0000000000123772
AUTHOR
Roger A. Lobo
A 20-year follow-up of young women with polycystic ovary syndrome.
OBJECTIVE: To determine whether hormonal, metabolic, and anthropomorphic parameters change over 20 years in women with polycystic ovary syndrome (PCOS). METHODS: One hundred ninety-three women with PCOS, aged 20–25 years, were diagnosed according to Rotterdam criteria, divided into four phenotypes (A–D), and followed at 5-year intervals for 20 years. Androgens, gonadotropins, insulin, glucose, body mass index, waist circumference, and ovarian volume were measured. RESULTS: At diagnosis, 57% had classic features (phenotype A), 9% had classic features without ovarian findings (phenotype B), 26% had the ovulatory phenotype (C), and 7% were nonhyperandrogenic (D). After 10 years, androgens decr…
Emergence of ovulatory cycles with aging in women with polycystic ovary syndrome (PCOS) alters the trajectory of cardiovascular and metabolic risk factors
Abstract STUDY QUESTION: What alters cardiovascular and metabolic risk factors with aging in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER: Lipid parameters, mainly low-density lipoprotein (LDL) cholesterol, increase with aging, but not in women who attain ovulatory cycles. WHAT IS KNOWN ALREADY: Cardiovascular and metabolic parameters tend to increase with aging, but this has not been shown in a prospective longitudinal study in women with PCOS. Correlates of these changes have not been identified. STUDY DESIGN: A prospective cohort of 118 hyperandrogenic women with PCOS who were followed from the age of 20-25 years at 5 year intervals for 20 years. PARTICIPANTS/MATERIALS, SE…
Increased anti-Mullerian hormone levels and ovarian size in a subgroup of women with functional hypothalamic amenorrhea: further identification of the link between polycystic ovary syndrome and functional hypothalamic amenorrhea.
Functional hypothalamic amenorrhea is a disorder characterized by cessation of menstrual cycles in the absence of organic disease. In most patients, it occurs in adult life after a stressful event and may be related to a condition of mild chronic energy deprivation. The endocrine pattern is characterized by low estrogen levels with an absent response to a progestogen challenge test and low-normal gonadotropin levels. A few studies have shown that some of these women may have some features of polycystic ovary syndrome; these features include an increased androgen response to gonadotropins, increased anti-Mullerian hormone levels, and altered ovarian morphology or increased ovarian size. Thes…
Does the level of serum antimüllerian hormone predict ovulatory function in women with polycystic ovary syndrome with aging?
Abstract OBJECTIVE: To determine possible prediction of regular menses with aging in anovulatory women with polycystic ovary syndrome (PCOS). DESIGN: Cohort. SETTING: Academic practice. PATIENT(S): A total of 54 anovulatory women with PCOS and 28 age- and weight-matched control subjects. INTERVENTION(S): Blood and ovarian ultrasound at baseline and after 5 years. MAJOR OUTCOME MEASURE(S): Serum antimüllerian hormone (AMH), gonadotropins, androgens, insulin sensitivity, and ovarian ultrasound. RESULT(S): After 5 years, there was a significant decrease in AMH in women with PCOS and control subjects (10 of 54 anovulatory women became ovulatory after 5 years). There was a significant negative c…
Is There Really Increased Cardiovascular Morbidity in Women with Polycystic Ovary Syndrome?
For some time, it has been assumed that women with polycystic ovary syndrome (PCOS) are at increased risk of developing cardiovascular disease (CVD). This has largely been on the basis of having many risk factors, including abnormal lipid profile, insulin resistance, and markers of inflammation. However, despite having these and other risk factors, we argue here, in the view of the authors, that there is no credible evidence that there is greater CVD morbidity in all women with PCOS. We analyze the existing data and discuss that overall CVD risk decreases with age when more CVD events are likely to occur, and introduce the possibility that there may be some unknown inherent protective facto…
Pituitary-adrenal responses to ovine corticotropin-releasing factor in polycystic ovary syndrome and in other hyperandrogenic patients.
This study was carried out to further characterize the pituitary-adrenal androgen responses of hyperandrogenic patients with 'classic' polycystic ovary syndrome (PCO) and others who were less distinctive and have been called 'PCO-like'. PCO-like patients differed from PCO only in that serum luteinizing hormone (LH) levels were normal and anovulation was not consistent. Ovine corticotropin-releasing factor (CRF) resulted in normal responses of adrenocorticotropic hormone and cortisol in the two groups when compared to controls, while androstenedione (delta 4A) and dehydroepiandrosterone (DHEA) responses were significantly elevated. There were no differences in the responses of PCO and PCO-li…
Features of polycystic ovary syndrome (PCOS) in women with functional hypothalamic amenorrhea (FHA) may be reversible with recovery of menstrual function
Since features of polycystic ovary syndrome (PCOS) have been found to be prevalent in women with functional hypothalamic amenorrhea (FHA), we wished to determine what happens to these features after recovery of menstrual function in FHA Design: Prospective cohort study. Twenty-eight women with FHA and 30 age-matched ovulatory controls were studied.Twenty-eight women with FHA and 30 age-matched ovulatory controls were studied. We measured serum estradiol, LH, FSH, testosterone, DHEAS, anti-Mullerian hormone (AMH), body mass index, and ovarian morphology on transvaginal ultrasound.At baseline, 12 of the 28 women (43%) had increased AMH (4.7 ng/mL), and higher testosterone and larger ovaries c…
Phenotypic variation in hyperandrogenic women influences the findings of abnormal metabolic and cardiovascular risk parameters.
In hyperandrogenic women, several phenotypes may be observed. This includes women with classic polycystic ovary syndrome (C-PCOS), those with ovulatory (OV) PCOS, and women with idiopathic hyperandrogenism (IHA), which occurs in women with normal ovaries. Where other causes have been excluded, we categorized 290 hyperandrogenic women who were seen consecutively for this complaint between 1993 and 2004 into these three subgroups. The aim was to compare the prevalence of obesity, insulin resistance, and dyslipidemia as well as increases in C-reactive protein and homocysteine in these different phenotypes with age-matched ovulatory controls of normal weight (n = 85) and others matched for body…
Metabolic syndrome in polycystic ovary syndrome (PCOS): lower prevalence in Southern Italy than in USA and the influence of criteria for the diagnosis of PCOS
Objective: Metabolic syndrome (MBS) is a common disorder and is thought to be extremely prevalent in polycystic ovary syndrome (PCOS). In the USA the prevalence of MBS in PCOS has been reported to be as high as 43–46% using Adult Treatment Panel III (ATP-III) criteria. Because of differences in diet, lifestyle and genetic factors, we postulated that the prevalence of MBS might not be as high in Italian women. This study sought to determine the prevalence of MBS in Italian women using both the ATP-III and the World Health Organization (WHO) criteria and to determine whether the prevalence is influenced by the way in which PCOS is diagnosed. Design: Assessment of the prevalence of MBS in 282 …
Time-dependent changes in serum 3α-androstanediol glucuronide correlate with hirsutism scores after ovarian suppression
The clinical utility of serum 3 alpha-androstanediol glucuronide level has been controversial. Among the concerns regarding its lack of utility has been the finding that suppression of serum 3 alpha-androstanediol glucuronide does not occur readily with treatment. We hypothesized that because the treatment of hirsutism requires a prolonged duration, a longer observation period is required for changes in serum 3 alpha-androstanediol glucuronide to be measured. Therefore, we studied the clinical and hormonal changes in 11 women treated for hirsutism with a gonadotropin-releasing hormone agonist (GnRH-a) for 1 year. A progressive reduction in Ferriman-Gallwey scores occurred, which was signifi…
Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females, with a high prevalence. The etiology of this heterogeneous condition remains obscure, and its phenotype expression varies. Two widely cited previous ESHRE/ASRMsponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008), respectively. The present third PCOS consensus report summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, e…
The association of serum androsterone glucuronide with inflammatory lesions in women with adult acne1
Serum androsterone glucuronide (AoG) is a metabolite of circulating androgens under the influence of 5α-reductase activity and has been shown to be particularly elevated in women with acne. In this study, we wanted to evaluate changes in AoG before and after treatment with an oral contraceptive or placebo, and to assess whether changes correlated with the number and type of acne lesions. In order to accomplish these aims, we obtained sera from a completed prospective randomized trial, which was designed to assess the effectiveness of an oral contraceptive compared to placebo. Assessments were carried out in 56 women with moderate acne who were treated with Ortho Tri-Cyclen (norgestimate and…
Prevalence and metabolic characteristics of adrenal androgen excess in hyperandrogenic women with different phenotypes
Background: Serum DHEAS has been found to be elevated in some women with polycystic ovary syndrome (PCOS). We wished to determine whether this prevalence is different in women with androgen excess who have different phenotypes and to correlate these findings with various cardiovascular and metabolic parameters. Methods: Two hundred and thirty-eight young hyperandrogenic women categorized into various diagnostic groups were evaluated for elevations in serum DHEAS, testosterone, glucose, insulin, quantitative insulin-sensitivity check index (QUICKI), cholesterol, HDL-C, LDL-C, triglycerides and C-reactive protein (CRP). Data were stratified based on elevations in DHEAS. Results: Serum DHEAS w…