Carlos Morán

Prevalence of Polycystic Ovary Syndrome and Related Disorders in Mexican Women

Background/Aims: Polycystic ovary syndrome (PCOS) has been found to affect 4–8% of women of reproductive age; however, in Mexican-Americans a prevalence of 12.8% has been reported. This study determines the prevalence of PCOS in a sample of Mexican women. Methods: This prospective cross-sectional study included 150 female Mexican volunteers aged 20–45 years. Menstrual cycles were recorded and hirsutism was graded. Pelvic ultrasound was performed and androgen levels were measured. PCOS was diagnosed by hyperandrogenism and/or hyperandrogenemia, and oligo-ovulation (NIH 1990 criteria), and also by 2 of 3 findings: oligo-ovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries (PCO) (Rotterdam 2003 criteria), excluding other disorders. Results: Nine of the 150 women were diagnosed with PCOS, a prevalence of 6.0% (95% CI: 1.9–10.1%), according to NIH criteria. The ultrasound morphology added one patient to give ten PCOS patients, a prevalence of 6.6% (95% CI: 2.3–10.9%) according to Rotterdam criteria. All PCOS patients presented oligo-ovulation, 9 had hirsutism and 7 of them had acne. Eight of the 10 PCOS patients had morphologic characteristics of PCO. Conclusion: The prevalence of PCOS in Mexican women is approximately 6.0%, similar to other populations, but lower than 12.8% reported in Mexican-American women.

Bacterial Infection and Semen Characteristics in Infertile Men

Semen samples of 190 men attending an andrology clinic were evaluated with bacteriological culture and categorized as negative (group I) and positive (group II); the effect of bacteriospemia on semen characteristics was also analyzed. Semen samples from both groups were simultaneously analyzed for routine parameters such as volume, sperm count, motility, viability and morphology. The semen culture was negative in 34% and positive in 66% of the samples. From 123 samples, 157 aerobes and 8 anaerobes were recovered. The most commonly isolated organism was Staphylococchs epidermidis (in 63% of the samples), followed by Streptococchs viridans (28%), Escherichia coli (9%), Staphylococcus aureus (5%), Streptococcus faecalis (5%), beta-hemolytic Streptococcus (4%), and Enterobacter agglomerans (4%). Other microorganisms, including Klebsiella sp, Candida sp., and Proteus mirabilis, were recovered in fewer than 4% of the specimens. The comparison of semen characteristics between infected and noninfected men showed that motile spermatozoa and viability were lower when the microorganisms were present in the semen. It would appear that the bacteria can have a direct effect on semen quality with negative consequences in fertility.

Upper Body Obesity and Hyperinsulinemia Are Associated with Anovulation

The objective of this study was to determine the effect of body fat distribution and hyperinsulinemia on the occurrence of ovulation. Fifty-six women (20–35 years old) either with overweight or obesity (body mass index ≥25) were studied. They were classified in two groups according to waist/hip ratio (WHR); one with predominance of adiposity in the upper body segment (n = 29, WHR >0.85) and the other with predominant adiposity in the lower body segment (n = 27, WHR ≤0.85). Basal body temperature and serum progesterone were determined in each cycle during 6 months. Serum insulin levels were measured at baseline and 30, 60, 90, 120 and 180 min after a 75-gram oral glucose load. The mean insulin values in response to oral glucose load in patients with upper body segment obesity were significantly higher than those corresponding to women with lower body segment obesity. Furthermore, the ratio between ovulated cycles and all the cycles studied in patients with upper body segment obesity was significantly lower than that observed in patients with lower body segment obesity. Upper body obesity seems to affect the ovulatory process and this may be related to the presence of hyperinsulinemia.

ACTH AND CRF-PRODUCING BRONCHIAL CARCINOID ASSOCIATED WITH CUSHING'S SYNDROME

A young female patient, with clinical and biochemical manifestations of severe hypercorticism and with the presence of a pituitary adenoma shown by computerized tomography, was thought to have Cushings syndrome of hypophysial origin. However, the surgically‐removed pituitary adenoma contained no ACTH, by immunocytology, and hypercorticism persisted after transsphenoidal adenomectomy. The patient died and autopsy demonstrated an ACTH and corticotrophin releasing factor (CRF)‐containing bronchial carcinoid. It can be concluded that bronchial carcinoids can produce ACTH and CRF and can mimic the clinical and biochemical manifestations of pituitary Cushings syndrome. Thus, the localization of the primary site of hypercorticism can be extremely difficult in patients who have an insidious, occult extrapituitary tumour. Further work is required to establish whether CRF plays a role in the causation of Cushings syndrome and whether the simultaneous secretion of this peptide can modify the clinical and biochemical manifestations of the ectopic ACTH syndrome.

Obesity differentially affects phenotypes of polycystic ovary syndrome.

Obesity or overweight affect most of patients with polycystic ovary syndrome (PCOS). Phenotypes are the clinical characteristics produced by the interaction of heredity and environment in a disease or syndrome. Phenotypes of PCOS have been described on the presence of clinical hyperandrogenism, oligoovulation and polycystic ovaries. The insulin resistance is present in the majority of patients with obesity and/or PCOS and it is more frequent and of greater magnitude in obese than in non obese PCOS patients. Levels of sexual hormone binding globulin are decreased, and levels of free androgens are increased in obese PCOS patients. Weight loss treatment is important for overweight or obese PCOS patients, but not necessary for normal weight PCOS patients, who only need to avoid increasing their body weight. Obesity decreases or delays several infertility treatments. The differences in the hormonal and metabolic profile, as well as the different focus and response to treatment between obese and non obese PCOS patients suggest that obesity has to be considered as a characteristic for classification of PCOS phenotypes.

The Role Of The Adrenal Cortex In Polycystic Ovary Syndrome

Adrenal androgen excess affects approximately 25% of PCOS patients. The exact etiology of this excess in PCOS patients is unclear. Some evidence that adrenal androgen excess may be a genetic trait. The adrenal androgen response to ACTH is highly individualized, and the relative response seems to be constant over time. In addition, there is a strong familial component to adrenal androgen levels in normal individuals and PCOS patients. It is possible that the tendency to overproduce adrenal androgens is an inherited risk factor for the development of PCOS. Overall, few hyperandrogenic patients actually have isolated deficiencies of 3 beta-hydroxysteroid dehydrogenase, 21-hydroxylase, and 11-hydroxylase. The ovarian hormonal secretion in PCOS can affect adrenal androgen secretion and metabolism, although this factor accounts for only part of this abnormality. More likely, the adrenal androgen excess results from a generalized hyperresponsiveness of the adrenal cortex to ACTH, but without an increase in CRH or ACTH sensitivity. Although glucocorticoid administration may improve the ovulatory function of these patients, the results are modest and cannot be predicted by the circulating androgen levels.

Obesity differentially affects serum levels of androstenedione and testosterone in polycystic ovary syndrome

OBJECTIVE To assess androstenedione (A) and T levels in obese and nonobese patients with polycystic ovary syndrome (PCOS) after GnRH and oral glucose tolerance tests (OGTT). DESIGN Cross sectional study. SETTING Clinical research center. PATIENT(S) Thirty patients with PCOS, of whom 15 were obese and 15 were nonobese, and 7 women without PCOS were included in the study. INTERVENTION(S) The GnRH test and OGTT were performed in all subjects. MAIN OUTCOME MEASURE(S) Basal and stimulated levels of LH, FSH, insulin, A, and total T were measured. Areas under the curve (AUCs) and AUC change after stimulation for these hormones were calculated. RESULT(S) The basal T levels were significantly higher in obese than in nonobese patients with PCOS. In contrast, the basal levels of A were similar in obese and nonobese patients with PCOS. The T(AUC) after GnRH was significantly greater in obese than in nonobese patients with PCOS but was not significantly different after OGTT. The A(AUC) after GnRH and OGTT was significantly greater in nonobese than in obese patients with PCOS. However, there were no significant differences in T(AUC) and A(AUC) changes after GnRH and OGTT. CONCLUSION(S) A different pattern in the levels of T and A with respect to obesity in PCOS was observed, suggesting a shift in ovarian enzymatic function.

Adrenal androgen excess and body mass index in polycystic ovary syndrome.

CONTEXT Adrenal hyperandrogenism affects approximately 25% of polycystic ovary syndrome (PCOS) patients but its relation to obesity is not totally understood. OBJECTIVE This study aimed to assess dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) levels in relation to body mass index (BMI) in PCOS. DESIGN AND SETTING This was a prospective observational study at an institutional practice at an obstetrics/gynecology hospital. PARTICIPANTS The study included 136 PCOS patients, 20-35 years old, and 42 age-matched control women. The participants were classified with the BMI cutoff value of 27 kg/m(2) as follows: 1) high-BMI PCOS patients; 2) low-BMI PCOS patients; 3) high-BMI control women; and 4) low-BMI control women. The data were reanalyzed with the BMI cutoff value of 30 kg/m(2) to corroborate the findings in obese and nonobese patients. MAIN OUTCOME MEASURE(S) Blood samples were taken and LH, FSH, insulin, T, androstenedione (A4), DHEA, DHEAS, and glucose levels were determined. Homeostatic model assessment was calculated. Pelvic and abdominal ultrasound for ovarian morphology and adipose tissue, respectively, were performed. RESULTS Obese PCOS patients presented significantly more insulin resistance than nonobese PCOS patients. The LH levels and LH/FSH ratio were significantly higher in low-BMI than in high-BMI PCOS patients. The A4 and DHEAS levels were significantly higher in nonobese than in obese PCOS patients. A significant correlation between LH and A4 in nonobese PCOS patients was observed. The frequency of hyperandrogenism by increased A4, and DHEA along with DHEAS was significantly higher in low-BMI PCOS patients compared with high-BMI PCOS patients. Some findings observed with the BMI cutoff value of 27 kg/m(2) changed with the cutoff value of 30 kg/m(2). CONCLUSIONS Low BMI more so than high BMI is associated with increased LH, high A4, DHEA, and DHEAS levels in PCOS patients. The BMI cutoff value of 27 kg/m(2) classified better than 30 kg/m(2) for hormonal and metabolic characteristics.

Prevalence of 3β-hydroxysteroid dehydrogenase–deficient nonclassic adrenal hyperplasia in hyperandrogenic women with adrenal androgen excess

OBJECTIVE We sought to determine the prevalence of 3beta-hydroxysteroid dehydrogenase-deficient nonclassic adrenal hyperplasia among adult hyperandrogenic women with dehydroepiandrosterone sulfate excess. STUDY DESIGN Thirty consecutive hyperandrogenic women with hirsutism, oligomenorrhea, or both and dehydroepiandrosterone sulfate levels of >8.5 micromol/L and 24 control subjects were studied. Basal sex hormone binding globulin, total and free testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, and basal and 60-minute corticotropin-stimulated 17-hydroxypregnenolone and dehydroepiandrosterone were measured, and the increment (change from basal to 60-minute value) was calculated. RESULTS Twenty-six (87%) and 25 (83%) of the 30 hyperandrogenic patients studied had 60-minute dehydroepiandrosterone and change in 0- to 60-minute dehydroepiandrosterone levels greater than the mean + 2 SD of control subjects, respectively. Six (20%) and 6 (20%) of the 30 hyperandrogenic patients had 60-minute 17-hydroxypregnenolone and 0- to 60-minute change in 17-hydroxypregnenolone levels greater than the mean + 2 SD of control subjects, respectively. However, none of the subjects had either 60-minute 17-hydroxypregnenolone levels or 60-minute dehydroepiandrosterone levels or both associated with the diagnosis of genetically proved 3beta-hydroxysteroid dehydrogenase deficiency (>5-fold of the control mean value). CONCLUSION 3beta-Hydroxysteroid dehydrogenase-deficient nonclassic adrenal hyperplasia is rare even among adult hyperandrogenic patients with adrenal androgen excess.

Determination of the steroidogenic capacity in premature ovarian failure

OBJECTIVE To determine the secretion of precursors, intermediate and final products of androgen biosynthesis in women with premature ovarian failure (POF). PATIENTS Seven patients 20 to 34 years of age with idiopathic POF and a control group of six women 27 to 29 years of age with normal ovarian function studied during the early follicular phase were included. DESIGN, INTERVENTIONS: In all patients an adrenal stimulation test was performed as follows: a short dexamethasone (DEX) inhibition was carried out the night before the corticotropin (ACTH, 0.25 mg, Cortrosyn; Organon, Orangeburg, NY) stimulation test, obtaining blood samples in basal conditions, post-DEX inhibition as well as at 60, 120, and 180 minutes after the ACTH bolus. MAIN OUTCOME MEASURES Using specific RIA serum concentrations of delta 5 precursors (pregnenolone, 17-hydroxypregnenolone, DHEA), delta 4 intermediates (P, 17-hydroxyprogesterone, androstenedione) and the final products T and cortisol (F) were measured. RESULTS Adrenal inhibition and stimulation responses in both groups of patients showed no differences for delta 5 precursors and F. On the other hand, delta 4 intermediates and androgens exhibited significant differences at the level of response to ACTH stimulation. Patients with POF had significantly lower values than those of control group. CONCLUSION An important decrement in the steroidogenesis was noticed in POF, particularly in androgen synthesis, revealing the selective participation of the adrenal gland in steroid production.