A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence

Polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These findings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence creates confusion and may be misleading.

Download Full-text

Faculty Opinions recommendation of Excessive ovarian production of nerve growth factor facilitates development of cystic ovarian morphology in mice and is a feature of polycystic ovarian syndrome in humans.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158769.619999 ◽

2009 ◽

Author(s):

Takashi Minegishi

Keyword(s):

Nerve Growth Factor ◽

Growth Factor ◽

Polycystic Ovarian Syndrome ◽

Nerve Growth ◽

Ovarian Morphology ◽

Ovarian Syndrome

Download Full-text

Establishing an anti-müllerian hormone (AMH) cut-off to determine polycystic ovarian morphology (PCOM) supporting diagnosis of polycystic ovarian syndrome (PCOS): the aphrodite study

Fertility and Sterility ◽

10.1016/j.fertnstert.2019.07.1116 ◽

2019 ◽

Vol 112 (3) ◽

pp. e391

Author(s):

Alexandra Dietz de Loos ◽

Martin Hund ◽

Katharina Buck ◽

Cindy Meun ◽

Johanna Sillman ◽

...

Keyword(s):

Polycystic Ovarian Syndrome ◽

Ovarian Morphology ◽

Ovarian Syndrome

Download Full-text

Excessive Ovarian Production of Nerve Growth Factor Facilitates Development of Cystic Ovarian Morphology in Mice and Is a Feature of Polycystic Ovarian Syndrome in Humans

Endocrinology ◽

10.1210/en.2008-1575 ◽

2009 ◽

Vol 150 (6) ◽

pp. 2906-2914 ◽

Cited By ~ 61

Author(s):

Gregory A. Dissen ◽

Cecilia Garcia-Rudaz ◽

Alfonso Paredes ◽

Christine Mayer ◽

Artur Mayerhofer ◽

...

Keyword(s):

Nerve Growth Factor ◽

Growth Factor ◽

Transgenic Mice ◽

Polycystic Ovarian Syndrome ◽

Sympathetic Nerves ◽

Antral Follicle ◽

Delayed Puberty ◽

Nerve Growth ◽

Ovarian Morphology ◽

Ovarian Syndrome

Although ovarian nerve growth factor (NGF) facilitates follicular development and ovulation, an excess of the neurotrophin in the rodent ovary reduces ovulatory capacity and causes development of precystic follicles. Here we show that ovarian NGF production is enhanced in patients with polycystic ovarian syndrome (PCOS) and that transgenically driven overproduction of NGF targeted to the ovary results in cystic morphology, when accompanied by elevated LH levels. NGF levels are increased in the follicular fluid from PCOS ovaries and in the culture medium of granulosa cells from PCOS patients, as compared with non-PCOS patients. Ovaries from transgenic mice carrying the NGF gene targeted to thecal-interstitial cells by the 17α-hydroxylase gene promoter produce more NGF than wild-type (WT) ovaries and are hyperinnervated by sympathetic nerves. Antral follicle growth is arrested resulting in accumulation of intermediate size follicles, many of which are apoptotic. Peripubertal transgenic mice respond to a gonadotropin challenge with a greater increase in plasma 17-hydroxyprogesterone, estradiol, and testosterone levels than WT controls. Transgenic mice also exhibit a reduced ovulatory response, delayed puberty, and reduced fertility, as assessed by a prolonged interval between litters, and a reduced number of pups per litter. Sustained, but mild, elevation of plasma LH levels results in a heightened incidence of ovarian follicular cysts in transgenic mice as compared with WT controls. These results suggest that overproduction of ovarian NGF is a component of polycystic ovarian morphology in both humans and rodents and that a persistent elevation in plasma LH levels is required for the morphological abnormalities to appear.

Download Full-text

Hyperandrogenism in polycystic ovarian syndrome and role of CYP gene variants: a review

Egyptian Journal of Medical Human Genetics ◽

10.1186/s43042-019-0031-4 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Sairish Ashraf ◽

Mudasar Nabi ◽

Shayaq ul Abeer Rasool ◽

Fouzia Rashid ◽

Shajrul Amin

Keyword(s):

Polycystic Ovarian Syndrome ◽

Polycystic Ovary ◽

Follicular Development ◽

Pulse Frequency ◽

Ovary Syndrome ◽

Ovarian Morphology ◽

Genetic And Environmental Factors ◽

Hallmark Feature ◽

Ovarian Syndrome

Abstract Background Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder characterized by anovulation, hyperandrogenism, and polycystic ovarian morphology. The pathophysiology of PCOS is not clear; however, disturbance in hypothalamic-pituitary-ovarian axis and abnormal steroidogenesis along with genetic and environmental factors act as main contributors to this disorder. Main text Hyperandrogenism, the hallmark feature of PCOS, is clinically manifested as hirsutism, acne, and alopecia. Excessive androgen production by ovaries as well as from adrenals contributes to hyperandrogenism. Abnormalities in the neuroendocrine system like increased pulse frequency of gonadotropin-releasing hormone, stimulating the pituitary for excessive production of luteinizing hormone than that of follicle-stimulating hormone is seen in PCOS women. Excess LH stimulates ovarian androgen production, whereas a relative deficit in FSH impairs follicular development. The imbalance in LH: FSH causes proliferation of ovarian theca cells leading to increased steroidogenesis, and ultimately leading to hyperandrogenism in PCOS women. Various genetic factors have been shown to be associated with abnormal steroidogenesis. CYP genes involved in steroidogenesis play an important role in androgen production and are considered as key players in hyperandrogenism in PCOS. Conclusion Polymorphisms in CYP genes can aggravate the hyperandrogenic phenotype in women with PCOS by either upregulating or downregulating their expression, thus increasing androgens further. However, this hypothesis needs to be validated by further studies.

Download Full-text

The association between anti-Müllerian hormone and vitamin 25(OH)D serum levels and polycystic ovarian syndrome in adolescent females

Reproductive Biology and Endocrinology ◽

10.1186/s12958-020-00676-y ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Samantha Simpson ◽

David B. Seifer ◽

Veronika Shabanova ◽

Anna Y. Lynn ◽

Catherine Howe ◽

...

Keyword(s):

Diagnostic Criteria ◽

Polycystic Ovarian Syndrome ◽

Retrospective Chart Review ◽

Serum Levels ◽

Adolescent Females ◽

Adult Women ◽

Clinical Markers ◽

Cross Sectional ◽

Pcos Group ◽

Ovarian Syndrome

Abstract Background High anti-Müllerian hormone (AMH) levels and 25-hydroxyvitamin D [25(OH)D] deficiency have been associated with polycystic ovarian syndrome (PCOS) in adult women, and implicated in its pathogenesis. Herein we determined if the level of both AMH and 25(OH)D are altered in adolescent females with clinical features of PCOS. Methods This is a cross-sectional study utilizing a retrospective chart review of 128 patients aged 12–20 referred to an academic adolescent gynecology and endocrinology clinic for an evaluation of suspected PCOS. Unadjusted comparisons of AMH and 25(OH)D distributions between subjects with and without PCOS were performed using the Wilcoxon Rank Sum test. Quantile regression was used to compare the median AMH and 25(OH)D between subject groups; adjusting for race, ethnicity, BMI, insurance type, age, and season when bloodwork was performed. Results Seventy-four subjects were classified as having PCOS by meeting ≥2 of the three Rotterdam diagnostic criteria, and 47 subjects met only one Rotterdam diagnostic criteria, and were used as the comparative non-PCOS group. There were statistically significant unadjusted differences in median levels of AMH and 25(OH)D. In the adjusted analyses, median AMH was significantly higher in the PCOS group compared to the non-PCOS group (+ 2.39 ng/mL, 95% CI 0.43, 4.35, p = 0.018); 25(OH)D was significantly lower in the PCOS group (− 9.01 ng/mL, 95% CI -14.49, − 3.53 p = 0.001). In our sample, adolescents in both groups had insufficient 25(OH)D level (22 ng/mL) and elevated BMI (32.2 kg/m2). Conclusions Adolescents with PCOS display high levels of AMH and low 25(OH)D levels. Since traditional clinical markers of PCOS may be physiologic in adolescents, AMH and 25(OH)D may be used as surrogate markers of PCOS risk in adolescents.

Download Full-text

Comparative study on the use of myoinositol and metformin in the improvement of clinical symptoms and biochemical parameters in women with polycystic ovarian syndrome

International Journal of Clinical Obstetrics and Gynaecology ◽

10.33545/gynae.2020.v4.i6b.737 ◽

2020 ◽

Vol 4 (6) ◽

pp. 87-92

Author(s):

Dr. Sangeereni M ◽

Dr. Abinaya Duraisingam

Keyword(s):

Comparative Study ◽

Biochemical Parameters ◽

Polycystic Ovarian Syndrome ◽

Clinical Symptoms ◽

Ovarian Syndrome

Download Full-text

Comparison of hCG Versus Gonadotropin-Releasing Hormone Agonist to Induce Oocyte Maturation in Assisted Reproductive Technology Cycles: A Retrospective Study

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2020.1034 ◽

2020 ◽

pp. 1

Author(s):

Gulay Beydilli Nacak ◽

Elif Tozkır ◽

Enis Ozkaya ◽

Ebru Cogendez ◽

Fatih Kaya

Keyword(s):

Gnrh Agonist ◽

Polycystic Ovarian Syndrome ◽

Gnrh Antagonist ◽

Control Group ◽

Study Group ◽

Ovarian Morphology ◽

Gnrh Agonist Trigger ◽

Ovarian Syndrome ◽

Agonist Trigger ◽

Hcg Trigger

OBJECTIVE: To compare some cycle characteristics and outcomes using a protocol consisting of a GnRH agonist trigger or hCG trigger after cotreatment with GnRH antagonist.STUDY DESIGN: Thirty-three patients under 35 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by GnRH agonist trigger and 132 patients under 35 years of age with the polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by hCG for IVF treatment. Patients were non-randomly assigned to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after antagonist protocol (control group).RESULTS: The positive pregnancy test was obtained in 70 women in the control group whereas in 13 cases in the study group (p=0.161). No case in the study group needed hospitalization whereas there were 15 cases in the control group who were required to be hospitalized due to ovarian hyperstimulation related symptoms (p=0.04).CONCLUSIONS: The use of a protocol consisting of a GnRH agonist trigger after GnRH antagonist cotreatment and freeze-all strategy reduces the risk of ovarian hyperstimulation syndrome in high-risk patients undergoing IVF without affecting pregnancy rates.

Download Full-text