Jacklyne Silva Barbosa

Comparison of steroidogenic pathways among normoandrogenic and hyperandrogenic polycystic ovary syndrome patients and normal cycling women

To compare the corticosteroidogenic enzyme activities between normal cycling non‐polycystic ovary syndrome (PCOS), and normoandrogenic PCOS (NA‐PCOS) and hyperandrogenic PCOS (HA‐PCOS) patients.

New insights into steroidogenesis in normo- and hyperandrogenic polycystic ovary syndrome patients

OBJECTIVE This study sought to examine corticosteroidogenic enzyme activities in normo- and hyperandrogenic polycystic ovary syndrome (PCOS) patients. SUBJECTS AND METHODS This cohort study included 81 patients with biochemical hyperandrogenism and 41 patients with normal androgen levels. Enzyme activities were assessed according to the serum steroid product/precursor ratios at baseline and after adrenal stimulation. RESULTS At baseline, in the delta 4 (Δ4) pathway, hyperandrogenic patients showed greater 17-hydroxylase and 17,20 lyase activities in converting progesterone (P4) into 17-hydroxyprogesterone (17-OHP4) and 17-hydroxypregnenolone (17-OHPE) into androstenedione (A) (p = 0.0005 and p = 0.047, respectively) compared to normoandrogenic patients. In the delta 5 (Δ5) pathway, the 17-hydroxylase and 17,20 lyase enzymes showed similar activities in both groups. Hyperandrogenic patients presented lower 21-hydroxylase, lower 11β-hydroxylase (p = 0.0001), and statistically significant increases in 3β-hydroxysteroid dehydrogenase II (3β-HSDII) activities (p < 0.0001). Following tetracosactrin stimulation, only the 17,20 lyase activity remained up-regulated in the Δ4 pathway (p < 0.0001). CONCLUSION Hyperandrogenic patients had higher 17,20 lyase activity, both at baseline and after adrenal stimulation. Greater conversion of dehydroepiandrosterone (DHEA) into A with normal conversion of 17-OHPE to 17-OHP4 in hyperandrogenic PCOS patients indicated different levels of 3β-HSDII activity in adrenal cells, and hyperandrogenic patients had lower 11β-hydroxylase and 21-hydroxylase activities.

Current insights into gonadotropic pituitary function in the polycystic ovary syndrome

Abstract Objective To assess the gonadotrope cell function in patients with polycystic ovary syndrome (PCOS). Methods This study included 42 patients with polycystic ovary syndrome, aged 26.6 ± 5.9 years, and 13 eumenorrheic controls, aged 30.1 ± 4.6 years. Gonadotropins, sex steroids, sex hormone binding globulin (SHBG), cortisol, thyroid stimulating hormone (TSH), prolactin, free thyroxin, and insulin were measured. Gonadotrope cell function was assessed at baseline and at 30 and 60 min after gonadotropin releasing hormone (GnRH) injection. Results Luteinizante hormone (LH), prolactin (PRL), total testosterone (T), androstenedione (A), and 17- hidroxyprogesterone (17-OHP4) levels were higher ( P P P P >0.05). Positive correlation between insulin and the AUC of LH was identified in controls. Conclusion The current study confirms the hypersecretion of LH in PCOS patients after the newest diagnostic systematization. The gonadotrope response to GnRH stimulation in PCOS patients was associated with the baseline levels of LH, P4, insulin.

Clinical and endocrine features of Brazilian infertile women with or without endometriosis: A comparative cross-sectional study

Abstract Objective To compare the clinical and endocrinological features of infertile Brazilian woman with or without endometriosis. Methods This is a cross-sectional comparative study including infertile patients without an established indication for in vitro fertilization or intracytoplasmatic sperm injection at a tertiary center for reproductive medicine. A complete investigation of the cause of female infertile included videolaparoscopy for pelvic cavity and peritoneal factor evaluation. Results Average patient age was (31.6±4.6) years. Sixty-nine percent patients presented with dysmenorrhea, 38% with bowel disturbances, and 21% with deep dyspareunia. Endometriosis was found in 76% of patients, and 91% had primary infertility. Dysmenorrhea was the only symptom that was more prevalent in infertile women with endometriosis. Compared to those without, patients with endometriosis had higher levels of follicle-stimulating hormone (FSH), prolactin (PRL), thyroid-stimulating hormone (TSH), and carcinogen antigen-125 and lower levels of luteinizing hormone (LH), estradiol, progesterone, and free thyroxin. Conclusions Endometriosis is highly prevalent in the Brazilian population and, dysmenorrhea is the only clinical symptom associated with the diagnosis of endometriosis. Infertile patients with endometriosis have higher levels of FSH, PRL and TSH than infertile women without endometriosis.

Prevalence of Elevated Glycated Hemoglobin Concentrations in the Polycystic Ovary Syndrome: Anthropometrical and Metabolic Relationship in Amazonian Women

Background To determine the prevalence of elevated glycated hemoglobin (HbA1c) and to examine its relationship with other carbohydrate metabolic parameter among Brazilian women with polycystic ovary syndrome (PCOS). Methods A cross-sectional study including 288 PCOS patients was conducted. Anthropometrical, clinical, biochemical and endocrine parameters were evaluated. Results The mean age was 26.92 ± 5.51 years. HbA1c mean concentration was 5.83±1.34%. In 38.54% of patients, HbA1c was ≥ 5.7%. HbA1c was positively correlated with body weight (r = 0.142, P = 0.017), body mass index (P = 0.000), waist:hip ratio (P = 0.000), fat mass (P = 0.000), conicity index (P = 0.000), triglyceride (P = 0.001), C-peptide (P = 0.000), total testosterone (P = 0.003), free testosterone (P = 0.000), free androgen index (P = 0.006) and fasting insulin (P = 0.025). Using the oral glucose tolerance test, HbA1c showed positive correlation with glucose concentrations at any point in time (P < 0.05). Conclusions HbA1c was elevated in nearly 40% of PCOS patients and it showed positive correlation with several anthropometric and metabolic factors and androgen levels. The current study provides further evidence that HbA1C is higher in PCOS patients and may have a potential role in the prediction of dysglycemic disease in these women.

Abnormal Bleeding During Menopause Hormone Therapy: Insights for Clinical Management

Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman’s characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT), it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies.

Reassessment of the laparoscopy role in the investigation of infertility and treatment plan determination

Abstract Objective To reassess the importance of laparoscopy in infertility investigation treatment plan determination. Methods The study enrolled 237 patients with infertility duration > 1 year. A complete investigation was performed in all patients and male factor was evaluated by medical history and semen analysis. In the case of normal semen or mild-to-moderate oligozoospermia, the female evaluation included screening for infection diseases, transvaginal ultrasound, hormone parameter, hysterosalpingography, and laparoscopy. The final treatment plan was decided according to laparoscopy findings and any modification of the initial proposal was taken as treatment change. Results At laparoscopy, normal pelvic cavity was found in 5.5%, endometriosis in 76.4%, pelvic adhesion in 17.2%, ovarian adhesion in 24.8%, peritubal adhesion 15.2%, unilateral tubal occlusion in 21.1%, bilateral tubal occlusion in 5.5%, and tubal sacculation, kinking, constriction, or fibrosis in 46.3%. Operative interventions during laparoscopy were endometriosis ablation/excision (74.6%), adhesiolysis (27.4%), and endometrioma cystectomy (4.6%). Laparoscopy determined to switch the initial treatment plan in 85 (35.8%) patients. Conclusions Pelvic cavity abnormalities, primarily endometriosis, have high prevalence in infertile Brazilian women. Laparoscopy provides a precise diagnosis of tuboperitoneal factor and may switch the initial treatment plan in at least one third of patients.

Is Glycated Hemoglobin Related to other Dysmetabolic Variables Implicated in the Increase of Cardiovascular Risk in Polycystic Ovary Syndrome? A Comparative Study

BACKGROUND In non-PCOS patients the concentration of glycated hemoglobin (HbA1C) has been employed to identify individuals at higher risk for impaired glucose tolerance (IGT) and diabetes mellitus. A few studies have examined the role of HbA1C in PCOS patients and current results are controversial. AIM To compare the strength of the association between glycated hemoglobin and other predictors of cardiovascular risk in polycystic ovary syndrome (PCOS). METHODS This cross-sectional study enrolled 197 PCOS patients and 72 non-PCOS women. Transvaginal ultrasound, biochemical and hormone measurement were performed. Glycated hemoglobin (HbA1C) was correlated with other variables related to dysmetabolic/vascular diseases. RESULTS The HbA1C levels were 6.0±1.4% and 4.9±0.4% in PCOS patients and non-PCOS controls, respectively (p<0.001). The HbA1C levels were≥5.7% in 46.4% of PCOS and in none of the control subjects (OR=90.8). HbA1C was well-correlated with several anthropometric, metabolic and endocrine parameters. Stepwise multiple regression including HbA1C and other known predictors of cardiovascular risk resulted in a significant model in which body mass index (BMI) and free testosterone exhibited the best correlation with HbA1C (adjusted R(2)=0.530; F=39.8; p<0.001). CONCLUSION HbA1C was elevated and correlated with anthropometric, biochemical and endocrine variables of metabolic/vascular disease risks in PCOS patients. Combined HbA1C, BMI and free testosterone levels provided a significant model with potential use to evaluate metabolic/vascular disease in PCOS patients.

The Low Prevalence of Y Chromosomal Microdeletions is Observed in the Oligozoospermic Men in the Area of Mato Grosso State and Amazonian Region of Brazilian Patients

Objective To determine the prevalence of chromosomal abnormalities and microdeletions on Y chromosome in infertile patients with oligozoospermia or azoospermia in Mato Grosso state, Brazil. Methods This cross-sectional study enrolled 94 men from infertile couples. Karyotype analysis was performed by lymphocyte culture technique. DNA from each sample was extracted using non-enzymatic method. Microdeletions were investigated by polymerase chain reaction (PCR). Results With the use of cytogenetic analysis, five patients (5.3%) had abnormal karyotype, one azoospermic patient (1.1%) had karyotype 46,XY,t(7;1) (qter-p35), one (1.1%) with mild oligozoospermia had karyotype 46, XY, delY(q), and two other azoospermic patients had karyotype 47,XXY, consistent with Klinefelter syndrome (KS). One of them (1.1%) with severe oligozoospermia had karyotype 46,XY,8p+. Microdeletion on Y chromosome was found in the azoospermia factor c (AZFc) region in only one azoospermic patient (1.1%). Conclusions The prevalence of genetic abnormalities in oligo/azoospermic Brazilian men from infertile couple was 5.3%, and microdeletion on Y chromosome was not a common finding in this population (1.1%).

Subclinical Hypothyroidism Impact on the Characteristics of Patients with Polycystic Ovary Syndrome. A Meta-Analysis of Observational Studies

Background/Aims: Definitive polycystic ovary syndrome (PCOS) diagnosis should exclude thyroid dysfunctions. The purpose of the study is to examine the impact of subclinical hypothyroidism on the characteristics of PCOS patients. Methods: A meta-analysis of the published observational studies was conducted. Medline, Scopus, and Cochrane database search was performed to identify the studies that compared euthyroid PCOS and subclinical hypothyroidism (SCH)-PCOS patients. A total of 9 studies were selected, totalizing the inclusion of 1,537 euthyroid PCOS and 301 SCH-PCOS. The data were expressed as raw mean difference and standard error, using the random-effects model. Heterogeneity among studies was examined using the Cochran’s test (Q) and I2 statistics. Results: Anthropometrical parameters were similar in both groups. Total cholesterol (TC) and triglyceride (TG) were higher in SCH-PCOS (p = 0.036 and p = 0.012). High-density lipoprotein cholesterol was lower in the SCH-PCOS group (p = 0.018). Fasting glucose was lower in euthyroid PCOS (p = 0.022). All androgen levels were similar in both group (p > 0.05 for all). Conclusion: TC, TG and fasting glucose were higher in SCH-PCOS patients. Because of the heterogeneity among studies, some summarized results should be interpreted with caution. Consistent data for future studies addressing PCOS diagnosis are provided.