Table 3 - uploaded by Roger A Pierson
Content may be subject to copyright.
Comparison of Clinical and Metabolic Features Among Women With Hirsutism Alone, Polycystic Ovaries Alone, and Controls. a
Source publication
The prevalence of polycystic ovary syndrome (PCOS) and its distinct clinical phenotypes were assessed using 3 sets of international diagnostic criteria in women self-reporting concerns over outward features of PCOS. Revised ultrasonographic criteria for polycystic ovaries (PCO) based on modern ultrasound technology were used. Of the participants, 5...
Similar publications
ABSTRACT
Introduction and Aim: Polycystic ovary syndrome (PCOS) has been characterized as an endocrine disorder by the presence of polycystic ovary along with excessive androgen secretion and ovary dysfunction. To eval-uate the association of CYP1A1 gene polymorphisms with Polycystic Ovary Syndrome Women among the Rural South Indian Population.
M...
Objective
Betatrophin is a newly identified circulating protein that is significantly associated with type 2 diabetes mellitus (T2DM), adiposity, and metabolic syndrome. The aim of this study was to investigate whether betatrophin levels and polycystic ovary syndrome (PCOS) were associated.
Methods
Circulating betatrophin levels were measured in 1...
Citations
... 16,17 Hyperandrogenic phenotypes have a worse cardiometabolic profile. 18 Infertility and cardiovascular disease may thus be linked with hyperandrogenism, dyslipidemia, obesity, and insulin resistance potentially playing a role. [19][20][21] Among the 12 baseline laboratory markers, including lipids and homocysteine, hs-CRP level was the most accurate predictor of CVD risk. ...
Scientists and medical experts are beginning to understand the significant role that a woman’s past reproductive experiences play in her potential risk of developing heart disease. Reproductive history is seldom considered when assessing the cardiovascular risk. Infertility, high blood pressure, and hypertension are risk factors for heart disease. Additional analyses were conducted to determine whether the apparent increase in risk could be influenced by other risk factors associated with infertility such as irregular menstruation, thyroid conditions, and waist circumference. This study aimed to investigate the association between cardiovascular risk and infertility in women and those who are fertile. The objectives of this study were to estimate the levels of serum creatinine kinase (MB) in both infertile and fertile control groups, as well as to estimate the LDL and HDL levels in the same groups. The study group comprised 78 participants, of which 39 were fertile and 39 were infertile. CK (MB), HDL, LDL, Uric acid, and high sensitivity C reactive Protein (hs-CRP) levels were analyzed. In this study, we discuss how infertility may share common pathways with cardiovascular diseases. Numerous mechanisms may be involved in mediating infertility, including ovulatory abnormalities, endometriosis, and uterine fibroids. For example, in addition to having lower HDL levels, women with polycystic ovary syndrome (PCOS) are more likely to have higher levels of total cholesterol, triglycerides, and LDL. PCOS patients typically exhibit elevated UA levels and hyperuricemia, which are commonly associated with increased androgen levels.
... A study by Wiweko et al. at Dr. Cipto Mangunkusumo General Hospital 2008 reported that a body mass index (BMI) of ≧ 25 kg/m 2 was observed in 73% of women with PCOS [24]. Additional research has observed that individuals with PCOS and hyperandrogenism exhibit a greater prevalence of visceral fat in comparison to subcutaneous fat, as indicated by a waist-hip circumference ratio surpassing 0.85 [25,26]. However, women diagnosed with PCOS may demonstrate a slender physique despite adhering to a diet characterized by elevated fat and sugar intake and low fiber content. ...
Background
Hyperandrogenism is frequently found in polycystic ovary syndrome (PCOS) and contributes to physical manifestations like hirsutism and obesity, along with infertility. This condition can result in anxiety, depression, and body image disorders, potentially leading to sexual dysfunction. The objective of this investigation was to assess the correlation among hirsutism, anthropometric characteristics, sexual dysfunction, and anxiety levels among infertile Indonesian women diagnosed with PCOS.
Methods
From December 2021 to December 2022, a cross-sectional study was undertaken involving 71 infertile women diagnosed with PCOS at Yasmin Clinic, Dr. Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. Hirsutism was assessed using the modified Ferriman-Gallwey (mFG) score; the anthropometric profile was assessed using BMI and waist-to-hip ratio. The assessment of sexual dysfunction was conducted using the Female Sexual Function Index (FSFI) questionnaire, while the evaluation of anxiety levels utilized the HAM-A questionnaires.
Results
In this study, it was discovered that 53.3% of subjects experienced sexual dysfunction. However, there was no statistically significant relationship between hirsutism, anthropometric profile, and sexual dysfunction score in infertile women with PCOS ( p > 0.05). Analysis of the overall FSFI domain score revealed that lubrication and satisfaction were lower in obese patients ( p = 0.02 and p = 0.03), but this did not contribute to an overall sexual dysfunction score. Also, we found that subjects who experienced sexual dysfunction had a higher anxiety score ( p < 0.005), with correlation analysis showing that Ferriman-Gallwey (FG) scores have a significant positive correlation with anxiety.
Conclusion
There is no correlation between hirsutism, anthropometric profile, and sexual dysfunction in infertile Indonesian women diagnosed with PCOS. However, hirsutism could play a role in causing anxiety in Indonesian PCOS women. Additional investigation is required, as female sexual function is an intricate subject.
... Our study reported the greater predisposition of classical phenotype A (32.8%) compared to other Rotterdam phenotypes. Similar results have been furnished by the studies carried out in Canada [32], Italy [33], China [34], Iran [35], Turkey [36], Lebanon [37], Greek [38], Iraq [39] and Mexico [40]. In contrary we report least prevalence of phenotype D, studies conducted in Vietnam [41], China [42], Sudan [43], Iran [44] follow the same results. ...
to relate with the pathogenesis of this disease. There was a notable association between an increasingly affluent diet, the presence of hirsutism, raised body mass index, obesity and metabolic syndrome in our population, making diet as an imperative factor to govern PCOS presentation. This study clearly implies the effect of unhealthy dietary habits to be associated with increasingly severe phenotype of PCOS, which can likely have implications on metabolic and fertility outcomes.
... Our findings indicated that including PCOM as part of the Rotterdam criteria could exaggerate the diagnostic accuracy of FNPO. However, using the 1990 NIH criteria to diagnose PCOS only captures those with the most severe manifestation of PCOS in terms of reproductive and metabolic dysfunction (Diamanti-Kandarakis and Panidis, 2007;Kauffman et al., 2008;Clark et al., 2014). Therefore, ultrasound image analysis blinded and conducted prior to phenotyping is critical in reducing bias associated with the inclusion of PCOM in the PCOS diagnosis of the study population. ...
BACKGROUND
Polycystic ovary morphology (PCOM) on ultrasonography is considered as a cardinal feature of polycystic ovarian syndrome (PCOS). Its relevance as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM.
OBJECTIVE AND RATIONALE
The aim of this systematic review and diagnostic meta-analysis was to assess the diagnostic accuracy of various ultrasonographic features of ovarian morphology in the diagnosis of PCOS.
SEARCH METHODS
Relevant studies published from 1 January 1990 to 12 June 2023 were identified by a systematic search in PubMed, Web of Science, Scopus, CINAHL, and CENTRAL. Studies that generated diagnostic accuracy measures (e.g. proposed thresholds, sensitivity, specificity) for PCOS using the following ultrasonographic markers met criteria for inclusion: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Studies on pregnant or post-menopausal women were excluded. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. Diagnostic meta-analysis was conducted using a bivariate model of pooled sensitivity and specificity, and visualized using forest plots and summary receiver-operating characteristic (SROC) curves.
OUTCOMES
From a total of 2197 records initially identified, 31 studies were included. Data from five and two studies were excluded from the meta-analysis due to duplicate study populations or limited data for the index test, leaving 24 studies. Pooled results of 20 adult studies consisted of 3883 control participants and 3859 individuals with PCOS. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81–87%; specificity: 91%, CI: 86–94%; AUC: 0.905) in adult women. OV and FNPS had similar pooled sensitivities (OV: 81%, CI: 76–86%; FNPS: 81%, CI: 70–89%) but inferior pooled specificities (OV: 81%, CI: 75–86%; FNPS: 83%, CI: 75–88%) and AUCs (OV: 0.856; FNPS: 0.870) compared to FNPO. Pooled results from four adolescent studies consisting of 210 control participants and 268 girls with PCOS suggested that OV may be a robust ultrasonographic marker for PCOS diagnosis albeit the current evidence remains limited. The majority of the studies had high risk of bias for the patient selection (e.g. lack of randomized/consecutive patient selection)and index test (e.g. lack of pre-proposed thresholds for comparison) domains across all ultrasonographic markers. As such, diagnostic meta-analysis was unable to determine the most accurate cutoff for ultrasonographic markers to diagnose PCOS. Subgroup analysis suggested that stratification based on previously proposed diagnostic thresholds, age, BMI, or technology did not account for the heterogeneity in diagnostic accuracy observed across the studies. Studies that diagnosed PCOS using the Rotterdam criteria had improved sensitivity for FNPO. Studies from North America had lower diagnostic accuracy when compared to Asian studies (FNPO: sensitivity) and European studies (OV: specificity, diagnostic odds ratio and positive likelihood ratio). Geographic differencesin diagnostic accuracy may potentially be due to differences in age, BMI, and diagnostic criteria of the PCOS group across regions.
WIDER IMPLICATIONS
This diagnostic meta-analysis supports the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS in adult women. OV and FNPS provide alternatives if total antral follicle counts cannot be accurately obtained. Our findingssupport the potential for ultrasonographic evidence of PCOM in adolescents as more data becomes available. Subgroup analysis suggests the need to investigate any relative contributions of geographical differences on PCOS phenotypes. These findings may provide the basis for the development of strategies and best practices toward a standardized definition of PCOM and a more accurateultrasonographic evaluation of PCOS.
... The Rotterdam criteria for PCOS recognize four clinical phenotypes of the syndrome. The most prevalent phenotype is the classic form [38], which meets all three current criteria for PCOS: clinical and/or biochemical hyperandrogenism (HA), menstrual dysfunction (oligo/amenorrhea) (Oligo) and polycystic ovarian morphology (PCOM)-phenotype A (Oligo + HA + PCOM). Phenotype B (HA + Oligo) and phenotype C (HA + PCOM) are less frequent. ...
Adipocyte fatty acid-binding protein (A-FABP) is mainly expressed in adipocytes. The risk of abdominal obesity and autoimmune thyroid disease is increased in women with polycystic ovary syndrome (PCOS). The objective of this study was to explore the relationship of serum concentration of A-FABP with parameters of obesity, e.g., waist to hip ratio (WHR) and the amount of adipose tissue assessed by bioelectrical impedance analysis (BIA), and thyroid hormone homeostasis in women with PCOS. We examined 66 women with PCOS and 67 healthy women. Serum concentrations of A-FABP and thyroid hormones were measured; the FT3/FT4 ratio, thyroid-stimulating hormone index (TSHI), thyrotrope thyroxine resistance index (TT4RI) and thyroid feedback quantile-based index (TFQI) were calculated. In the PCOS group, serum concentrations of A-FABP, FT3 and the FT3/FT4 ratio were significantly higher in comparison to the control group (all p < 0.05). A correlation of A-FABP with WHR (r = 0.26, p = 0.04) and the percentage of adipose tissue (r = 0.33, p = 0.01) has been found only in women with PCOS. We observed no correlation between serum levels of A-FABP and TSHI, TT4RI or TFQI in women with PCOS (all p > 0.05). Our results indicate that A-FABP is an adipokine that may be connected with abdominal obesity independently of thyroid hormone homeostasis in PCOS patients.
... In accordance with previous reports [34][35][36], phenotype A was the most common (50.39% of the PCOS diagnoses) in our study population, whereas phenotype B resulted in less frequent diagnoses in 14.12%. The normo-androgenic phenotype D accounted for 26.47%, which is different from results observed in some other studies [37,38]. There is no dispute that phenotype A as the severe group is the most prevalent phenotype, although the relative prevalence of each phenotype varies in different ethnic groups. ...
Objective: To investigate sexual function stratified according to four clinical phenotypes of polycystic ovary syndrome (PCOS) and its association with clinical and quality of life parameters, and to compare these with healthy controls in Chinese women with PCOS. Methods: A cross-sectional study was designed in 1000 PCOS women and 500 control women aged 18–45 years. PCOS women were grouped into four clinical phenotypes according to the Rotterdam Criteria. FSFI (Female Sexual Function Index), SF-12 (the 12-item short form health survey) and clinical and hormonal characteristics likely to affect sexual function were determined. Results: 809 PCOS women and 385 control women with complete parameters were evaluated after screening. Phenotype A had a lower total FSFI mean score (23.14 ± 3.22) compared with phenotype D and control group (p < 0.05). The control group had the highest total FSFI mean score (24.98 ± 3.78). For the percentage at risk of sexual dysfunction, phenotype A (87.5%) and phenotype B (82.46%) had a higher risk of female sexual dysfunction (FSD) than that in phenotype C (75.34%), phenotype D (70.56%) and control group (61.30%) (p < 0.05). SF-12 mental domain scores were significantly lower in phenotypes A and B compared with phenotypes C and control group (p < 0.05). Infertility treatment, bioavailable testosterone, psychological factors, age and waist circumference presented negative correlation with female sexual function. Conclusions: The risk of FSD in PCOS women seemed to be associated with PCOS clinical phenotypes. The classical PCOS phenotype with oligo-ovulation and hyperandrogenism had a higher risk of sexual dysfunction.
... Women with PCOS also frequently suffer from metabolic dysfunction, obesity, infertility and are at an increased risk of pregnancy complications and long-term cardiovascular disease [5][6][7][8][9][10]. There exists, however, significant heterogeneity among the phenotypic expressions of PCOS and disease sequelae may vary across a woman's lifespan [11,12]. Furthermore, while there are around 30 genes associated with the development of PCOS [13][14][15], pathogenesis of this disease is complex, multi-factorial and not fully elucidated, thus diagnosis relies on identifying features of the syndrome following exclusion of known disorders affecting ovulation or hyperandrogenism. ...
... Most recently, a slightly reduced follicle number threshold has been proposed by the 2018 International Evidence Based Guidelines for the Assessment and Management of PCOS, at ≥20 follicles per ovary and/or an ovarian volume of ≥10 cm 3 [23]. Whether use of different follicle number thresholds has true clinical relevance outside of providing a diagnostic label is debatable, as the degree of hyperandrogenemia better predicts metabolic risk and has more clinical relevance (in addition to oligo-anovulation) than ovarian morphology for most patients with PCOS [11]. Likely, ultrasound criteria will continue to evolve as technology improves and new, more reliable criteria continue to be developed. ...
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women. Much of the confusion surrounding PCOS diagnosis stems from the broad heterogeneity of symptomology experienced by women with PCOS. The diverse features of the syndrome have led to a number of diagnostic criteria over the years. This manuscript describes each of the current composite criteria and individually breaks down each component. The importance of accurate diagnosis for both clinical care and research is emphasized.
... 6 In another study done by Clark et al., the prevalence of Frank PCOS was 66%, ovulatory PCOS was 13%, normoandrogenic PCOS was 11%, and non-PCO PCOS was 9%. 7 In a study done in India by Sachdeva et al., the most prevalent phenotype was phenotype A of 67.7% and the least prevalent was phenotype D of 3.6% (Table 1). 3 ...
... Three distinct definitions are used for the diagnosis of PCOS which reflects the phenotypic variation or diversity of the syndrome 4 . The National Institute of Health (NIH) consensus panel in 2012, classified PCOS: (1) Phenotype A or Full-blown syndrome PCOS (H+O+P), (2) Phenotype B or Non-PCO PCOS (H+O), (3) Phenotype C or Ovulatory PCOS (H+P), (4) Phenotype D or Non-hyperandrogenic PCOS (O+P) 5 . Predictive frequencies of polycystic ovarian syndrome vary in different literatures, ranging from 2.2% -26.0% 1 . ...
Polycystic ovary syndrome (PCOS) is a polygenic and multifactorial condition, regarded as the most common endocrine abnormality of women in reproductive period. It is commonly assumed that insulin resistance, hyperandrogenism and obesity significantly influence the pathophysiological process of PCOS. This study was designed to estimate hormonal parameters in different phenotypes of PCOS. The cross sectional descriptive type of observational study was carried out at Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to June 2019. Data were collected from purposively selected 107 patients with PCOS by interview, clinical examination and laboratory investigations using a pretested case record form. Data were analyzed by computer software, SPSS-version 22.0. Hormonal parameters in different phenotypes of PCOS were compared with ANOVA test. Phenotype A was found in highest number (59.8%) followed by phenotype B (14.9%), phenotype D (14.0%) and phenotype C (11.2%). Biochemical hyperandrogenism was observed highest in phenotype A (57.8%) followed by phenotype B (36.4%) and phenotype C (6.1%). Biochemical or clinical hyperandrogenism was not observed among patients of phenotype D. Altered LH:FSH ratio was high in phenotype A (14.1%) and Phenotype B (2.8%). Increased serum prolactin level was found highest in phenotype A (10.3%) and increased serum TSH was found highest in phenotype D (4.7%). Statistically significant difference was observed among levels of serum testosterone of different phenotypes (p<0.001). Hormonal derangements among different phenotypes reflect the severity of reproductive dysfunction and metabolic aberrations. Screening for metabolic risks of diverse phenotypes is important to detect and prevent long term health consequences of PCOS.
... Our results were supported by the other studies on the different populations across the world, [36][37][38][39]. Another study from the United States delivered a high prevalence of dyslipidemia in women with PCOS [40]. Exon 10 of LHCGR contains rs2293275 and rs12470652 SNPs that lead to changes in the amino acids at positions 312 and 291, respectively. ...
Background
Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder that affects women at their child bearing age. The exact etiology is uncertain, however the involvement of multiple genes and environmental interactions has been proposed for the advancement of PCOS. The aim of present study was to evaluate the association of LHCGR variants (rs2293275 and rs12470652) with PCOS in Punjab.
Methods
The present case–control study comprised a total of 743 women (421 PCOS cases and 322 healthy controls). Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism technique (PCR–RFLP). Biochemical analysis was carried out to measure the levels of cholesterol, High-density lipoprotein (HDL), Low-density lipoprotein (LDL), Very low-density lipoprotein (VLDL), triglycerides, testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). All the statistical analysis was done using SPSS (version21, IBM SPSS, NY, USA).
Results
The mutant genotype (AA) and mutant allele (A) of rs2293275 conferred 1.7 and 1.3 fold risk, respectively and mutant allele (C) of rs12470652 conferred 2.3 fold risks towards PCOS progression. Levels of cholesterol and triglycerides were elevated and HDL levels were lower in PCOS cases as compared to controls. Total testosterone and luteinizing hormone levels were also found to be higher in PCOS cases.
Conclusion
Our study postulated that LHCGR variants are playing a cardinal role in the progression of PCOS and can be used to assess the risk of PCOS in women of reproductive age.
