Interventional studies for polycystic ovarian syndrome in children and adolescents

Co-regulative effects of chitosan-fennel seed extract system on the hormonal and biochemical factors involved in the polycystic ovarian syndrome

There is a renewed interest in the application of chitosan-based drug delivery systems over the last few years. In this study, the ionic gelation method was used to prepare chitosan-engaged tripolyphosphate ions, as the cross-linking molecule, (Chit-TPP) and concurrent loading of the biomolecules of the ethanolic extract of fennel, Foeniculum vulgare, seed (FEC@NBC). The samples were characterized by SEM, DLS, TGA, FTIR, XRD, GC-MS, and zeta potential, and their effects on the related hormonal and biochemical factors of the rats with polycystic ovarian syndrome (PCOS) were assessed. The estradiol valerate-induced PCOS in female rats was confirmed by vaginal smear test and subsequent histological screening. The PCOS-induced rats were treated by fennel seed extract (FSX), Chit-TPP, and FEC@NBC. The process of treatment was monitored by measuring the serum levels of testosterone, luteinizing hormone, follicle-stimulating hormone, insulin, glucose, high-density lipoprotein cholesterol, total cholesterol, and total triglyceride after 16 days of treatment and compared with healthy control and untreated PCOS-control groups. The FEC@NBC administration contributed to the remarkable hormonal, glucose, and lipid profile regulation in the rats with PCOS. The significance of FEC@NBC performance in dealing with PCOS complications compared to that of the only extract could be resulted from the effective targeted delivery and stability of phytomolecules when encapsulated in Chit-TPP.

Arg1201Gln mutation of insulin receptor impairs tyrosine kinase activity and causes insulin resistance: a case report

Type A insulin resistance syndrome (TAIRS) is a rare subtype of congenital insulin resistance (IR), which is characterized by specific clinical manifestations without clear diagnostic criteria and is easily misdiagnosed or overlooked. Herein we present a case of TAIRS with acanthosis nigricans (AN), severe IR, polycystic ovaries, hyperandrogenism and its consequence such as menstrual disturbances, acne and hirsutism. A heterozygous mutation, p.Arg1201Gln, in the insulin receptor (INSR) was detected. This mutation in the tyrosine kinase domain has been described before and shown to impair tyrosine kinase activity and is responsible for IR.

Metabolic syndrome in Iranian adolescents with polycystic ovary syndrome

Background Metabolic syndrome (MS) in adolescents is a risk factor for type 2 diabetes and cardiovascular diseases. Objective The present study aimed to determine the prevalence of MS in 14-18-year-old girls. Methods This analytical case-control study was conducted on 3200 high school students with polycystic ovarian syndrome (PCOS). PCOS was confirmed by an endocrinologist after detection of clinical hyperandrogenism (acne, hirsutism and alopecia) and oligomenorrhea, rejection of hypothyroidism and hyperprolactinemia and performance of abdominal sonography. In the second stage, the prevalence of MS was compared between 70 girls with PCOS and 45 healthy girls using the ATPIII, Cooki and Ferranti scales. The study data were collected using a demographic questionnaire, body mass index (BMI) graph, the WC graph and standard blood pressure graph in adolescents. Then, the data were analyzed using the t-test and the χ2-test. Results Based on the Ferranti scale, the prevalence of MS was 10.4% and 0% in the case and control groups, respectively. The highest prevalence was related to hyperandrogenism and polycystic ovaries phenotype (11.6% vs. 0%, p = 0.05). Based on the Cooki and ATPIII scales, the prevalence of this disorder was 4.1% in the case group and 0.67% in the control group, with the highest rate being related to hyperandrogenism, oligomenorrhea and polycystic ovaries phenotype (7.5% vs. 0%, p = 0.28). Conclusion In comparison to the control group, the prevalence of MS in the patients with PCOS was 10-fold higher according to the Ferranti scale and nearly 3.5-fold higher based on the Cooki and ATPIII scales. Thus, long-term follow-up is suggested in these patients.

Myo-Inositol in the Treatment of Teenagers Affected by PCOS

Objective. To compare the effectiveness of myo-inositol (MI) and oral contraceptive pills (OCPs) in monotherapy and MI in combination with OCPs in the treatment of teenagers affected by polycystic ovary syndrome (PCOS). Methods. 61 adolescent girls aged 13-19 years, with PCOS, were involved in the prospective, open-label study. Patients were randomized into three groups: I group, 20 patients receiving drospirenone 3 mg/ethinyl estradiol 30 μg; II group, 20 patients receiving 4 g myo-inositol plus 400 mg folic acid; III group, 21 patients receiving both medications. Results. After receiving MI significant reduction in weight, BMI, glucose, C-peptide, insulin, HOMA-IR, FT, and LH was detected. The levels of SHBG, TT, FAI, DHEA-S, and AMH did not change statistically significantly. After receiving OCPs weight and BMI slightly increased, but metabolic parameters did not change. Combination of MI and OCPs did not change weight and BMI, but reduction in C-peptide, insulin, and HOMA-IR was detected. TT, FT, FAI, DHEA-S, LH, and AMH levels decreased and SHBG increased. Conclusions. Administration of MI is a safe and effective method to prevent and correct metabolic disorders in teenagers affected by PCOS. With combination of MI and OCPs antiandrogenic effects are enhanced, negative impact of OCPs on weight gain is balanced, and metabolic profile is improved.

Features of Polycystic Ovary Syndrome in adolescence

RATIONALE

To elucidate the prepubertal risk factors associated with the development of Polycystic Ovary Syndrome (PCOS) and determine the special clinical manifestations of the syndrome in this transitional time of a woman's life.

OBJECTIVE

To propose therapeutic targets and regimens, not only to prevent the long-term complications of the syndrome, but also to improve the self-esteem of a young girl who matures into womanhood.

METHODS AND RESULTS

A systematic review of literature was performed through electronic database searches (Pubmed, Medline and Embase). Studies published in English-language, peer-reviewed journals from 1996 to 2013 were included. The selected studies focused on the risk factors, the unique features and treatment options of the PCOS in puberty. The pathogenesis of the PCOS was hypothesized to be based on interactions between genetic and certain environmental factors. The diagnosis was usually difficult in young girls. The syndrome was related to a greater risk of future infertility, type II diabetes mellitus, the metabolic syndrome and cardiovascular disease. Early treatment was crucial to prevent the long-term complications of the syndrome, especially infertility and cardiovascular disease.

DISCUSSION

The recognition of the early signs of PCOS during or even before adolescence is of great importance. It is essential to establish the correct diagnosis for PCOS and rule out other causes of androgen excess in young women with hyperandrogenism. The type of treatment applied should be considered on an individual basis.

ABBREVIATIONS

PCOS = Polycystic Ovary Syndrome.

Association between circulating adiponectin levels and polycystic ovarian syndrome

Background

Low adiponectin levels in polycystic ovarian syndrome (PCOS) have been largely attributed to obesity which is common among these patients. In addition, evidence also suggests that low adiponectin in PCOS may be related to insulin resistance (IR) in these women. However, studies on the role of adiponectin in younger and lean patients are limited. Therefore, the aim of the present study was to examine the association of adiponectin levels in young and lean women with PCOS.

Methods

A case–control study was conducted at the Dow University of Health Sciences, Karachi, Pakistan. Cases were 75 patients of PCOS with Body Mass Index (BMI) &23 aged 16–35 years and 75 healthy age and BMI matched controls were selected from family and friends of the cases. Demographic details, family history and past medical history were obtained through interview by a physician. Anthropometric measurements included weight and height of the participants. Fasting glucose, total cholesterol, high-density lipoprotein (HDL), insulin, adiponectin, and androgen levels were determined. IR was calculated using homeostasis model assessment for insulin resistance (HOMA-IR). Logistic regression models were used to assess the association between adiponectin and PCOS after adjusting for co-variates.

Results

On multivariable analysis, PCOS cases were 3.2 times more likely to have low adiponectin level (OR = 3.2, 95% CI 1.49-6.90, p-value 0.003) compared to the controls after adjustment for age, BMI, family history, marital status, total cholesterol, HDL level and IR. Females with a family history of PCOS were significantly more likely to have lower adiponectin (OR = 3.32, 95% CI 1.27-8.67, p-value 0.014) compared to those who did not have a family history of PCOS. The associations of IR and family history with low adiponectin level also remained statistically significant after adjustments for covariates.

Conclusion

Serum adiponectin levels are independently associated with PCOS and are only partly explained by IR. Adiponectin level may serve as a potential independent biomarker for diagnosis of PCOS in young and lean women with fewer symptoms, or women with a family history of PCOS.

Diagnosis and treatment of polycystic ovarian syndrome in adolescents

PURPOSE OF REVIEW

To review what is understood about the pathophysiology of polycystic ovarian syndrome (PCOS), the diagnostic challenges of PCOS in adolescent women, associated risk factors, as well as the best evidence-based treatment options for adolescence.

RECENT FINDINGS

Diagnosing PCOS in adolescents requires a unique set of criteria for which no single marker currently exists. Adolescents at high risk for developing the syndrome are congenital virilization, low birth weight, premature pubarche, central precocious puberty, large for gestational age girls born to overweight mothers, obesity syndromes, insulin-resistant features, and girls born to parents with PCOS, central obesity, or diabetes in whom PCOS ought to be suspected when associated with irregular menses. Insulin, hyperandrogenemia, and adipocytokines are integral players in the pathophysiology of PCOS. PCOS may be an inheritable trait; however, no gene has yet been identified. Quality of life remains a concern for young women with PCOS. Lifestyle modifications geared to prevent long-term sequelae remain the first-line treatment in conjunction with oral contraceptive pills.

SUMMARY

Identifying PCOS in adolescents remains a diagnostic dilemma, but early intervention and treatment can improve long-term health.

Health-related quality of life among adolescents with polycystic ovary syndrome

OBJECTIVE

To explore health-related quality of life (HRQoL) among adolescents with polycystic ovary syndrome (PCOS).

DESIGN

Qualitative study.

SETTING

Two out-patient gynecology clinics in Yorkshire, England.

PARTICIPANTS

Fifteen young women diagnosed with PCOS were recruited.

METHODS

Semistructured interviews were carried out, transcribed verbatim, and subjected to thematic analysis using NVivo software version 2.0.

RESULTS

A few areas were identified where PCOS had a positive impact upon HRQoL (e.g., improved relationships). However, overall the condition had a negative impact upon HRQoL. Weight problems (in particular the difficulties associated with managing/maintaining weight) and body perceptions appeared to be the most significant contributors to a reduced HRQoL. Menstrual dysfunction, fertility issues, and hirsutism also had adverse affects on emotional well-being, self-perception (including poor body image, self-consciousness, & low self-esteem), social functioning, and sexual behavior. A number of participants described receiving insufficient information from health care professionals (HCPs) and negative experiences in relation to the diagnosis and management of their condition.

CONCLUSION

Overall, PCOS has a negative impact on the HR QoL of adolescent girls with the condition. Emotional and social functioning appeared to be most affected rather than areas of physical functioning. Future research is needed to identify ways to improve communication between adolescents with PCOS and their HCPs, particularly around the diagnosis and potential for infertility. Finally, HCPs need to be more aware of the emotional impact of PCOS upon adolescents' HRQoL and of the potential for poor sexual health through risk-taking behaviors that may occur due to the potential loss of fertility.