Polycystic Ovary Syndrome Among Female Adolescents With Congenital Adrenal Hyperplasia

Background: Polycystic ovary syndrome is a disorder but with unclear etiology that its diagnosis depends on exclusion of other etiologies with ovulatory disorders and androgen excess as congenital adrenal hyperplasia, 21-hydroxylase deficient non classic congenital adrenal hyperplasia (NCAH), adrenal or ovarian androgen-secreting tumors, disorders of adrenocortical dysfunction as Cushing’s disease, and abuse of androgenic or anabolic drugs. Polycystic ovary syndrome affects approximately 6-15% of women in reproductive age and constitutes 50% of the causes of infertility in women. Aim of the Work: To compare the efficacy of letrozole on ovulation induction to that of clomiphene citrate in women suffering polycystic ovary syndrome and the effect on the follicular maturation, endometrial thickness and pregnancy rate. This study was carried in the outpatient infertility clinic of Ain-Shams Maternity Hospital during the period from November 2020 till April 2021. Patients and Methods: This study included 80 infertile women diagnosed as having polycystic ovary syndrome. Women were randomized into two groups. Letrozole group (1) included 40 women who were given the aromatase inhibitor (Letrozole) orally in a 5mg dose daily from day 3 to day 7 of the menstrual cycle. While Clomiphene citrate group (2) included 40 women who were given the clomiphene citrate orally in 100mg dose daily from day 3 to day 7 of the menstrual cycle. All women were counseled and informed consent was obtained before recruitment. Results: In this study, ovulation rate was significantly more frequent in the Letrozole group (82.5%, 33 women reached ovulation successfully) than in Clomiphene citrate group (60%, 24 women reached ovulation successfully) within P value=0.024. Clomiphene citrate at a dose of 100mg showed more efficacies in the number of follicle ≥18mm than Letrozole at a dose of 5mg. In Letrozole group, the number of follicles (≥18mm in diameter) ranged from 1 to 2 with a Mean±SD= 1.4±0.65 and in Clomiphene citrate group, the number of follicles (≥18mm in diameter) ranged from 1 to 3 with a Mean±SD= 1.9± 0.41 (P value=0.0001). Conclusion: Letrozole can be considered as a first line treatment of anovulation in polycystic ovary syndrome. But, moreover studies including larger number of cases will further confirm the efficacy of letrozole versus clomiphene citrate in induction of ovulation, reaching to the optimum doses for aromatases inhibitors, more observation on endometrial thickness, incidence of pregnancy outcomes, incidence of abortion and incidence of congenital fetal malformations.

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Pelvic floor parameters in women with gynecological endocrinopathies: a systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.12.1742 ◽

2020 ◽

Vol 66 (12) ◽

pp. 1742-1749

Author(s):

Júlia Ferreira Fante ◽

Cristine Homsi Jorge Ferreira ◽

Cassia Raquel Teatin Juliato ◽

Cristina Laguna Benetti-Pinto ◽

Glaucia Miranda Varella Pereira ◽

...

Keyword(s):

Systematic Review ◽

Polycystic Ovary Syndrome ◽

Pelvic Floor ◽

Congenital Adrenal Hyperplasia ◽

Quality Assessment ◽

Muscle Activity ◽

Polycystic Ovary ◽

Adrenal Hyperplasia ◽

Ovary Syndrome ◽

Ovarian Insufficiency

SUMMARY There is no pooled information about pelvic floor parameters (muscle assessment, disorders) of women with gynecologicaL endocrinopathies (eg. polycystic ovary syndrome, congenital adrenal hyperplasia, premature ovarian insufficiency). Given that, a systematic review was performed on the Pubmed, Scopus, Google Scholar, Scielo and PEDro databases regarding the main gynecological endocrinopathies [polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), congenital adrenal hyperplasia (CAH) and hyperprolactinemia (HPL)] since their inception to April 2020. Data quality assessment was made by the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. A total of 4,272 results were retrieved from all databases. After excluding duplicate results and screening by title and abstract, nine studies were selected for quantitative analysis. Seven studies were performed with women with PCOS and two studies with POI. Women with PCOS presented a higher prevalence of urinary incontinence (UI) among obese women, a higher thickness of the levator ani muscle, and higher levels of muscle activity measured by surface electromyograph when compared to the control women. Regarding POI, there was no association with UI, FI, and POP. NOS found that the quality assessment for these selected studies ranged from 5 to 8. We concluded that higher pelvic muscle activity and volume were found in women with PCOS, with further studies needed to confirm this data. Literature was scant about POI, CAH, and HPL.

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Diagnosis and management of patients with hyperandrogenism in early reproductive age

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2021-5-124-130 ◽

2021 ◽

Vol 20 (5) ◽

pp. 124-130

Author(s):

E.P. Khashchenko ◽

◽

O.I. .Lisitsyna ◽

E.V. Uvarova ◽

◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Congenital Adrenal Hyperplasia ◽

Oral Contraceptives ◽

Clinical Symptoms ◽

Polycystic Ovary ◽

Reproductive Age ◽

Adrenal Hyperplasia ◽

Ovary Syndrome ◽

Combined Oral Contraceptives ◽

Diagnosis And Management

Hyperandrogenism is characterized by the presence of clinical symptoms and / or biochemical parameters of high androgen levels. Dermopathy and particularly acne and hirsutism are regarded as the main clinical markers of hyperandrogenism. Cosmetic problems associated with hyperandrogenism are often the reason for young woman to seek medical attention. Body hair growth in atypical areas, acne and trophic skin changes have a significant effect on the emotional state, provoke a sense of imperfection and loss of attractiveness, and reduce the quality of life. Concomitant menstrual disorders (up to 50–75%) complicate the patient’s state and determine an increased risk of gynecological disorders in the future. The causes of hyperandrogenism in early reproductive age can be varied: from more common physiological hyperandrogenism in adolescence, idiopathic hyperandrogenism, polycystic ovary syndrome (PCOS) and the atypical form of congenital adrenal hyperplasia to less common hyperthecosis, acromegaly, hyperprolactinemia, hypothyroidism, Cushing’s disease, and androgen-secreting tumors. The diagnostic search should begin with assessing complaints and clinical symptoms, and a complete physical examination. To confirm biochemical hyperandrogenism, total and free testosterone, and free androgen index are evaluated. Additional methods of examination are used to clarify the diagnosis. Treatment is prescribed in accordance with the established diagnosis. Androgen-secreting tumors require surgical intervention. Other causes of hyperandrogenism are usually treated with medication. According to current recommendations, combined oral contraceptives are the first-line therapy for the most common conditions accompanied by hyperandrogenism (hirsutism, acne vulgaris, PCOS) in early reproductive age. A clinical solution may be a combined administration of microdoses of ethinylestradiol (20 μg) and drospirenone (3 mg), progestagen with antiandrogenic property in the mode 24 + 4 (for instance: Dimia). This article presents clinical cases of diagnosis and management tactics for patients of early reproductive age with hyperandrogenism. Conclusion. The differential diagnosis of physiological and pathological conditions accompanied by hyperandrogenism is one of the current challenges for obstetrician-gynecologist. A properly developed algorithm of examination, interpretation of its results, therapy and prevention of complications are of great importance. Key words: acne, alopecia acreata, congenital adrenal hyperplasia, hyperandrogenism, hirsutism, girls, drospirenone, combined oral contraceptives, contraception, adolescents, early reproductive age, polycystic ovary syndrome, ethinylestradiol

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Definition of hormonal cut-off values for discriminating polycystic ovary syndrome from non classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Endocrine Abstracts ◽

10.1530/endoabs.63.p334 ◽

2019 ◽

Author(s):

Claudia Oriolo ◽

Soara Menabo ◽

Daniela Ibarra Gasparini ◽

Paola Altieri ◽

Francesca Corzani ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Congenital Adrenal Hyperplasia ◽

Polycystic Ovary ◽

Adrenal Hyperplasia ◽

Hydroxylase Deficiency ◽

Ovary Syndrome ◽

Definition Of ◽

21 Hydroxylase Deficiency

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Isolation of urinary C-20α- and C-20β-hydroxy-C21-steroid metabolites in cases of congenital adrenal hyperplasia, postpubertal virilizing syndrome and polycystic ovary syndrome

Steroids ◽

10.1016/s0039-128x(79)80004-5 ◽

1979 ◽

Vol 33 (1) ◽

pp. 33-44 ◽

Cited By ~ 2

Author(s):

G. Halperin ◽

I. Maschler

Keyword(s):

Polycystic Ovary Syndrome ◽

Congenital Adrenal Hyperplasia ◽

Polycystic Ovary ◽

Adrenal Hyperplasia ◽

Ovary Syndrome

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Steroid Screening Tools Differentiating Nonclassical Congenital Adrenal Hyperplasia and Polycystic Ovary Syndrome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa369 ◽

2020 ◽

Vol 105 (8) ◽

pp. e2895-e2902

Author(s):

Giovana D N Maffazioli ◽

Tania A S S Bachega ◽

Sylvia A Y Hayashida ◽

Larissa G Gomes ◽

Helena P L Valassi ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Congenital Adrenal Hyperplasia ◽

Polycystic Ovary ◽

Characteristic Curve ◽

Screening Tools ◽

Acth Test ◽

Adrenal Hyperplasia ◽

Ovary Syndrome ◽

Cross Sectional ◽

Cortisol Ratio

Abstract Purpose To analyze the performance of basal 17OH-progesterone (17OHP) levels versus the basal 17OHP/cortisol ratio in nonclassical congenital adrenal hyperplasia (NCAH) and polycystic ovary syndrome (PCOS) differential diagnosis. Basal 17OHP levels >10 ng/mL have been used to confirm NCAH diagnosis without the adrenocorticotropic hormone (ACTH) test; however, the optimal cutoff value is a matter of debate. Methods A cross-sectional study was performed at the endocrinology and gynecological endocrinology outpatient clinics of a tertiary hospital. A total of 361 patients with PCOS (age 25.0 ± 5.3 years) and 113 (age 19.0 ± 13.6 years) patients with NCAH were enrolled. Basal and ACTH-17OHP levels were measured by radioimmunoassay, and CYP21A2 molecular analysis was performed to confirm hormonal NCAH diagnosis. Receiver operating characteristic curve analysis compared basal 17OHP levels and the 17OHP/cortisol ratio between NCAH and PCOS patients. Results Basal 17OHP levels were higher in NCAH patients than in those with PCOS (8.85 [4.20-17.30] vs 1.00 [0.70-1.50] ng/mL; P < 0.0001), along with 17OHP/cortisol ratio (0.86 [0.47-1.5]) vs 0.12 [0.07-0.19]; P < 0.0001, respectively). Basal 17OHP levels and the 17OHP/cortisol ratio were strongly correlated in both groups (rho = 0.82; P < 0.0001). Areas under the curves for basal 17OHP levels (0.9528) and the 17OHP/cortisol ratio (0.9455) were not different to discriminate NCAH and PCOS (P > 0.05). Basal 17OHP level >5.4 ng/mL and 17OHP/cortisol ratio >2.90 had 100% specificity to identify NCAH. Main Conclusions Basal 17OHP levels >5.4 ng/mL can be used to perform differential diagnoses between NCAH and PCOS, dismissing the ACTH test. The basal 17OHP/cortisol ratio was not superior to basal 17OHP levels in this scenario.

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