Veronica Lazzarini

Adolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels

OBJECTIVE To evaluate the metabolic profiles of adolescents with different phenotypes of polycystic ovary syndrome (PCOS). DESIGN Observational study. SETTING University outpatient clinic. PATIENT(S) Adolescents with PCOS (n = 120) were divided into four groups: oligomenorrhea and hirsutism (O-H, n = 50), oligomenorrhea, hirsutism, and polycystic ovaries (PCO-O-H, n = 22), oligomenorrhea, hirsutism, and hyperandrogenemia (A-O-H, n = 28), oligomenorrhea, and hirsutism, hyperandrogenemia, and polycystic ovaries (PCO-A-O-H, n = 20). A control group of age-matched adolescents (n = 30) was included. INTERVENTION(S) Subjects underwent physical and ultrasound evaluations; fasting blood samples were taken for the measurement of endocrine and metabolic parameters. MAIN OUTCOME MEASURE(S) The endocrine and metabolic profiles were evaluated. RESULT(S) Adolescents with PCOS showed reduced insulin sensitivity and dyslipidemia. Triglycerides, and total and low-density lipoprotein cholesterol were higher in the phenotypes with hyperandrogenemia. Insulin resistance and body mass index were not significantly different between PCOS phenotypes. Triglyceride positively and high-density lipoportein cholesterol levels negatively correlated with free testosterone and free androgen index. CONCLUSION(S) The risk of metabolic alterations may vary in adolescent PCOS patients with different phenotypes. Hyperandrogenemia is a risk factor for dyslipidemia. This information may be of relevance in counseling adolescents with PCOS.

Comparison of effects of 3 mg drospirenone plus 20 μg ethinyl estradiol alone or combined with metformin or cyproterone acetate on classic metabolic cardiovascular risk factors in nonobese women with polycystic ovary syndrome

OBJECTIVE To evaluate the effects of a pill with drospirenone (3 mg) plus ethinyl E(2) (20 μg) (DRP/20EE) alone or associated with metformin or cyproterone acetate (CPA) on some metabolic cardiovascular risk factors in women with polycystic ovary syndrome (PCOS). DESIGN Randomized, open-label clinical trial. SETTING Academic medical clinic. PATIENT(S) Forty-eight hirsute women with PCOS. INTERVENTION(S) Patients were randomized to treatment with DRP/20EE or with DRP/20EE plus metformin (1,500 mg/d) or with DRP/20EE plus CPA (12.5 mg/d, 10 days per cycle) for 6 months. MAIN OUTCOME MEASURE(S) Blood pressure, lipid profile, and indexes of glucose tolerance and insulin sensitivity were assessed before and after 6 months of treatment. RESULT(S) Body mass index and blood pressure were not modified by any treatment. Treatment with DRP/EE20 did not change the lipid profile; DRP/EE20 plus metformin significantly increased high-density lipoprotein cholesterol concentrations; DRP/EE20 plus CPA significantly increased triglycerides and total cholesterol. The area under the curve for insulin was significantly decreased by DRP/EE20 and DRP/EE20 plus metformin, but it was significantly increased by DRP/EE20 plus CPA. Treatment with DRP/EE20 plus CPA significantly increased the homeostasis model assessment of insulin resistance index and significantly reduced the glucose to insulin ratio index. Treatment with DRP/EE20 significantly increased the glucose to insulin ratio index. CONCLUSION(S) Treatment with DRP/EE20 improved insulin sensitivity in hirsute women with PCOS, with no deterioration of lipid profile. This effect was not ameliorated by the addition of metformin. The positive metabolic effects of DRP are abolished by the concomitant use of CPA.

Hyperandrogenemia influences the prevalence of the metabolic syndrome abnormalities in adolescents with the polycystic ovary syndrome.

Objective. The prevalence of the metabolic syndrome (MBS) abnormalities in Italian adolescents with polycystic ovary syndrome (PCOS) was evaluated. Design. Retrospective chart review. Setting. University outpatient clinic. Participants. Fifty-three adolescents with PCOS. Interventions. Subjects underwent a physical evaluation. Fasting blood samples were taken for the evaluation of metabolic parameters. Main outcome measures. The prevalence of MBS abnormalities according to de Ferranti criteria was assessed. Results. 9.4% of adolescents with PCOS had the MBS (three abnormalities). Twelve girls (22.7%) had two abnormalities. Seventeen (32.1%) of PCOS girls have no MBS abnormalities. PCOS adolescents with the MBS were more obese, insulin resistant and they had significantly higher levels of total and free testosterone. The number of metabolic abnormalities correlated with free, total testosterone, free androgen index (FAI) and body mass index (BMI). Groups with two or three abnormalities were not differentiated by BMI, insulin, lipids, blood pressure, but they were differentiated by total and free testosterone and FAI. Adolescents with the MBS have higher total and free testosterone and FAI than girls with two MBS abnormalities. Conclusions. The MBS and its components are present in some adolescents with PCOS, placing them at increased risk for cardiovascular disease early in adulthood. Hyperandrogenemia is a risk factor for MBS independent of obesity.

La contraccezione ormonale oggi

RiassuntoLa contraccezione ormonale è stata negli anni profondamente modificata nei suoi costituenti, dosaggi e regimi di somministrazione. È oggi possibile disporre di preparati che, accanto a un effetto contraccettivo ottimale, possono essere usati a scopo terapeutico per la cura di numerose patologie benigne (acne, dismenorrea grave, dolore pelvico, metrorragie, ecc.). Tra i vantaggi non contraccettivi sicuramente di rilievo è la protezione che la pillola contraccettiva esercita nei confronti del tumore dell’ovaio, endometrio e colon retto. A fronte di questi effetti positivi, i preparati ormonali attualmente disponibili risultano nel complesso privi di gravi effetti collaterali. Luso di basse dosi di etinilestradiolo e di progestinici privi di attività androgenica ha portato infatti alla riduzione fino annullamento di effetti collaterali da sempre legati alla contraccezione estro-progestinica come la patologia cardiovascolare.