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Depression, anxiety and cardiometabolic risk in polycystic ovary syndrome

BACKGROUND Polycystic ovary syndrome (PCOS) is associated with psychological and metabolic disturbances. The aim of this study was to determine whether depression, anxiety and reduced health-related quality of life (HRQOL) are more common in women with PCOS and associated with metabolic risk. METHODS The study included 226 PCOS patients and 85 BMI-matched healthy control women. All participants completed standardized questionnaires assessing depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory) and both depression and anxiety (Hospital Anxiety and Depression Scale and General Health Questionnaire). Patients also completed a PCOS HRQOL questionnaire. Hirsutism scores, serum androgens and lipids were obtained. All subjects underwent a standard oral glucose tolerance test. RESULTS 28.6% of PCOS women versus 4.7% of control women had clinical depression scores indicating an 8.1-fold increased risk of depression in PCOS (P < 0.001). Depression and anxiety scores were higher in PCOS women than controls (P < 0.01 for all subscales). Obese PCOS subjects had higher depression scores and rates than non-obese PCOS women (P < 0.05). Depression scores were significantly correlated with insulin resistance and lipid parameters and with the number of components comprising the metabolic syndrome. Menstrual and hirsutism problems were the most serious concerns followed by emotional problems on the HRQOL. CONCLUSIONS Depression and anxiety are more common in patients with PCOS compared with healthy women. Depression in PCOS might be associated with obesity and metabolic abnormalities including insulin resistance and dyslipidemia.

Effect of an oral contraceptive on emotional distress, anxiety and depression of women with polycystic ovary syndrome: a prospective study

STUDY QUESTION We aimed to determine the impact of an oral contraceptive (OC) treatment on health-related quality of life (HRQOL), depressive and anxiety symptoms in polycystic ovary syndrome (PCOS). SUMMARY ANSWER OC therapy in PCOS improves hirsutism and menstrual disturbances, along with HRQOL. This improvement is not associated with any change in the prevalence of depressive and anxiety symptoms. WHAT IS KNOWN AND WHAT THIS ARTICLE ADDS: Limited data are available regarding the effects of an OC on HRQOL, and depressive and anxiety symptoms in PCOS. This study reports the effects of the ethinyl estradiol/drospirenone (EE/DRSP) OC on an HRQOL questionnaire for women with PCOS (PCOSQ), depressive and anxiety symptoms after 6 months of treatment. DESIGN Prospective observational study. All participants completed PCOSQ, Beck Depression Inventory, Hospital Anxiety and Depression Scale and General Health Questionnaire. Serum androgens, fasting insulin, fasting and postload glucose values during an oral glucose tolerance test were measured. Changes in these variables and the scores of questionnaires were evaluated after 6 months of treatment with EE/DRSP (3 mg/30 μg). PARTICIPANTS AND SETTING Thirty-six patients with PCOS without a previous psychiatric diagnosis were included in the study. MAIN RESULTS AND THE ROLE OF CHANCE The main complaints of the patients were hirsutism and irregular menses. Accordingly, menstrual and hirsutism problems were the most serious concerns followed by emotional problems on the PCOSQ. Eight patients (22.2%) had clinical depression scores. After treatment, regular menstrual cycles were attained and hirsutism was significantly improved in all patients. Hirsutism and emotion domains of the PCOSQ improved at 6 months (P< 0.05 for both). Depression was improved in five of eight depressive patients and four new patients showed increased depression scores. Overall, depression, anxiety mean scores and depression rates did not show a significant change. BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION The study is subject to the strengths and limitations of observational study design. A limitation of our study is the small sample size and lack of data related to possible confounding factors. GENERALIZABILITY TO OTHER POPULATIONS Generalizable to Caucasian PCOS.

Association between novel adipocytokines adiponectin, vaspin, visfatin, and thyroid: An experimental and clinical update.

Adipose tissue secretes a variety of active biological substances, called adipocytokines, that act in an autocrine, paracrine, and endocrine manner. They have roles in appetite control, thermogenesis, and thyroid and reproductive functions. All these molecules may lead to local and generalized inflammation, mediating obesity-associated vascular disorders including hypertension, diabetes, atherosclerosis, and insulin resistance. Thyroid dysfunction is associated with changes in body weight, thermogenesis, and energy expenditure. The connections between cardiovascular risk factors such as dyslipidemia, impaired glucose tolerance, insulin resistance, atherosclerosis, and thyroid dysfunction have been reported in several studies. The adipocytokines serve as causative or protective factors in the development of these disorders in the states of thyroid dysfunction. Abnormal levels of adipocytokines (adiponectin (ADP), leptin, resistin, vaspin, and visfatin) in hypo- and hyperthyroidism have been reported with controversial results. This review aims to update the implication of novel adipokines ADP, vaspin, and visfatin in thyroid dysfunction.

Body composition in lean women with polycystic ovary syndrome: effect of ethinyl estradiol and drospirenone combination

BACKGROUND Limited data are available regarding the potential effects of oral contraceptives (OCs) on body fat distribution particularly in lean women with polycystic ovary syndrome (PCOS). In the current study, we aimed to evaluate the influence of ethinyl estradiol and drospirenone on body composition. STUDY DESIGN Participants included 28 lean patients with PCOS and 28 age- and body mass index (BMI)-matched healthy women. The PCOS patients received ethinyl estradiol 30 mcg/drospirenone 3 mg for 6 months. Body composition parameters were assessed by bioelectrical impedance analysis. Serum androgens, lipids, insulin resistance and glucose metabolism measures were also determined. RESULTS At baseline, the PCOS patients and controls had similar body composition, lipids, insulin resistance and glucose metabolism parameters. Total and trunk fat percentages were negatively correlated with sex hormone binding globulin and were positively correlated with homeostatic model assessment of insulin resistance and free androgen index in the PCOS group.. After 6 months of treatment in the PCOS patients, total fat percentage increased from 24.5%±7.1% to 26.0%±6.1% (p=.035) and trunk fat percentage increased from 20.2%±8.9% to 22.2%±7.1% (p=.014), although weight, BMI and waist to hip ratio (WHR) remained unchanged. CONCLUSION Lean women with PCOS have similar body composition compared to healthy women. OC therapy for 6 months in PCOS patients results in an increased total and trunk fat percentage despite no change in clinical anthropometric measures including weight, BMI and WHR.

Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome

Oral contraceptives alone or in combination with antiandrogens are commonly used in the treatment for polycystic ovary syndrome (PCOS). We aimed to determine the effects of ethinyl estradiol/drospirenone (EE‐DRSP) plus spironolactone therapy on inflammation and cardiometabolic risk in PCOS.

Periodontal disease in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) and periodontal disease (inflammatory diseases of the tissues around teeth) are common disorders associated with diabetes and cardiometabolic risk. Comprehensively examining the periodontal status in PCOS, this study suggests that the susceptibility for periodontal disease may significantly increase in patients with PCOS compared with healthy young women, and that local/periodontal oxidant status appears to be affected in PCOS.

Ethinyl estradiol-drospirenone vs ethinyl estradiol-drospirenone plus metformin in the treatment of lean women with polycystic ovary syndrome.

Oral contraceptive use might be associated with cardiometabolic risk in PCOS. We aimed to compare the effects of ethinyl estradiol–drospirenone (EE/DRSP) alone vs EE/DRSP plus metformin on clinical and cardiometabolic parameters in PCOS.

Serum resistin and high sensitive CRP levels in patients with subclinical hypothyroidism before and after L-thyroxine therapy

Background Subclinical hypothyroidism (SH) is defined by increased thyrotropin (TSH) and normal free thyroxine (fT4) and free triiodothyronine (fT3) levels. Resistin is secreted from adipose tissue and is reported to be associated with insulin resistance and/or inflammation. High sensitive CRP (hs-CRP) is a reliable marker of inflammation. Data related to levels of resistin and hs-CRP in SH and the effect of L-thyroxine treatment on those is limited. We aimed to determine the levels of resistin and hs-CRP in women with SH, and potential effects of L-thyroxine therapy on those levels. Material/Methods Thirty-six patients with SH and 27 age- and BMI-matched healthy control women were included. Waist circumference (Wc), waist-to-hip ratio (WHR), resting energy expenditure (REE), fat mass (FM) and lean mass (LM), TSH, free T4 (fT4), free T3 (fT3), total cholesterol (TC), triglycerides (TG), and HDL- and LDL-cholesterol were determined in all participants. Patients received L-thyroxine treatment for 6 months, after which all measurements were repeated. Resistin and hs-CRP levels were studied from frozen samples after the completion of the study. Results The 2 groups had similar values for Wc, WHR, FM, LM, TC, TG, HDL-C, LDL-C, resistin, and hs-CRP at the beginning. fT4 were higher, whereas TSH was lower in the control group. Resistin and hs-CRP levels did not change after treatment. hs-CRP correlated with BMI and FM before and after treatment. Conclusions Our results suggest that achievement of euthyroid status by replacement therapy did not change resistin or hs-CRP levels in women with SH. hs-CRP correlated with parameters of obesity, which emphasizes the role of body weight in inflammation.

Pigment epithelium‐derived factor increases in type 2 diabetes after treatment with metformin

Pigment epithelium‐derived factor (PEDF) has anti‐angiogenic, immunomodulatory and anti‐inflammatory properties. In addition to the significant role it plays in reducing diabetic complications, PEDF is now used in the treatment of certain cancers. It possibly plays a role in insulin resistance cases, too. However, whether metformin treatment has any significant effects on PEDF levels is not known. In this study, we investigated the regulation of PEDF in type 2 diabetes in relation to fat mass and insulin resistance before and after the use of metformin for treatment.

Serum vaspin levels in hypothyroid patients

OBJECTIVE To elucidate the link between TSH and obesity, the relationship between TSH and adipocytokines were previously studied. Animal studies demonstrated a possible relationship between vaspin levels and thyroid functions. In this study, we aimed to investigate vaspin levels in hypothyroid states and its relationship with insulin resistance parameters in humans. DESIGN Prospective observational study. METHODS We enrolled 27 overt hypothyroid, 33 subclinical hypothyroid and 41 euthyroid patients. We measured the body mass index (BMI), fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance index (HOMA-IR), lipid profile, TSH, free triiodothyronine, free thyroxine and vaspin levels. The change in vaspin levels in 12 overt hypothyroid patients after establishment of euthyroidism was analysed. RESULTS All groups were age-matched. Overt hypothyroid group had higher BMI values (P<0.05) than other groups. No significant difference was observed in insulin levels and HOMA-IR among the groups (P>0.05). Adjusted vaspin levels for BMI and age were similar among the groups. Mean vaspin levels in overt, subclinical and euthyroid patients were 1.20 ± 1.17, 1.48 ± 0.93 and 0.95 ± 0.75  ng/ml respectively (P>0.05). There was no significant association between vaspin levels and BMI, fasting glucose, insulin and HOMA-IR (P>0.05). Establishing euthyroidism in hypothyroid patients did not result in a significant change in vaspin levels (before and after treatment, 1.35 ± 1.06 and 1.25 ± 0.68  ng/ml, respectively; P>0.05). CONCLUSION We herein present novel data indicating vaspin levels are neither altered in overt and subclinical hypothyroidism nor have a relationship with features of insulin resistance in hypothyroid patients.