PCOS than in those with no PCOS (16.05% vs 10.73%; P=0.001). The proportion differed significantly between patients with and those without hyperandrogenism (13.12% vs 17.30%; P=0.002) and showed moderate accuracy in diagnosing hyperandrogenism before treatment. We noted a decrease in monocytes post-treatment in patients given metformin and Diane-35 plus metformin. CONCLUSIONS The proportion of CD16++ monocytes was most significantly associated with hyperandrogenism before treatment. Our findings suggest that the proportion of CD16++ monocytes in peripheral blood might be related to the inflammatory condition of PCOS.
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Affiliation(s)
- Lingli Tang
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Jiangfeng Ye
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yingli Shi
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Xiaoyong Zhu
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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Abstract
The relationship of sex hormones to obesity and inflammation has been extensively studied. Research on endogenous and exogenous sex steroids, including studies on animal models of metabolic syndrome (MetS), has indicated that sex hormones are involved in metabolic pathways relevant to MetS. Lower testosterone levels in men and higher levels in women increase risks of MetS and type 2 diabetes mellitus (T2DM). Lower levels of sex hormone-binding globulin increase risks of MetS and T2DM in both sexes. Skin diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance. Insulin resistance increases the risk for metabolic and potentially cardiovascular complications, and patients with such skin diseases should be followed for a prolonged time to determine whether they develop these complications. Early intervention may help delay or prevent the onset of T2DM and decrease cardiovascular risks.
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Affiliation(s)
| | - Nicholas Leader
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - George Kroumpouzos
- Department of Dermatology,Warren Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, Jundiaí, SP, Brazil, Brazil* GK Dermatology, South Weymouth, MA.
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Vuguin P, Sopher AB, Roumimper H, Chin V, Silfen M, McMahon DJ, Fennoy I, Oberfield SE. Alterations in Glucose Effectiveness and Insulin Dynamics: Polycystic Ovary Syndrome or Body Mass Index. Horm Res Paediatr 2017; 87:359-367. [PMID: 28478437 PMCID: PMC5914159 DOI: 10.1159/000471804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/17/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS To delineate the relationship of polycystic ovary syndrome (PCOS), obesity, and hyperandrogenism (HA) with glucose and insulin dynamics in adolescents across a broad body mass index (BMI). METHODS Seventy-four PCOS subjects (aged 16 years) and 82 controls (aged 16 years) were evaluated by an oral glucose tolerance test. Subjects were categorized by BMI: normal weight (21 ± 0.4), overweight/obesity (OO; 33 ± 1.0), and severe obesity (SO; 48 ± 1.4). Indices of glucose and insulin dynamics were determined. Multiple linear regression analysis was used to evaluate the contribution of PCOS, HA, and BMI to these indices. RESULTS BMI was significantly associated with systolic and diastolic blood pressure and insulin resistance. A significant interaction between BMI and PCOS and indices of post-glucose load was observed. The mean difference in peak glucose, early glucose response, area under the curve for glucose, and glucose effectiveness (SgIo) between PCOS and control subjects was significantly different between OO and SO. In PCOS subjects, testosterone was positively associated with BMI, fasting insulin, early insulin response, and diastolic blood pressure, and negatively associated with SgIo. CONCLUSIONS Abnormal glucose dynamics in adolescents with PCOS is mainly due to SO. The combination of PCOS and SO has a synergistic effect on glucose dynamics when compared to all other groups.
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Affiliation(s)
- Patricia Vuguin
- Division of Pediatric Endocrinology, Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032
| | - Aviva B. Sopher
- Division of Pediatric Endocrinology, Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032
| | - Hailey Roumimper
- Division of Pediatric Endocrinology, Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032
| | - Vivian Chin
- Division of Pediatric Endocrinology, Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032
| | - Miriam Silfen
- Division of Pediatric Endocrinology, Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032
| | - Donald J. McMahon
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York Presbyterian/Columbia University Medical Center, New York, New York 10032
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032
| | - Sharon E. Oberfield
- Division of Pediatric Endocrinology, Children’s Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032
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Batista da Silva J, de Melo EM, Micussi MT, Dantas de Azevedo G, Lemos TM, Spyrides MH, Arrais RF, Maranhão TM. [Prevalence of metabolic syndrome in pubertal stages of female students]. Rev Salud Publica (Bogota) 2017; 18:425-436. [PMID: 28453105 DOI: 10.15446/rsap.v18n3.43065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/24/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To analyze the prevalence of metabolic syndrome (MS) in pubertal stages of female students. Methods Cross-sectional study of 449 school children between eight and 18 years, stratified by pubertal stage, body mass index (BMI) and body fat percentage (BF %). The MS was classified according to the International Diabetes Federation. The analysis by frequency distribution, confidence intervals (95 %), Chi-square and odds ratio for associations was performed. Results The prevalence of MS was 3.3 % (CI:2 %-5 %) and 2.5 % (CI: 0.1 - 5 %) in pubertal and 7.9% (CI:3.2 % - 12.6 %) in the post-pubescent, with a significant association of this group with MS (X² = 5.2 [p <0.02]). The odds ratio shows that post-pubescent girls (3.3 [CI: 1.2 to 5]) and obese girls (2.1 [CI: 2 - 2.2]) are more likely to have MS, indicating significant linear association between BMI and the outcome (X²=29.4 [p<0.001]). Pubescent children under 10 years of age with MS had higher %G. The prevalent components were altered waist circumference (27.2 % [CI23 %-31 %]) and low HDL cholesterol (39.6 % [CI 35 % - 44 %]), as well as prevalence of systemic hypertension in post-pubertal girls. Conclusions MS begins in the pubertal stage, with prevalence in the post-pubertal stage. Excess fat is a trigger in children under 10 years of age. Prevention strategies are needed for the population of children and adolescents.
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Affiliation(s)
- João Batista da Silva
- Faculdade de Educação Física-FAEF, Universidade do Estado do Rio Grande do Norte, Mossoró, Brasil,
| | - Elza M de Melo
- Universidade do Estado do Rio Grande do Norte, Natal, Brasil,
| | | | | | - Telma M Lemos
- Universidade do Estado do Rio Grande do Norte, Natal, Brasil,
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Javed A, Kumar S, Simmons PS, Lteif AN. Phenotypic Characterization of Polycystic Ovary Syndrome in Adolescents Based on Menstrual Irregularity. Horm Res Paediatr 2016; 84:223-30. [PMID: 26184981 DOI: 10.1159/000435883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/10/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) in adolescents is associated with adverse metabolic outcomes. The association of menstrual irregularity with metabolic risk among adolescents with PCOS was assessed. METHOD A retrospective medical record review of 366 adolescents with PCOS aged 13-18 years was conducted, from which 265 girls newly diagnosed with PCOS were included and divided into those presenting with primary amenorrhea (PA), secondary amenorrhea (SA) and oligomenorrhea (OM). Androgen concentrations and markers of metabolic risk were compared among the groups. RESULTS Most subjects presented with OM (PA = 17, SA = 30 and OM = 218). Subjects with PA were younger than those with OM but not different from those with SA. Mean BMI was not different between groups. Total testosterone and insulin levels were higher in PA than SA and OM (p < 0.01 and 0.02, respectively). Fasting glucose was higher in PA than OM (p = 0.048) but not different from SA. Triglyceride levels were higher in PA than SA and OM (p < 0.001 each). More subjects with PA and SA had metabolic syndrome (52%) than those with OM (29.1%) (p = 0.027). The differences in triglycerides and glucose persisted despite BMI adjustment in multivariate regression models. CONCLUSION Adolescents with PCOS presenting with PA are at risk of metabolic disease beyond expected based on BMI.
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Affiliation(s)
- Asma Javed
- Division of Pediatric and Adolescent Gynecology, Mayo Clinic, Rochester, Minn., USA
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15
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Echiburú B, Crisosto N, Maliqueo M, Pérez-Bravo F, de Guevara AL, Hernández P, Cavada G, Rivas C, Clavel A, Sir-Petermann T. Metabolic profile in women with polycystic ovary syndrome across adult life. Metabolism 2016; 65:776-782. [PMID: 27085784 DOI: 10.1016/j.metabol.2016.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess insulin sensitivity, insulin secretion and metabolic profile in women with polycystic ovary syndrome (PCOS) in different stages of reproductive life. MATERIALS AND METHODS In a cross-sectional study, 190 PCOS women (PCOSw) and 99 controls (Cw) aged between 18 and 55years were included. PCOSw and Cw were distributed into 3 stages of reproductive life: early reproductive age (18-34years old), late reproductive age (35-40years old) and perimenopausal period (41-55years old). Waist circumference (WC), body mass index (BMI) and blood pressure (BP) were recorded. An oral glucose tolerance test (OGTT) with measurement of glucose and insulin was performed. Sex steroids and lipid profile were also determined in the fasting sample. Insulin sensitivity was assessed by HOMA-IR and ISI composite, and insulin secretion by HOMA-β and insulinogenic index. Visceral adiposity index (VAI) and lipid accumulation product (LAP) were also calculated. Metabolic syndrome (MS) was assessed by the IDF and ATPIII criteria. RESULTS At early reproductive age, PCOSw showed higher BMI, WC, and VAI and a higher prevalence of MS compared to Cw (p<0.05). In addition, at late reproductive age PCOSw also showed elevated total cholesterol, triglycerides, insulin secretion, LAP and BP. At perimenopausal period, these parameters were not different between Cw and PCOSw. Within the PCOSw group, HOMA-β was lower at late reproductive and perimenopausal periods compared to the early reproductive age. Regarding control women, a deterioration of anthropometric and metabolic parameters was observed in perimenopausal women compared to early and late reproductive women. CONCLUSIONS Our results suggest that metabolic derangements associated with PCOS are more evident at the early and late reproductive ages. On the other hand, during perimenopause, there is no further deterioration of metabolic parameters. Nevertheless, a disruption in pancreatic β-cell function is evidenced at this stage.
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Affiliation(s)
- Bárbara Echiburú
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile
| | - Nicolás Crisosto
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile
| | - Manuel Maliqueo
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile
| | - Francisco Pérez-Bravo
- Laboratory of Nutritional Genomics, Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Amanda Ladron de Guevara
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile
| | - Paola Hernández
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile
| | - Gabriel Cavada
- Public Health Department, University of Chile and University of Los Andes, Santiago, Chile
| | - Catalina Rivas
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile
| | - Andrés Clavel
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile
| | - Teresa Sir-Petermann
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile.
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Namazi MR, Parhizkar AR, Jowkar F. Serum levels of hypersensitive-C-reactive protein in moderate and severe acne. Indian Dermatol Online J 2015. [PMID: 26225329 PMCID: PMC4513404 DOI: 10.4103/2229-5178.160256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Elevation of C-reactive protein (CRP) has been reported to occur in psoriasis, urticaria, acne, rosacea and many other dermatological and nondermatological conditions. Chronic systemic inflammation has been implicated in the development of neuropsychiatric/degenerative disorders, atherosclerosis, coronary artery disease, diabetes mellitus and even carcinogenesis. The present study is designed to determine whether the level of inflammation created by acne vulgaris could be high enough to raise the serum levels of high-sensitive CRP. MATERIALS AND METHODS Forty-two patients with moderate and severe acne vulgaris were enrolled, along with 44 age and sex matched healthy blood donors as controls. Hypersensitive-CRP (Hs-CRP) was measured in both groups. RESULTS Hypersensitive-C-reactive protein levels in the case group varied between 0 and 28.1 μg/ml with an average of 2.24 ± 4.87 μg/ml (mean ± standard deviation) and a median of 0.6 μg/ml (interquartile range [IQR] =0.3, 1.4 μg/ml). Hs-CRP levels of the control group varied between 0 and 14 μg/ml with an average of 3.12 ± 3.67 μg/ml and a median of 1.5 μg/ml (IQR = 0.55, 5.0 μg/ml). No significant difference of Hs-CRP level between the two groups was seen (t = -0.961, 95% confidence interval: Lower = -2.6942, upper = 0.9377; P = 0.339). Additionally, no significant difference in the level of Hs-CRP was noted between the moderate and severe acne groups (95% confidence interval: Lower = -5.2495, upper = 1.6711; P = 0.165). CONCLUSION Acne vulgaris, even in its severe grades (excluding acne fulminans and acne conglobata), does not induce significant inflammation at the systemic level.
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Affiliation(s)
- M R Namazi
- Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Department of Liverpool Hospital Dermatology, Conjoint Faculty Member, University of New South Wales, Sydney, Australia
| | - A R Parhizkar
- Department of Dermatology, Fasa University of Medical Sciences, Fasa, Iran
| | - F Jowkar
- Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Dogan BA, Arduc A, Tuna MM, Karakılıc E, Dagdelen I, Tutuncu Y, Berker D, Guler S. Association of mean platelet volume with androgens and insulin resistance in nonobese patients with polycystic ovary syndrome. Int J Endocrinol Metab 2014; 12:e18642. [PMID: 25745486 PMCID: PMC4338650 DOI: 10.5812/ijem.18642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/13/2014] [Accepted: 05/17/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mean platelet volume (MPV) is generally accepted as a new marker of cardiovascular disease risk in several studies. OBJECTIVES This study aimed to determine the association of MPV with androgen hormones and insulin resistance (IR) in nonobese patients with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS A total of 136 patients with newly diagnosed reproductive-age PCOS (regarding the criteria of new PCOS phenotypes, based on the Rotterdam criteria) who were nonobese with the mean age of 25 years (25.39 ± 5.51) and mean body mass index (BMI) of 21 kg/m(2) (22.07 ± 2.13) were included. In addition, 59 healthy subjects with mean age of 26 years (22.07 ± 2.13) and mean BMI of 22 kg/m(2) (21.52 ± 3.84) were recruited as control. Total blood count (including MPV), total testosterone, free testosterone, dehydroepiandrosterone-sulfate (DHEAS), and androstenedione levels were recorded. IR was calculated from blood chemistry measurements of fasting insulin and glucose according to updated homeostasis model assessment. RESULTS No differences were observed in mean MPV values between patients and control group (9.02 fL (8.5-10.1) and 8.9 fL (7.7-9.1), respectively; P = 0.777). MPV values were similar among nonobese patients with and without IR and control subjects (P > 0.05). We detected significantly lower values of MPV in patients with hyperandrogenemia in comparison to patients with normal androgen levels (8.7 and 9.5 fL, P = 0.012). There was a negative correlation between total testosterone, DHEAS, and MPV (P = 0.016, r = -0.229; and P = 0.006, r = -0.261, respectively). Multiple logistic regression analyses confirmed the independence of these associations. CONCLUSIONS Our study revealed that nonobese women with and without PCOS have similar MPV values. While IR does not have any effect on MPV, elevated androgen levels are associated with a low MPV in nonobese patients with PCOS.
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Affiliation(s)
- Bercem Aycicek Dogan
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
- Corresponding author: Bercem Aycicek Dogan, Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey. Tel: +90-3125084734, Fax: +90-3123114340, E-mail:
| | - Ayse Arduc
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes-Endocrine and Obesity Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Mazhar Muslum Tuna
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Ersen Karakılıc
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Iffet Dagdelen
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Yasemin Tutuncu
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Dilek Berker
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Serdar Guler
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
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Ramezani Tehrani F, Rashidi H, Bahri Khomami M, Tohidi M, Azizi F. The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran. Reprod Biol Endocrinol 2014; 12:89. [PMID: 25224635 PMCID: PMC4180586 DOI: 10.1186/1477-7827-12-89] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/26/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrinopathy, associated with metabolic abnormalities. Metabolic features of various phenotypes of this syndrome are still debatable. The aim of present study hence was to evaluate the metabolic and hormonal features of PCOS phenotypes in comparison to a group of healthy control. METHODS A total of 646 reproductive-aged women were randomly selected using the stratified, multistage probability cluster sampling method. The subjects were divided into five phenotypes: A (oligo/anovulation + hyperandrogenism + polycystic ovaries), B (oligo/anovulation + hyperandrogenism), C (hyperandrogenism + polycystic ovaries) and D (oligo/anovulation + polycystic ovaries). Hormonal and metabolic profiles and the prevalence of metabolic syndrome among these groups were compared using ANCOVA adjusted for age and body mass index. RESULTS Among women with PCOS (n = 85), those of groups A and C had higher serum levels of insulin and homeostatic model assessment for insulin resistance (HOMA-IR), compared to PCOS women of group D. Serum concentrations of cholesterol, low density lipoprotein, triglycerides and glucose in group A were higher than in other phenotypes, whereas the metabolic syndrome was more prevalent among group B. CONCLUSIONS Women who had all three components of the syndrome showed the highest level of metabolic disturbances indicating that metabolic screening of the severest phenotype of PCOS may be necessary.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homeira Rashidi
- Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahnaz Bahri Khomami
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Aye MM, Kilpatrick ES, Afolabi P, Wootton SA, Rigby AS, Coady AM, Sandeman DD, Atkin SL. Postprandial effects of long-term niacin/laropiprant use on glucose and lipid metabolism and on cardiovascular risk in patients with polycystic ovary syndrome. Diabetes Obes Metab 2014; 16:545-52. [PMID: 24401089 DOI: 10.1111/dom.12255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/31/2013] [Accepted: 12/19/2013] [Indexed: 01/10/2023]
Abstract
AIM This study investigated the effect of long-term niacin/laropiprant therapy on CV risk and IR in obese women with PCOS. METHODS In this double-blind randomized placebo-controlled trial, 13 and 12 PCOS women completed a 12 week course of niacin/laropiprant or placebo, respectively. Fasted subjects had an endothelial function test (EndoPat2000) and then consumed a mixed meal with blood sampled postprandially for 6 h before and after intervention. RESULTS By 12 weeks, niacin/laropiprant lowered low-density lipoprotein cholesterol (LDL-c) (13%) and increased HDL-c (17%). Despite a reduction in fasting triglycerides (21%), the drug had no effect on their postprandial rise (2.69 ± 1.44 vs. 2.49 ± 1.14 mmol/l, p = 0.72). However, following the mixed meal, plasma glucose area under the response curve increased from 13.1 ± 2.9 to 14.0 ± 2.8 mmol/l, p = 0.05, as a consequence of both increased insulin resistance [HOMA-IR: 2.2 (1.2, 4.2) vs. 3.8(1.3, 5.5), p = 0.02] and a reduced acute insulin response to glucose [424 (211, 975) vs. 257(122, 418) pmol/mmol, p = 0.04]. Niacin/laropiprant did not improve RHI (1.97 ± 0.40 vs. 2.05 ± 0.58, p = 0.33) or hsCRP. CONCLUSIONS In PCOS, niacin/laropiprant had a significant negative impact on postprandial glucose and no improvement in postprandial hypertriglyceridaemia, with at least the former mediated through increased IR and reduced β-cell function. This data may help explain why the improvement in fasting lipids has not translated into improved CV risk markers in PCOS.
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Affiliation(s)
- M M Aye
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
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20
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Ezeh U, Yildiz BO, Azziz R. Referral bias in defining the phenotype and prevalence of obesity in polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:E1088-96. [PMID: 23539721 PMCID: PMC3667270 DOI: 10.1210/jc.2013-1295] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The described phenotype of the polycystic ovary syndrome (PCOS) has been primarily based on findings in a referred (self or otherwise) population. It is possible that the phenotype of PCOS would be different if the disorder were to be detected and studied in its natural (unbiased) state. OBJECTIVE Our objective was to compare the phenotype of PCOS detected in an unselected population with that identified in a referral population. PARTICIPANTS Participants included 292 PCOS patients identified at a tertiary care outpatient facility (referral PCOS) and 64 PCOS women (unselected PCOS) identified through the screening of a population of 668 seeking a pre-employment physical. Among the women undergoing a pre-employment physical, 563 did not demonstrate features of the disorder (unselected controls). All PCOS subjects met the National Institutes of Health 1990 criteria for the disorder. MAIN OUTCOME MEASURES We estimated prevalence of obesity and severity of disease burden. RESULTS Referral PCOS subjects had greater mean body mass index and hirsutism score and higher degrees of hyperandrogenemia, were more likely to be non-Hispanic White (83.90%), and demonstrated a more severe PCOS subphenotype than unselected PCOS or unselected controls. The prevalence of obesity and severe obesity in referral PCOS was 2.3 and 2.5 times greater than estimates of the same in unselected PCOS and 2.2 and 3.8 times greater than estimates in unselected controls, respectively. Alternatively, unselected PCOS subjects had a prevalence of obesity and severe obesity and a mean body mass index similar to those of the general population from which they were derived. CONCLUSION The phenotype of PCOS, including the racial/ethnic mix, severity of presentation, and rate of obesity, is affected significantly by whether the PCOS subject arises from a referral population or through unselected screening, likely reflecting the degree of patient concern and awareness and access to healthcare.
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Affiliation(s)
- Uche Ezeh
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Kansra AR, Menon S. PCOS: perspectives from a pediatric endocrinologist and a pediatric gynecologist. Curr Probl Pediatr Adolesc Health Care 2013; 43:104-13. [PMID: 23582592 DOI: 10.1016/j.cppeds.2013.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 12/13/2022]
Abstract
Polycystic ovary syndrome is the most common endocrinopathy recognized in women of childbearing age with a prevalence of 4-12%. The prevalence of the disorder in adolescent population is poorly defined. The pathogenesis as well as the management of this disorder is widely debated.
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Affiliation(s)
- Alvina R Kansra
- Department of Pediatrics, Section of Endocrinology & Diabetes, Medical College of Wisconsin, Milwaukee, WI, USA.
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Esfahanian F, Zamani MM, Heshmat R, Moini nia F. Effect of Metformin compared with hypocaloric diet on serum C-reactive protein level and insulin resistance in obese and overweight women with polycystic ovary syndrome. J Obstet Gynaecol Res 2012; 39:806-13. [DOI: 10.1111/j.1447-0756.2012.02051.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/21/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Fatemeh Esfahanian
- Endocrinology and Metabolism Research Center; Internal Medicine Department; Vali-Asr Hospital; Tehran; Iran
| | | | - Ramin Heshmat
- Endocrinology and Metabolism Research Center; Epidemiology and Biostatistics Department; Dr Shariati Hospital; Tehran University of Medical Sciences; Tehran; Iran
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Zhu JP, Teng YC, Zhou J, Lu W, Tao MF, Jia WP. Increased mean glucose levels in patients with polycystic ovary syndrome and hyperandrogenemia as determined by continuous glucose monitoring. Acta Obstet Gynecol Scand 2012; 92:165-71. [PMID: 23072215 DOI: 10.1111/aogs.12031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Women with polycystic ovary syndrome are at risk of developing type 2 diabetes mellitus. This study aimed to evaluate the influence of hyperandrogenemia on glucose metabolism in polycystic ovarian syndrome patients. DESIGN Cohort study. SETTING Reproductive Endocrinology Clinic of the Shanghai Sixth People's Hospital. SAMPLE Fifty-three patients were recruited from June 2008 to December 2009, including 28 women with hyperandrogenism and 25 without hyperandrogenemia. METHODS Anthropometric parameters, including weight, height, body mass index and waist-to-hip ratio, as well as sex hormones, were measured. An oral glucose tolerance test, including fasting and two hour glucose and insulin levels, was recorded. Insulin resistance was evaluated by homeostatic model assessment of insulin resistance, and patients underwent continuous glucose monitoring. MAIN OUTCOME MEASURES Mean blood glucose level, mean amplitude of glycemic excursion, frequency of glycemic excursion and the percentage of time of hypoglycemia and hyperglycemia during a 48 h period. RESULTS No differences in age, body mass index, waist-to-hip ratio, fasting and two hour glucose and insulin concentrations were observed between the groups. The hyperandrogenism group had higher levels of luteinizing hormone and dehydroepiandrosterone sulfate (p < 0.05). However, continuous glucose monitoring showed that the minimal blood glucose and mean blood glucose were significantly higher in hyperandrogenemia group (p = 0.004). The percentage of time for hypoglycemia (≤70 mg/dL) was higher in the hyperandrogenemia group (p = 0.002). CONCLUSIONS Polycystic ovarian syndrome patients with hyperandrogenemia had an increased mean glucose value, which may place them at increased risk for developing type 2 diabetes.
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Affiliation(s)
- Jie-Ping Zhu
- Department of Obstetrics and Gynecology, the Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Knebel B, Lehr S, Janssen OE, Hahn S, Nitzgen U, Jacob S, Haas J, Muller-Wieland D, Kotzka J. Genetic variants in central metabolic genes influence some but not all relations of inflammatory markers in a collective with polycystic ovary syndrome. Arch Physiol Biochem 2012; 118:219-29. [PMID: 22738153 DOI: 10.3109/13813455.2012.697903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Patients with polycystic ovary syndrome (PCOS) suffer, in addition to reproductive disturbances, from symptoms of the metabolic syndrome like insulin resistance, elevated coronary risk and visceral obesity. Genes with confirmed associations to the metabolic syndrome are also candidate genes for a relationship to metabolic parameters of the PCOS syndrome. The study presented indicates that genetic variants of the transcription factors LXRα or PPARγ and the PON-1 or the IGF-2 cluster are associated with altered metabolic phenotypes in PCOS patients. Next to this the absolute cytokine levels and the relation of certain cytokines to IL2, IL12 or INFγ are depending on the genotype. These observations support the hypothesis that various genetic variants in metabolic relevant genes might not only alter the metabolic characteristics within a cohort of PCOS patients but might also influence the cytokine level and the overall pattern of secreted cytokines.
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Affiliation(s)
- Birgit Knebel
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Leibniz Center for Diabetes Research, Düsseldorf, Germany
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Pinola P, Lashen H, Bloigu A, Puukka K, Ulmanen M, Ruokonen A, Martikainen H, Pouta A, Franks S, Hartikainen AL, Järvelin MR, Morin-Papunen L. Menstrual disorders in adolescence: a marker for hyperandrogenaemia and increased metabolic risks in later life? Finnish general population-based birth cohort study. Hum Reprod 2012; 27:3279-86. [PMID: 22933528 DOI: 10.1093/humrep/des309] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Are self-reported menstrual disorders associated with hyperandrogenaemia and metabolic disturbances as early as in adolescence? SUMMARY ANSWER Menstrual disorders at the age 16 are a good marker of hyperandrogenaemia, and an adverse lipid profile was associated with higher androgen levels. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Hyperandrogenism per se has been suggested to be a significant metabolic risk factor in women and a cause of physical and psychological morbidity in adolescent girls. A weak positive correlation has been described between hyperandrogenaemia and obesity in adolescent girls, but the clinical consequences are still poorly understood. Hyperandrogenism and insulin resistance are also key features of polycystic ovary syndrome (PCOS), and women with PCOS are consequently at an increased risk of developing type 2 diabetes mellitus and/or metabolic syndrome, and may have increased cardiovascular morbidity. Our findings confirm that the association between menstrual disorders, hyperandrogenism, obesity and metabolic risks is already evident in adolescence. STUDY DESIGN This population-based, cross-sectional study used postal questionnaires to targeting 15-16-year-old girls in the Northern Finland Birth Cohort 1986 (n= 4567). PARTICIPANTS AND SETTING There were 3669 girls who answered the postal questionnaire and out of 3373 girls who also underwent clinical examinations and blood tests, 2448 were included in the analyses. The questionnaire included one question about the regularity and length of the menstrual cycle: 'Is your menstrual cycle (the interval from the beginning of one menstrual period to the beginning of the next period) often (more than twice a year) longer than 35 days?' The girls who answered 'yes' to this question were considered to be suffering from menstrual disorders and were classified as 'symptomatic'. The girls who answered 'no' were defined as 'non-symptomatic'. MAIN RESULTS AND THE ROLE OF CHANCE There were 709 (29%) girls who reported menstrual disorders (symptomatic girls) and 1739 who had regular periods (non-symptomatic girls). In the whole population and in both study groups, there were significant correlations between body mass index (BMI) (and waist-to-hip ratio), hyperandrogenaemia and metabolic parameters. Symptomatic girls exhibited significantly higher serum concentrations of testosterone (P= 0.010), lower levels of sex hormone-binding globulin (P =0.042) and higher free androgen indices [FAIs; geometric mean 3.38 (interquartile range (IQR): 2.27, 5.18) versus 3.08 (IQR: 2.15, 4.74), P= 0.002]. The two groups had comparable BMI and insulin sensitivity, and serum levels of glucose, insulin and lipids. There was a significant linear trend towards higher FAI values in the higher BMI quartiles in both symptomatic and non-symptomatic girls. In the whole population, there was a statistically significant linear decrease in high-density lipoprotein concentrations (P < 0.001) and higher triglyceride concentrations (P =0.004) in the upper FAI quartile. IMPLICATIONS Information regarding menstrual disorders in adolescence is a good marker of hyperandrogenaemia and may be an early risk factor for the development of PCOS in adulthood. The association between obesity, hyperandrogenism and metabolic risks is already evident in adolescence, which strengthens the importance of noting menstrual disorders at an early stage. BIAS, LIMITATIONS, GENERALIZABILITY: The cross-sectional nature of the study does not allow us to draw conclusions concerning the metabolic risks of this population in later life. The diagnosis of menstrual disorders was based on a questionnaire, suggesting a risk of information bias in reporting the symptoms. This study was not designed to diagnose PCOS, as ultrasonography was not available and there was no clinical evaluation of hyperandrogenism (i.e. hirsutism). However, we were able to take into account potential confounding factors in the analyses. STUDY FUNDING/COMPETING INTERESTS This work was supported by grants from the Finnish Medical Society Duodecim, the North Ostrobothnia Regional Fund, the Academy of Finland (project grants 104781, 120315, 129269, 1114194, SALVE), University Hospital Oulu, Biocenter, University of Oulu, Finland (75617), the European Commission (EURO-BLCS, Framework 5 award QLG1-CT-2000-01643) and the Medical Research Council, UK (PrevMetSyn/SALVE). None of the authors have any conflict of interest to declare.
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Affiliation(s)
- P Pinola
- Department of Obstetrics and Gynaecology, University Hospital of Oulu, PL 23 90029 OYS, Oulu, Finland
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Skroza N, Tolino E, Semyonov L, Proietti I, Bernardini N, Nicolucci F, La Viola G, Del Prete G, Saulle R, Potenza C, La Torre G. Mediterranean diet and familial dysmetabolism as factors influencing the development of acne. Scand J Public Health 2012; 40:466-74. [DOI: 10.1177/1403494812454235] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To investigate the effects of adherence to the Mediterranean diet and familial dysmetabolisms on acne development. Methods: A community-based case–control study was carried out in Italy enrolling cases as acneic outpatients of a dermatological ambulatory service and controls as clinically healthy acne-free subjects. Food consumption were evaluated with a validated food-frequency questionnaire, exploring the consumption of pasta, meat, cheese, fish, fruit, vegetables, and olive oil. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean diet scale that incorporated the main characteristics of this diet. A logistic regression analysis estimated the variables who predicted the odds of being case, using those variables that at the univariate analysis yielded a p-value <0.25. Results are presented as odds ratio (OR) or adjusted OR (AOR). Results: The study included 93 cases (36.6% males, median age 17 years) and 200 controls (32% males, median age 16 years). The Mediterranean diet score ≥6 revealed a protective effect towards acne (crude OR 0.22, 95% CI 0.08–0.64). Logistic regression analysis showed that familial hypercholesterolaemia, diabetes, and hypertension are strong risk factors for acne (AOR 8.79, 95% CI 1.67–46.22; 3.32, 95% CI 1.27–8.63; and 2.73, 95% CI 1.07–6.96, respectively), while the Mediterranean diet represents a protective factor (score ≥6, AOR 0.31, 95% CI 0.11–0.89). Conclusions: The odds for familial dysmetabolisms was higher in cases than in controls, confirming their role in determining or maintaining acne. Moreover, this is the first study demonstrating a protective role of the Mediterranean diet in the pathogenesis of acne.
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Affiliation(s)
- Nevena Skroza
- Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Ersilia Tolino
- Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Leda Semyonov
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Ilaria Proietti
- Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Nicoletta Bernardini
- Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Francesca Nicolucci
- Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Giorgio La Viola
- Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Del Prete
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Rosella Saulle
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Concetta Potenza
- Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
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Samara-Boustani D, Colmenares A, Elie C, Dabbas M, Beltrand J, Caron V, Ricour C, Jacquin P, Tubiana-Rufi N, Levy-Marchal C, Delcroix C, Martin D, Benadjaoud L, Jacqz Aigrain E, Trivin C, Laborde K, Thibaud E, Robert JJ, Polak M. High prevalence of hirsutism and menstrual disorders in obese adolescent girls and adolescent girls with type 1 diabetes mellitus despite different hormonal profiles. Eur J Endocrinol 2012; 166:307-16. [PMID: 22127492 DOI: 10.1530/eje-11-0670] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare the pubertal development, the hormonal profiles and the prevalence of hirsutism and menstrual disorders in obese adolescent girls and adolescent girls with type 1 diabetes mellitus (T1DM). METHODS Data were collected from 96 obese adolescent girls and 78 adolescent girls with T1DM at Tanner stage IV or V, whose ages ranged between 11.9 and 17.9 years. RESULTS High prevalence of hirsutism and menstrual disorder was found in the obese adolescent girls (36.5 and 42% respectively) and the adolescent girls with T1DM (21 and 44% respectively). The obese girls were significantly younger at pubarche, thelarche and menarche than the girls with T1DM. Hirsutism in the obese girls and those with T1DM was associated with hyperandrogenaemia and a raised free androgen index (FAI). When the cause of the raised FAI was investigated in both the groups of girls with hirsutism, the raised FAI in the obese girls was due to low serum sex hormone-binding globulin (SHBG) levels. In contrast, the raised FAI of the girls with T1DM and hirsutism was due to hyperandrogenaemia. Menstrual disorders in the T1DM girls were associated also with hyperandrogenaemia unlike obese girls. CONCLUSIONS Hirsutism and menstrual disorders are common in obese adolescent girls and adolescent girls with T1DM. Although hyperandrogenaemia is present in both groups of girls, the androgenic profiles of the two groups differ. The hyperandrogenaemia in the obese girls is primarily due to their decreased serum SHBG levels, whereas the hyperandrogenaemia in the girls with T1DM is due to their increased androgen production.
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Affiliation(s)
- Dinane Samara-Boustani
- Paediatric Endocrinology and Diabetes Unit, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
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Hart R, Doherty DA, Mori T, Huang RC, Norman RJ, Franks S, Sloboda D, Beilin L, Hickey M. Extent of metabolic risk in adolescent girls with features of polycystic ovary syndrome. Fertil Steril 2011; 95:2347-53, 2353.e1. [DOI: 10.1016/j.fertnstert.2011.03.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/23/2011] [Accepted: 03/01/2011] [Indexed: 02/04/2023]
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30
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Traub ML. Assessing and treating insulin resistance in women with polycystic ovarian syndrome. World J Diabetes 2011; 2:33-40. [PMID: 21537458 PMCID: PMC3083905 DOI: 10.4239/wjd.v2.i3.33] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/10/2010] [Accepted: 12/17/2010] [Indexed: 02/05/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS) is a highly prevalent hormonal and metabolic disorder among reproductive aged women worldwide. Women with PCOS have widely varying phenotypes and seek medical care for differing reasons. In addition to concern for menstrual cycle function, ovulation, hirsutism and acne, many PCOS women have abnormal glucose metabolism. While diabetes mellitus and impaired glucose tolerance are easily diagnosed, the diagnosis of and concern for insulin resistance as a precursor disorder is underappreciated. Insulin resistance may be the first important marker of metabolic disease in PCOS women at risk for metabolic syndrome and coronary artery disease.
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Affiliation(s)
- Michael L Traub
- Michael L Traub, Island Reproductive Services, Staten Island, NY 10314, United States
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31
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Lambrinoudaki I. Cardiovascular risk in postmenopausal women with the polycystic ovary syndrome. Maturitas 2010; 68:13-6. [PMID: 20943333 DOI: 10.1016/j.maturitas.2010.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the commonest endocrine disorders, affecting 5-10% of the female population of reproductive age. "Classic" PCOS is characterized by clinical or biochemical hyperandrogenism and oligo-ovulation. According to the 2003 Rotterdam criteria, two additional phenotypes are recognized: (1) the ovulatory patient with androgen excess and polycystic ovarian morphology and (2) the anovulatory patient with polycystic ovarian morphology without androgen excess. PCOS is associated with an adverse cardiometabolic profile, consisting of increased total or central adiposity, increased blood pressure, a pro-atherogenic lipid profile, increased inflammatory markers, insulin resistance and abnormal glucose metabolism. Furthermore, the incidence of overt or gestational diabetes mellitus, as well as of preeclampsia is significantly higher in PCOS patients. Among the various PCOS phenotypes, those with evidence of androgen excess have the highest burden of cardiovascular risk. Studies evaluating the incidence of cardiovascular disease in postmenopausal women with PCOS are extremely sparse. The available data so far indicate that coronary heart disease, as well as cerebrovascular disease is more common in postmenopausal PCOS patients. Persisting high androgen levels through the menopause, obesity and maturity onset diabetes mellitus are proposed as the main mechanisms accounting for the increased risk.
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Affiliation(s)
- Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 27, Themistokleous Street, Dionysos, GR-14578 Athens, Greece.
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Brand JS, van der Tweel I, Grobbee DE, Emmelot-Vonk MH, van der Schouw YT. Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and meta-analysis of observational studies. Int J Epidemiol 2010; 40:189-207. [DOI: 10.1093/ije/dyq158] [Citation(s) in RCA: 208] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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