Polycystic ovary syndrome in obese adolescents

The relationship between hormonal levels and hematological parameters in cystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is characterized by the abnormal production of ovarian androgens resulting in elevated levels of male sex hormones in women. This condition is often marked by the development of a group of small cysts, fluid-filled sacs (cysts) in the ovaries. This study aimed to analyze serum levels of prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and specific hematological parameters in women with PCOS. In total, 70 women were enrolled, of which 50 were diagnosed with PCOS at an obstetrics institution in Karbala from February and May 2022, and 20 were excluded. Participant selection was based on the Rotterdam 2003 criteria, and we excluded postmenopausal women, those with hyperprolactinemia, and those with overt thyroid dysfunction. The control group included 20 fertile women with normal hormone levels, regular menstrual cycles, and no signs of hyperandrogenism, as verified by ultrasonography. Ages 15 to 46 were similar with regard to the frequency of illness, with those under 36 having a higher incidence. Data were collected via questionnaires, hormone level assessments, and complete blood count (CBC) tests. There was a significant increase in hormone levels (LH, FSH, prolactin, TSH) and CBC values (WBC, Hb, and Plt) in the PCOS group compared to the control group. We observed that women between 26 and 35 were more susceptible to PCOS. Furthermore, women who were overweight demonstrated a higher susceptibility to the syndrome.

Agrochemicals and obesity

Obesity has become a very large concern worldwide, reaching pandemic proportions over the past several decades. Lifestyle factors, such as excess caloric intake and decreased physical activity, together with genetic predispositions, are well-known factors related to obesity. There is accumulating evidence suggesting that exposure to some environmental chemicals during critical windows of development may contribute to the rapid increase in the incidence of obesity. Agrochemicals are a class of chemicals extensively used in agriculture, which have been widely detected in human. There is now considerable evidence linking human exposure to agrochemicals with obesity. This review summarizes human epidemiological evidence and experimental animal studies supporting the association between agrochemical exposure and obesity and outlines possible mechanistic underpinnings for this link.

Family-Based Association Study of rs17300539 and rs12495941 Polymorphism in Adiponectin Gene and Polycystic Ovary Syndrome in a Chinese Population

Backgriond

Polycystic ovary syndrome (PCOS) is a complex disease that has both genetic and environmental components. Adiponectin plays an important role in the regulation of insulin sensitivity and insulin resistance (IR) in PCOS. The aim of this study was to determine 2 single-nucleotide polymorphisms (SNPs) variants (rs12495941 and rs17300539) of the adiponectin gene (ADIPOQ) in polycystic ovary syndrome (PCOS) families.

Material/Methods

We recruited 197 PCOS probands, their biological parents, and 192 controls. Anthropometric variables, including hip circumference (HC) and waist circumference (WC), were measured in all subjects during their first visit to the outpatient department. Serum T, FBG, FINS, TC, TG, LDL, and HDL levels were measured. PCOS patients were divided into 2 groups based on BMI: group A (BMI <25 kg/m²) and group B (BMI ≥25 kg/m²). Parents of PCOS were accordingly categorized into group C and group D (fathers), and group E and group F (mothers). The associations among ADIPOQ rs12495941, rs17300539, and PCOS were analyzed using the transmission disequilibrium test (TDT).

Results

A significant association was found between SNP rs17300539 and PCOS in our Chinese population. The levels of TG and FINS and the genotype frequencies of rs17300539 are significantly different between overweight and lean PCOS. No significant association was detected for rs12495941.

Conclusions

TDT confirms that rs17300539 of ADIPOQ is strongly associated with the risk of PCOS in a Chinese Han population, but rs12495941 of ADIPOQ is not associated with the occurrence of PCOS.

Quality of life in overweight (obese) and normal-weight women with polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) is characterized by phenotypic heterogeneity and has a wide variety of consequences. Approximately half of women with PCOS are overweight or obese, and their obesity may be a contributing factor to PCOS pathogenesis through different mechanisms. The aim of this study was to evaluate if PCOS alone affects the patients' quality of life and to what extent obesity contributes to worsen this disease.

DESIGN

To evaluate the impact of PCOS on health-related quality-of-life (HRQoL), 100 Mediterranean women with PCOS (group A), 50 with a body mass index (BMI) >25 kg/m² (group A₁) and 50 with BMI <25 kg/m² (group A₂), were recruited. They were evaluated with a specific combination of standardized psychometric questionnaires: the Symptom Checklist-90 Revised, the 36-Item Short-Form Health Survey, and the Polycystic Ovary Syndrome Questionnaire. The patients were compared with a normal-weight healthy control group of 40 subjects (group B). Another control group of 40 obese healthy women (group C) was used to make a comparison with PCOS obese patients (A₁).

RESULTS

Our results showed a considerable worsening of HRQoL in PCOS patients (A) compared with controls (B). In addition, patients with PCOS and BMI >25 (A₁) showed a significant and more marked reduction in scores, suggesting a lower quality of life, compared with controls (B) and with normal-weight PCOS patients (A₂).

CONCLUSION

PCOS is a complex disease that alone determines a deterioration of HRQoL. The innovative use of these psychometric questionnaires in this study, in particular the PCOS questionnaire, has highlighted that obesity has a negative effect on HRQoL. It follows that a weight decrease is associated to phenotypic spectrum improvement and relative decrement in psychological distress.

The impact of obesity on hyperandrogenemia in Korean girls

PURPOSE

As metabolic complication and polycystic ovarian syndrome due to childhood obesity is rising, the role of hyperandrogenemia (HA) and hyperinsulinism is receiving attention. The aims of this study were to investigate the presence of obvious HA according to pubertal status and to find potential etiologic determinants of HA in Korean obese (OB) girls.

METHODS

We analyzed 91 girls aged 6-17 years (prepuberty, n=54; puberty, n=37). Each girl was classified as being either normal weight (NW) or OB. Anthropometric measurements were obtained and blood test was performed early in the morning after at least 8 hours of fasting to measure glucose, insulin, total testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular-stimulating hormone, estradiol, and progesterone.

RESULTS

The plasma levels of free testosterone (FT) and DHEAS were markedly higher in OB girls compared to NW girls in puberty (FT, P=0.009; DHEAS, P=0.046) but not in prepuberty (FT, P=0.183; DHEAS, P=0.052). Hyperinsulinemia and high homeostasis model assessment of insulin resistance (HOMA-IR) values were found regardless of pubertal status in OB girls. The significant related factor to HA in puberty was the body mass index Z-score (P=0.003). But HOMA-IR, LH, and progesterone levels were not relevant to HA in pubertal girls.

CONCLUSION

OB prepubertal girls did not show HA in the present study but they should be regularly monitored because they already had hyperinsulinemia. OB pubertal girls had significant HA and hyperinsulinemia, and obesity per se was the most important factor for HA.

Evaluation of Apelin and Insulin Resistance in Patients with PCOS and Therapeutic Effect of Drospirenone-Ethinylestradiol Plus Metformin

BACKGROUND

The aim of this study was to determine the relevance of apelin and insulin resistance (IR) with polycystic ovary syndrome (PCOS) and to assess the possible therapeutic effect of the combined therapy of drospirenone-ethinylestradiol (DRSP-EE) combined with metformin.

MATERIAL AND METHODS

Sixty-three PCOS patients and 40 non-PCOS infertile patients were recruited. The fasting serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), prolactin (PRL), estradiol (E2), glucose (FBG), insulin (FINS), and apelin at the early follicular phase were measured. To further investigate the relation between apelin and IR, we treated the PCOS patients with DRSP-EE (1 tablet daily, 21 d/month) plus metformin (500 mg tid) for 3 months. All of the above indices were measured again after treatment.

RESULTS

1) Levels of apelin, LH, LH/FSH, T, and FINS, as well as homeostatic model assessment of IR (HOMA-IR) in PCOS patients, were significantly higher than in the control group before treatment. 2) These indices significantly decreased after treatment with DRSP-EE plus metformin. 3) Correlation analysis showed that apelin level was positively correlated with body mass index (BMI), FINS level, and HOMA-IR.

CONCLUSIONS

Apelin level significantly increased in PCOS patients. The combined therapy of DRSP-EE plus metformin not only decreases IR, but also improves apelin level. This combination is a superior approach for PCOS treatment.

Adiponectin in women with polycystic ovary syndrome

Background

Though adiponectin has been associated with insulin resistance and cardiovascular risk factors, the relationship between adiponectin and polycystic ovary syndrome (PCOS) remains controversial. The aim of this study was to compare adiponectin level in women with PCOS and without PCOS, and to investigate the relationship between adiponectin level and metabolic variables including insulin resistance.

Methods

60 women with PCOS were enrolled along with a control group of 80 healthy women, matched for age and body mass index (BMI). We measured hormonal and metabolic parameters, as well as the plasma adiponectin concentration of each participant. We estimated the insulin sensitivity according to the quantitative insulin sensitivity check index (QUICKI).

Results

The PCOS group displayed significantly lower level of adiponectin (P < 0.001) after adjustment for age, BMI, mean blood pressure, fasting glucose, fasting insulin, and several metabolic parameters. Adiponectin levels were positively correlated with QUICKI in the PCOS group (P < 0.001) and the control group (P = 0.03). Following step-wise multiple regression analysis, however, adiponectin level was positively correlated with QUICKI in the control group only (P = 0.03). In addition, adiponectin level was found to be independently associated with HDL-cholesterol level (P < 0.001) and BMI (P = 0.02) in the PCOS group and independently associated with HDL-cholesterol (P = 0.02) in the control group.

Conclusion

We report decreased adiponectin level in PCOS patients in relation to controls independently of insulin resistance or other metabolic factors. And adiponectin is associated with both lipid metabolism and obesity, which, in turn, is related to insulin resistance in PCOS. Further studies are needed to clarify the mechanism of adiponectin in PCOS.

Attrition in paediatric weight management: a review of the literature and new directions

Paediatric obesity continues to be one of the most important health issues facing children and families today, and there remains a need for effective treatment options. There are a few reports in the literature demonstrating high rates of attrition from paediatric weight management programmes, ranging from 27% to 73%. While some studies show that racial/ethnic minorities, the economically disadvantaged and those with higher levels of obesity are at risk, other studies do not. There is some consistency in reasons given by families for attrition from treatment, most often scheduling issues and programmes not meeting family needs or expectations. This review highlights identified contributors to attrition from paediatric weight management and provides a framework to study this problem, based on models of adherence to paediatric medical regimens.

The impact of eating behavior on psychological symptoms typical of reactive hypoglycemia. A pilot study comparing women with polycystic ovary syndrome to controls

The idea that diet can affect mood and behavior in women with polycystic ovary syndrome (PCOS) by altering blood glucose levels has become popular in recent years. This paper describes an online survey (N=462) of 24 women with PCOS, 299 healthy control women, 47 women who possibly had undiagnosed PCOS, and 92 men. The groups were compared for symptoms of mood and behavioral symptoms typical of reactive (postprandial) hypoglycemia. The outcome measures were two questionnaires that measure states associated with hypoglycemia: the Hypoglycemia Symptom Checklist-7 (HSC-7), which measures behavioral symptoms and the Mood Adjective Checklist (MACL), which measures emotional states. Controlling for age and body mass index (BMI) using between-groups analysis of covariance (ANCOVA), the women with PCOS scored significantly higher than the other three groups (p<0.001) on the outcome measures. These differences remained statistically significant in a subset of twelve women with PCOS compared to twelve healthy control women closely matched for age, BMI, and eating behavior. The findings are suggestive of hypoglycemia-related mood and behavioral problems in PCOS. Future research should test whether blood glucose levels correlate with these symptoms in PCOS, and whether a low glycemic index ('low-GI') diet improves the symptoms.