Gesthimani Mintziori

The complex interaction between obesity, metabolic syndrome and reproductive axis: a narrative review.

The aim of this narrative review is to provide current evidence for the interaction between obesity, metabolic syndrome (MS) and reproductive axis. Gonadotropin-releasing hormone (GnRH) pulses and, consequently, normal function of reproductive (hypothalamus-pituitary-gonadal) axis depend on normal energy balance, which presupposes sufficient food intake, reasonable energy consumption and average thermoregulatory costs. In case of an energy imbalance, reproductive dysfunction may occur. In young women, excessive leanness is accompanied by puberty delay, whereas premature puberty might be a manifestation of obesity. In a similar way, obesity in men affects fertility. Excess adipose tissue results in increased conversion of testosterone to estradiol, which may lead to secondary hypogonadism through reproductive axis suppression. Moreover, oxidative stress at the level of the testicular micro-environment may result in decreased spermatogenesis and sperm damage. Products of the adipocyte, such as leptin, adiponectin and resistin, and gut peptides, such as ghrelin, are considered to be crucial in the interaction between energy balance and reproduction. Finally, an indirect evidence for the interplay between MS and reproductive axis is the fact that when treating components of one, parameters of the other can be improved as well. These therapeutic interventions include lifestyle modifications, pharmacological agents, such as sex hormone replacement therapy, and surgical procedures. Although many issues remain unclear, the elucidation of the complex interaction between MS and reproductive axis will have obvious clinical implications in the therapeutic approach of both entities.

Meta-analysis of cardiovascular disease risk markers in women with polycystic ovary syndrome

BACKGROUND The relation between polycystic ovary syndrome (PCOS) and cardiovascular disease (CVD) remains unclear. In an attempt to provide high-quality evidence on the relation between PCOS and CVD, relevant literature for CVD risk markers [C-reactive protein (CRP), homocysteine (Hcy), tumor necrosis factor-alpha (TNF-α), plasminogen activator inhibitor-1 (PAI-1), lipoprotein (a) [Lp(a)], advanced glycation end-products (AGEs), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1) and fibrinogen] in women with PCOS was reviewed and analyzed. METHODS A systematic search was conducted electronically using specific eligibility criteria. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated and combined appropriately. To ensure synthesis of the best available evidence, sensitivity analyses were performed. RESULTS A total of 130 data sets were included in 11 different outcomes, involving 7174 and 5076 CVD markers in women with PCOS and controls, respectively. Women with PCOS demonstrated significantly elevated CRP [WMD (95% CI) 0.99 (0.77-1.21)], Hcy [2.25 (1.46-3.03)], PAI-1 antigen [16.96 (7.25-26.28)], PAI-1 activity [0.71 (0.18-1.23)], VEGF [1.72 (0.96-2.48)], ADMA [0.19 (0.08-0.3)], AGEs [3.91 (2.36-5.45)] and Lp(a) [0.81 (0.58-1.04)] concentrations compared with controls, yet with significant between-study heterogeneity. Borderline significance (not robust in the sensitivity analyses) was detected for TNF-α [0.75 (0.07-1.44)], ET-1 [1.06 (0.52-1.59)] and fibrinogen [0.20 (0.01-0.39)], whereas no difference was detected for IL-6 [0.71 (-0.16 to 1.59)]. CONCLUSIONS Women with PCOS have increased serum concentrations of CVD risk markers compared with controls. Whether this apparent risk is translated into increased incidence of CVD in later life remains to be elucidated.

Obesity in the ageing man.

As the population is ageing globally, both ageing and obesity are recognized as major public health challenges. The aim of this narrative review is to present and discuss the current evidence on the changes in body composition, energy balance and endocrine environment that occur in the ageing man. Obesity in the ageing man is related to changes in both body weight and composition due to alterations in energy intake and total energy expenditure. In addition, somatopenia (decreased GH secretion), late-onset hypogonadism (LOH), changes in thyroid and adrenal function, as well as changes in appetite-related peptides (leptin, ghrelin) and, most importantly, insulin action are related to obesity, abnormal energy balance, redistribution of the adipose tissue and sarcopenia (decreased muscle mass). A better understanding of the complex relationship of ageing-related endocrine changes and obesity could lead to more effective interventions for elderly men.

Concealment of Information in Clinical Practice: Is Lying Less Stressful Than Telling the Truth?

From the Lab of Hygiene; Lab of Physi-ology, Medical School, Aristotle Univer-sity, Thessaloniki, Greece.Submitted May 31, 2007; acceptedJune 21, 2007.The first and second author haveconducted the same amount of workand share first authorship.Authors’ disclosures of potential con-flicts of interest and author contribu-tions are found at the end of thisarticle.Corresponding author: E. Panagopoulou,Lab of Hygiene, 54124, Medical School,Aristotle University, Thessaloniki, Greece;e-mail: efharis@the.forthnet.gr.© 2008 by American Society of ClinicalOncology0732-183X/08/2607-1175/

Thyroid function during ovarian stimulation: a systematic review

20.00DOI: 10.1200/JCO.2007.12.8751

EMAS position statement: Non-hormonal management of menopausal vasomotor symptoms

OBJECTIVE To review the evidence regarding thyroid function and thyroid autoimmunity (TAI) changes in women undergoing ovarian stimulation (OS). DESIGN Studies eligible for the systematic review were those that reported data on thyroid function or TAI both before and during OS or within 1 month after OS. SETTING Academic hospital. PATIENT(S) Women with abnormal thyroid function or TAI (n = 419) and controls (n = 425). INTERVENTION(S) Ovarian stimulation. MAIN OUTCOME MEASURE(S) Serum TSH, free thyroxine, free tri-iodothyronine and thyroid antibodies. RESULT(S) Seven studies, between 2000 and 2011, were included. Serum TSH concentrations were significantly increased in three studies and were not changed in two studies. Serum free thyroxine concentrations were increased in two studies, were not changed in one, and were decreased in another. Serum free tri-iodothyronine concentrations were not changed in the only study in which they were measured. Thyroid antibody concentrations were decreased in one study and were not changed in two studies, even in the presence of changes in thyroid function. CONCLUSION(S) The current evidence is inconclusive regarding OS effect on thyroid function or TAI. Serum TSH concentrations may be increased during or within 1 month after OS, exceeding the threshold of 2.5 mU/L suggested for the first trimester of pregnancy, but further prospective studies are needed to provide conclusive evidence for or against universal evaluation of thyroid function and TAI in women undergoing OS.

Association of TSH concentrations and thyroid autoimmunity with IVF outcome in women with TSH concentrations within normal adult range.

AIM To review non-hormonal therapy options for menopausal vasomotor symptoms. The current EMAS position paper aims to provide to provide guidance for managing peri- and postmenopausal women who cannot or do not wish to take menopausal hormone therapy (MHT). MATERIAL AND METHODS Literature review and consensus of expert opinion. RESULTS Non-hormonal management of menopausal symptoms includes lifestyle modifications, diet and food supplements, non-hormonal medications and application of behavioral and alternative medicine therapies. There is insufficient or conflicting evidence to suggest that exercise, supplements or a diet rich in phytoestrogens are effective for vasomotor menopausal symptoms. Selective serotonin-reuptake inhibitors (SSRIs), serotonin norepinephrine-reuptake inhibitors (SNRIs) and gabapentin could be proposed as alternatives to MHT for menopausal symptoms, mainly hot flushes. Behavioral therapies and alternative medicine interventions have been tried, but the available evidence is still limited. CONCLUSIONS A number of interventions for non-hormonal management of menopausal vasomotor symptoms are now available. For women who cannot or do not wish to take estrogens, non-hormonal management is now a realistic option.

Consequences of hyperthyroidism in male and female fertility: pathophysiology and current management.

Background/Aims: This study aimed to evaluate the association of thyroid-stimulating hormone (TSH) concentrations and presence of thyroid autoimmunity (TAI) with the live birth rate in euthyroid women undergoing in vitro fertilization (IVF). Methods: This study of retrospective design included 158 euthyroid women (TSH 0.5-4.5 µIU/ml) who underwent IVF from January 2006 to December 2010. Thyroid parameters were measured on day 3 of the previous nontreatment cycle. Women were subgrouped and analyzed according to their TSH concentrations (low: 0.5-2.5 vs. high: 2.6-4.5 µIU/ml) and TAI (present vs. absent). Results: No difference in the live birth rate was found between the TSH (low: 34.2% vs. high: 36.8%, p = 0.763) or TAI (present: 26.7% vs. absent: 34.3%, p = 0.568) subgroups. Conclusion: This study found no evidence that increased TSH concentrations or the presence of TAI determined before IVF affect the live birth rate in euthyroid women. A better insight into the role of thyroid function during application of IVF is needed.

EMAS position statement: Fertility preservation

Thyroid hormone acts on the oocytes, sperm and embryo during fertilization, implantation and placentation. Both hypothyroidism and hyperthyroidism may influence fertility. However, evidence of the association of hyperthyroidism with infertility is scarce and sometimes conflicting. Thyroid hormone influences human reproduction via a variety of mechanisms at both the central and the peripheral level. Infertility may occur in hyperthyroid men and women, but it is usually reversible upon restoration of euthyroidism. This review aims to summarize the available data on the association of hyperthyroidism and infertility in both men and women and to provide practical suggestions for the management of these patients.

Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: assessment of non-invasive indices predicting hepatic steatosis and fibrosis.

INTRODUCTION The increasing incidence of malignant diseases that often require gonadotoxic treatment and the tendency to become a parent later in life result in an increased need for fertility preservation. AIMS The aim of this position statement is to provide and critically appraise evidence on available options for fertility preservation in both pre-pubertal and post-pubertal men and women. MATERIALS AND METHODS Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS Fertility preservation should be a priority when treating children or adults of reproductive age with agents that may have hazardous effects on the reproductive system. Gonadotoxicity should be kept at a minimum. If gonadotoxic treatment has to be used, methods of fertility preservation should be discussed, as early as possible.