Ming I. Hsu

Inappropriate gonadotropin secretion in polycystic ovary syndrome.

OBJECTIVE To evaluate inappropriate gonadotropin secretion in women with polycystic ovary syndrome (PCOS). DESIGN Retrospective study. SETTING Academic tertiary center. PATIENT(S) A total of 373 women were classified into three groups: [1] healthy control women (n = 48); [2] women who were positive for PCOS risk factor; and [3] women with PCOS (n = 251). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Gonadotropin levels, LH-FSH ratio, body mass index, and clinical and/or biochemical presentations of PCOS. RESULT(S) The area under the receiver operating characteristic curve, used to predict PCOS for the LH-FSH ratio, showed similar diagnostic performance to total T and average ovarian volume. The LH-FSH ratio exhibits greater observed accuracy than total T and average ovarian volume for evaluation of women with oligomenorrhea or anovulation. An LH-FSH ratio of >1 presented the best combination of sensitivity and specificity. Body mass index was positively correlated with total T in non-PCOS and PCOS groups; however, body mass index was negatively correlated with LH in PCOS but showed no correlation in non-PCOS subjects. CONCLUSION(S) The LH-FSH ratio is a valuable diagnostic tool in evaluating women with PCOS and oligomenorrhea or anovulation, and an LH-FSH ratio of >1 may be used as a decision threshold. The link between body mass index and LH may provide clues for further understanding the pathological milieu of PCOS.

Clinical and biochemical presentation of polycystic ovary syndrome in women between the ages of 20 and 40

BACKGROUND The clinical features and metabolic complications of polycystic ovary syndrome (PCOS) may change with age. This study was designed to investigate the clinical and biochemical characteristics of PCOS patients between the ages of 20 and 40. METHODS The study included 781 Taiwanese women, of whom 453 were diagnosed with PCOS and 328 were non-PCOS controls. Anthropometric components, androgens, endocrine, insulin resistance, and metabolic components were measured and correlated with age. Above parameters were compared between younger and elder women with PCOS. RESULTS Age had significant negative correlations with androgens (total testosterone and dehydroepiandrosterone sulfate), the modified Ferriman-Gallwey score and the prevalence of acne and hirsutism. Age had significant positive correlations with fasting glucose, cholesterol, triglycerides and low-density lipoprotein. The 453 women who fulfilled diagnostic criteria for PCOS were classified by age into two groups: Group A (20-29 years old, n= 294) and Group B (30-40 years old, n= 159). Group A had significantly higher total testosterone levels than Group B. Group B had higher fasting insulin and glucose levels, triglycerides, body mass index and waist measurements and a higher incidence of obesity than Group A. The average ovarian volume was not significantly different among the two groups. CONCLUSIONS Increased age is accompanied by a decrease in the prevalence of both clinical and biochemical hyperandrogenism in women. Hyperandrogenism is the important factor for young women with PCOS; however, abdominal obesity and certain metabolic disturbances became major concerns for older women with PCOS.

Cluster analysis of cardiovascular and metabolic risk factors in women of reproductive age

OBJECTIVE To study the association between endocrine disturbances and metabolic complications in women seeking gynecologic care. DESIGN Retrospective study, cluster analysis. SETTING Outpatient clinic, university medical center. PATIENT(S) 573 women, including 384 at low risk and 189 at high risk of cardiometabolic disease. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Cardiovascular and metabolic parameters and clinical and biochemical characteristics. RESULT(S) Risk factors for metabolic disease are associated with a low age of menarche, high levels of high-sensitivity C-reactive protein and liver enzymes, and low levels of sex hormone-binding globulin. Overweight/obese status, polycystic ovary syndrome, oligo/amenorrhea, and hyperandrogenism were found to increase the risk of cardiometabolic disease. However, hyperprolactinemia and premature ovarian failure were not associated with the risk of cardiometabolic disease. In terms of androgens, the serum total testosterone level and free androgen index but not androstenedione or dehydroepiandrosterone sulfate (DHEAS) were associated with cardiometabolic risk. CONCLUSION(S) Although polycystic ovary syndrome is associated with metabolic risk, obesity was the major determinant of cardiometabolic disturbances in reproductive-aged women. Hyperprolactinemia and premature ovarian failure were not associated with the risk of cardiovascular and metabolic diseases. CLINICAL TRIAL REGISTRATION NUMBER NCT01826357.

Antiapoptotic Agent Sphingosine-1-Phosphate Protects Vitrified Murine Ovarian Grafts

Significant follicle loss from frozen ovarian grafts is unavoidable. The authors evaluated the protective effects of the antiapoptotic agent sphingosine-1-phosphate (S1P) on vitrified ovarian grafts. Three-week-old sexually immature female FVB mice were divided into 4 groups, fresh, control without S1P, 0.5 mmol/L S1P, and 2 mmol/L S1P. The ovaries were pretreated with S1P for 1 hour and then cryopreserved by modified vitrification. The frozen–thawed ovaries were autotransplanted under the back muscles of mice for 10 days. Expression of apoptosis-related genes encoding caspase 3 and c-Myc was analyzed in the vitrified ovaries and 10 days after transplantation using real-time quantitative polymerase chain reaction. To quantify the ovarian reserve, anti-Müllerian hormone (AMH) levels and follicles were measured in the 10-day vitrified ovarian grafts. Caspase 3 and c-Myc messenger RNA did not differ significantly in the 4 groups after vitrification but was significantly upregulated in the control group after transplantation. The AMH levels and primordial follicle pool were significantly higher in the S1P-treated groups than in the control group but lower than that in the fresh group. The S1P protects vitrified ovarian grafts from ischemic reperfusion injury rather than from vitrification-associated process.

Obesity is the predominant predictor of impaired glucose tolerance and metabolic disturbance in polycystic ovary syndrome

Objective. To evaluate the contribution to glucose intolerance and metabolic syndrome of obesity combined with the diagnostic criteria of polycystic ovary syndrome (PCOS). Design. Prospective study. Setting. University teaching hospital from 31 August 2010 to 31 August 2011. Population. Two hundred and twenty women with PCOS and seventy normal control women. Methods. The clinical and biochemical characteristics of women with PCOS and control women were evaluated. Main outcome measures. The impact of obesity, hyperandrogenism, oligo‐anovulation and polycystic ovary morphology on impaired glucose tolerance and metabolic disturbances. Results. Obese women with PCOS had significantly higher insulin resistance than obese normal control women. Logistic regression analysis showed that obesity was the only factor that predicted impaired glucose tolerance and metabolic syndrome. Use of the area under the receiver operating characteristic curve (AUROC) for the body mass index to predict impaired glucose tolerance and metabolic syndrome was more accurate than AUROCs for serum total testosterone level and the average menstrual interval. Conclusions. Body weight status was the major factor determining the risk of impaired glucose tolerance and metabolic syndrome in women with PCOS. Obesity should be treated as the major factor determining long‐term health consequences associated with PCOS.

Obesity and inflammatory biomarkers in women with polycystic ovary syndrome.

OBJECTIVE To evaluate the roles of obesity and inflammatory biomarkers associated with medical complications in women with PCOS. STUDY DESIGN Retrospective, BMI-matched study. A total of 330 patients, including 165 women with PCOS and 165 women without PCOS, were evaluated. The insulin resistance (homeostasis model assessment insulin resistance index - HOMA) and lipid profiles were assessed. The adiponectin, leptin, ghrelin, resistin, anti-müllerian hormone (AMH), sex hormone-binding globulin (SHBG), high sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) levels were also measured. RESULTS Women with PCOS had significantly higher AMH, fasting insulin, total cholesterol, and low-density lipoprotein levels and lower SHBG levels compared with the controls. There was no difference in the serum obesity and inflammatory biomarkers between the PCOS cases and the controls. After adjusting for BMI and age, IL-6 was positively correlated with HOMA, and SHBG was negatively correlated with HOMA, triglyceride, and LDL. CONCLUSIONS The serum adipokines levels are not good markers for PCOS. PCOS patients were characterized by their high AMH and low SHBG levels. A low level of SHBG should play an important role in the pathogenesis of the medical complications observed in women with PCOS. Clinical trial registration number NCT01989039.

Serum ferritin levels and polycystic ovary syndrome in obese and nonobese women

OBJECTIVE The aim of this study is to evaluate serum ferritin levels and polycystic ovary syndrome (PCOS)-related complications in obese and nonobese women. MATERIALS AND METHODS This retrospective study included 539 (286 with PCOS and 253 without PCOS). RESULTS Serum ferritin correlated with menstrual cycle length, sex hormone-binding globulin, total testosterone, androstenedione, triglyceride, and total cholesterol in both obese and nonobese women. Obese women with high ferritin levels exhibited higher insulin resistance, impaired glucose tolerance, and liver enzymes (glutamic oxaloacetic transaminase, glutamic pyruvic transaminase) than obese women with low ferritin levels. However, among nonobese women, insulin resistance and risk of diabetes were not significantly different between the high and low ferritin groups. Independent of obesity, hypertriglyceridemia was the major metabolic disturbance observed in women with elevated serum ferritin levels. CONCLUSION Elevated serum ferritin levels are associated with increased insulin resistance and risk of diabetes in obese women but not in nonobese women. However, higher serum ferritin levels were correlated with a greater risk of hyperglyceridemia in both obese and nonobese women. Therefore, hypertriglyceridemia in women with PCOS might be associated with iron metabolism.

A comparative study of cutaneous manifestations of hyperandrogenism in obese and non-obese Taiwanese women

PurposeThe aim of the study was to investigate the impact of obesity on cutaneous manifestations of clinical hyperandrogenism.MethodsA total of 627 Taiwanese women of reproductive age were included.ResultsWomen with acne had a greater incidence of PCOS, hyperandrogenemia and hirsutism, and had higher serum total testosterone than women without acne. Obese women, even with significantly higher serum total testosterone levels, had lower incidence of acne than non-obese women, and this was found uniformly across the hyperandrogenemia and the non-hyperandrogenemia groups. Although BMI had a significantly positive correlation with serum total testosterone in the studied women, obese women presented less acne than the non-obese subjects.ConclusionsObese women, regardless of having higher serum testosterone levels, had a lower incidence of acne than non-obese women; however, the factuality was not found in hirsutism.

RISK FACTORS OF URINARY FREQUENCY AMONG WOMEN AGED 60 AND OLDER IN TAIWAN

OBJECTIVE To assess the associated risk factors for daytime urinary frequency among Taiwanese women aged = 60 years. MATERIALS AND METHODS Daytime urinary frequency, defined by the International Continence Society, and its associated problems were evaluated, and medical history and sociodemographic variables were recorded. A total of 2,410 women were selected by a multistage random sampling method. The factors were assessed by frequency and Pearsons ?2 test using a significance level of < 0.05. RESULTS A total of 621 women of those initially selected in the study died before completion of this study. Face-to-face interviews with 1,521 women were completed, producing a response rate of 85.0% (1,521/1,789 women). The prevalence of daytime urinary frequency was significantly related to body mass index (p = 0.018), diabetes mellitus (p = 0.017), hypertension (p = 0.015), previous drug allergy (p = 0.003), smoking (p = 0.005), hormone therapy (p = 0.019), parity (p = 0.019), and urinary incontinence (p = 0.000). However, there was no association between urinary frequency and previous gynecologic surgery, hysterectomy, alcohol consumption, marital status, childbirth, and age of menopause. CONCLUSION The results of this study showed a relatively high risk of urinary frequency development in patients with urinary incontinence, diabetes mellitus, hypertension, obesity, and smoking that are preventable, modifiable, or controllable. Better quality of health education for these women, drawing their attention to the associated factors, may have an impact on the prevalence of urinary frequency.

VERY EARLY STAGE ADENOCARCINOMA ARISING FROM ADENOMYOSIS IN THE UTERUS

OBJECTIVE Malignant transformations of adenomyosis in premenopausal women with normal endometrium are extremely rare. We report a case of adenocarcinoma arising from an adenomyotic focus in the uterus, which was found unexpectedly in a woman undergoing myomectomy for adenomyosis. CASE REPORT A 47-year-old premenopausal woman presented with massive vaginal bleeding and anemia. She was admitted and underwent myomectomy under the initial diagnosis of uterine leiomyoma. Microscopic studies revealed endometrioid adenocarcinoma, which was a malignant transformation of a focus of adenomyosis in the surgical specimen. A total hysterectomy and bilateral salpingo-oophorectomy with pelvic and para-aortic lymphadenectomy was then performed. Pathologic studies showed no residual tumors in the entire resected specimen except for the previous lesion. The endometrium had normal thickness with mild proliferative activity throughout the cavity. There was no atrophic or hyperplastic change in the whole endometrium. The adenocarcinoma was present exclusively in the myometrium, and a transition between the carcinoma and the adenomyotic glands was observed. CONCLUSION This case report presents evidence that adenocarcinoma may a rise de novo from an adenomyotic lesion in the uterus.