ORIGINAL ARTICLE Reproductive endocrinology. Submitted on February 15, 2013; resubmitted on May 15, 2013; accepted on May 20, 2013
|
|
- Iris Johnston
- 5 years ago
- Views:
Transcription
1 Human Reproduction, Vol.28, No.9 pp , 2013 Advanced Access publication on June 11, 2013 doi: /humrep/det255 ORIGINAL ARTICLE Reproductive endocrinology Assessment of glucose metabolism in polycystic ovary syndrome: HbA1c or fasting glucose compared with the oral glucose tolerance test as a screening method E. Lerchbaum 1, *, V. Schwetz 1, A. Giuliani 2, and B. Obermayer-Pietsch 1 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria 2 Department of Gynaecology and Obstetrics, Medical University of Graz, 8036 Graz, Austria *Correspondence address. Tel: ; Fax: ; elisabeth.lerchbaum@medunigraz.at Submitted on February 15, 2013; resubmitted on May 15, 2013; accepted on May 20, 2013 studyquestion: Are HbA1c and fasting glucose (FG) useful in predicting the presence of prediabetes and type 2 diabetes (T2DM) in a large cohort of women with polycystic ovary syndrome (PCOS)? summaryanswer: HbA1c and FGarenot suitable as screening tools for prediabetes in a large cohort of PCOS women but do showa good level of agreement with T2DM. what is known already: Women with PCOS have an increased risk of prediabetes and T2DM. As performing an oral glucose tolerance test (OGTT) is time consuming, HbA1c and FG have been suggested as screening tools for prediabetes and T2DM. study design, size, duration: This was a cross-sectional study of 671 women with PCOS conducted from 2006 to participants/materials, setting, methods: The study was carried out at the endocrinological outpatient department of the Medical University of Graz, Austria. We performed 75 g 2-h OGTTs and measured HbA1c in 671 women with PCOS aged years with a median BMI of 24.2 ( ) kg/m 2. PCOS was defined according to the Rotterdam criteria. Prediabetes (FG mg/dl and/or 2-h glucose mg/dl and/or HbA1c %) and T2DM (FG 126 mg/dl and/or 2-h glucose 200 mg/dl and/or HbA1c 6.5%) were diagnosed according to the American Diabetes Association (ADA) criteria. Levels of agreement between different definitions were analyzed using k-index. main results and the role of chance: According to the ADA criteria, we found prediabetes and T2DM in 12.8% (n ¼ 76) and 1.5% (n ¼ 9) of PCOS women, respectively. When using elevated HbA1c ( %) for defining prediabetes, 19 (3.2%) of all PCOS women had prediabetes with a k-index of When using elevated FG ( mg/dl) for defining prediabetes, 31 (5.2%) of all the PCOS women were diagnosed with prediabetes with a k-index of Further, elevated HbA1c ( 6.5% defining T2DM) was found in six (0.9%) PCOS women (k-index 0.80), and elevated FG ( 126 mg/dl diagnosing T2DM) was found in seven PCOS women (1%; k-index 0.82). limitations, reasons for caution: Our results are limited to an Austrian cohort of PCOS women diagnosed by Rotterdam criteria with a median BMI in the normal weight range. wider implications of the findings: Our results are in line with results from previous smaller PCOS cohorts. Our findings do not support the recommendation that FG or HbA1c can be used for the screening of prediabetes in women with PCOS. For such women, OGTT should be performed for screening of prediabetes. Whether this finding is generalizable to other cohorts remains to be determined in further studies. study funding/competing interest(s): The authors declare no study funding and no competing interests. trial registration number: Not applicable. Key words: polycystic ovary syndrome / oral glucose tolerance test / prediabetes / type 2 diabetes / HbA1c & The Author Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please journals.permissions@oup.com
2 2538 Lerchbaum et al. Introduction Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders with a prevalence of 20% when the Rotterdam criteria (Yildiz et al., 2012) are used. PCOS is characterized by increased ovarian and adrenal androgen secretion, hyperandrogenic symptoms, menstrual irregularity and polycystic ovaries (Ehrmann, 2005). Although the pathophysiology of PCOS is not fully understood, insulin resistance and obesity, central obesity in particular, seem to play a key role in the development of PCOS (Gambineri et al., 2002; Ehrmann, 2005). The tendency to accumulate body fat in intra-abdominal fat stores, which is frequently observed in PCOS, is linked to an increased risk of type 2 diabetes (T2DM) and cardiovascular disease (Williams, 2004). Because insulin resistance and central obesity are associated with an increased risk of prediabetes and T2DM (Wehr et al., 2011; Lerchbaum et al., 2013), screening of all PCOS women using a 2-h oral glucose tolerance test (OGTT) was recommended by the Androgen Excess Society (AES) in 2007 (Salley et al., 2007). A more recent consensus statement by the AES (2010) recommends the performance of a 2-h OGTT only in obese (BMI. 30 kg/m 2 ) or in lean/overweight PCOS women with at least one additional risk factor such as a personal history of gestational diabetes (GDM), a family history of T2DM or advanced age (.40 years; Wild et al., 2010). This approach might seem reasonable due to the fact that an OGTT is time-consuming and difficult to perform in all affected women considering the high prevalence of PCOS. Recently, the American Diabetes Association (ADA) suggested that hemoglobin A1c (HbA1C) and fasting glucose (FG) are as appropriate as a 75 g 2-h OGTT to screen for T2DM or prediabetes (American Diabetes Association, 2013). However, FG has been classified as an insufficient screening tool in a recent systematic review on previous small studies in PCOS women (Tomlinson et al., 2010). HbA1c might be considered a screening tool due to its advantages over FG and OGTT such as greater convenience (fasting is not required) and less day-to-day variability during periods of stress or illness. Recently, Celik et al. (2013) investigated a cohort including 252 Turkish women with PCOS and reported that HbA1c is not a reliable screening tool in PCOS women for detecting prediabetes. To our knowledge, to date there is no study of the utility of HbA1c or FG versus OGTT in detecting prediabetes and T2DM in central European cohorts. Thus, we aimed to examine the utility of HbA1c and FG in estimating the risk of prediabetes and T2DM in a large cohort including 671 PCOS women from Austria diagnosed with the Rotterdam criteria. Further, we evaluated the prevalence of prediabetes and T2DM in PCOS women according to BMI and the prevalence of additional risk factors as suggested by the AES in 2010 (Wild et al., 2010). Materials and Methods Subjects The study cohort consisted of 671 women with PCOS, aged years who were routinely referred to our outpatient clinic for PCOS evaluation from 2006 to We included consecutive patients who fulfilled all of the inclusion criteria and none of the study exclusion criteria. Written informed consent was obtained from each woman before study entry. The women with PCOS consulted our outpatient clinic for PCOS-related symptoms such as hirsutism, acne, obesity, infertility or menstrual irregularities. PCOS was diagnosed using the Rotterdam criteria (The Rotterdam ESHRE/ASRM-Sponsored consensus workshop group, 2004) in order to obtain a large and broad cohort of PCOS women. Two out of the following three characteristics are required to confirm the diagnosis: clinical and/or biochemical signs of hyperandrogenism, oligo- and/or anovulation, polycystic ovaries (by ultrasound). Hyperandrogenism was defined by the clinical presence of hirsutism (modified Ferriman Gallwey score 6), acne or alopecia and/or elevated androgen levels (normal range of total testosterone:,0.77 ng/ml, free testosterone:,0.013 ng/ml and DHEAS:,2.75 mg/ ml). Oligo- and/or anovulation were defined by the presence of oligomenorrhea or amenorrhea. Polycystic ovarian morphology was examined by ultrasound. Polycystic ovaries were defined as the presence of 12 or more follicles in each ovary measuring 2 9 mm in diameter and/or increased ovarian volume (.10 ml; calculated using the formula 0.5 length width thickness; The Rotterdam ESHRE/ASRM-Sponsored consensus workshop group, 2004). Hyperprolactinemia, Cushing s syndrome, congenital adrenal hyperplasia and androgen-secreting tumors were excluded by specific laboratory analyses [prolactin, cortisol, adrenocorticotropic hormone (ACTH), 17alpha-OH progesterone]. PCOS women did not take any medication known to affect endocrine parameters, carbohydrate metabolism or serum lipid profile for at least 3 months before entering the study. Ethical approval The study protocol was approved by the ethics committee of the Medical University of Graz and written informed consent was obtained from each patient. Procedures Standard anthropometric data [height, weight, waist circumference (WC), hip circumference (HC), blood pressure] were obtained from each subject. WC was measured in a standing position midway between the lower costal margin and the iliac crest. HC was measured in a standing position at the maximum circumference over the buttocks. The BMI was calculated as the weight in kilograms divided by the square of the height in meters. Hirsutism was quantified with the modified Ferriman Gallwey score. Moreover, basal blood samples for assays of hormones [total testosterone, sex hormone-binding globulin (SHBG), androstenedione, DHEAS, ft3, ft4, TSH, 17alpha-OH progesterone, prolactin, cortisol, ACTH], glucose, HbA1c and serum lipids were collected between 8.00 and 9.00 a.m. after an overnight fast. Assays were performed in the same laboratory as where they came in and laboratory kits and the assays did not change between 2006 and Total testosterone and SHBG were measured on a daily basis (assays were run concurrently on the same day) and stored at 48C until analysis. Free testosterone values were calculated from total testosterone, SHBG and albumin according to Vermeulen (1999). The free androgen index (FAI) was calculated as total testosterone (nmol/l)/shbg (nmol/l) * 100. All the participants underwent a fasting 75 g OGTT. Blood samples were drawn after 30, 60 and 120 min for glucose determination. Data on HbA1c were available for 612 PCOS women. Normal weight was defined as BMI, 25 kg/m 2 and overweight/obesity as BMI 25 kg/m 2. Prediabetes and T2DM were defined according to the ADA (American Diabetes Association, 2013) as follows: Prediabetes: FG mg/dl and/or 2-h glucose during 75 g OGTT between 140 mg/ dl-199 mg/dl and/or HbA1c %; T2DM: FG 126 mg/dl and/or 2 h glucose during 75 g OGTT 200 mg/dl and/or HbA1c 6.5%. Further, PCOS women were stratified according to the prevalence of risk factors suggested by the AES 2010 (Wild et al., 2010) into two groups: no risk factors or at least one risk factor (BMI. 30 kg/m 2 and/or personal history of GDM and/or family history of T2DM and/or advanced age.40 years).
3 HbA1c, FG and OGTT as screening methods in PCOS 2539 Biochemical analyses Total testosterone and prolactin, TSH, ft3, ft4 and cortisol (Siemens, Erlangen, Germany) were measured by luminescence immunoassay. Intra- and inter-assay coefficients of variation (CVs) for total testosterone measurements were 6.2 and 4.7%, respectively. SHBG was measured by luminescence immunoassay (Roche, Basel, Switzerland) with an intra- and inter-assay CV of 1.3 and 2.1%, respectively. Albumin was measured by photometric assay (Roche, Vienna, Austria). DHEAS (LDN Labor Diagnostika Nord GmbH, Nordhorn, Germany), androstenedione and 17a-OH progesterone (DiaMetra, BioVendor, Brno, Czech Republic) were measured by ELISA with intra- and inter-assay CVs of,10%. Hypotheses The hypothesis of our study is that HbA1c and FG are as suitable as a 75 g OGTT in estimating the risk of prediabetes and T2DM in PCOS women. Further, we evaluate the prevalence of prediabetes and T2DM in PCOS women according to BMI and the prevalence of additional risk factors as suggested by the AES in 2010 (Wild et al., 2010). Statistical analyses Data are presented as median with interquartile range unless otherwise stated. The distribution of data was analyzed by descriptive statistics and the Kolmogorov Smirnov test. All parameters were found to be nonnormally distributed. The Kruskal Wallis test, Mann Whitney U-test and x 2 test were used for comparisons between groups. To evaluate whether HbA1c and FG are as suitable as OGTT in detecting prediabetes and T2DM, we used k-statistics. Levels of agreement between the different definitions of prediabetes and T2DM were analyzed using sensitivity, specificity and the k-index, which is considered excellent for values.0.80, good for values , moderate for values between 0.41 and 0.60, fair for values between 0.21 and 0.40 and weak for levels All statistical procedures were performed with SPSS version 20 (SPSS Inc., Chicago, IL, USA). A P-value of,0.05 was considered statistically significant. Results The baseline characteristics of PCOS women according to their glucose tolerance are presented in Table I. As expected, women with prediabetes or T2DM had a higher prevalence of (central) obesity, higher blood pressure and an adverse lipid profile compared with PCOS women with normal glucose tolerance. Further, women with T2DM had significantly higher FAI and free testosterone levels and lower SHBG levels than women with normal glucose tolerance or prediabetes. Testosterone levels were significantly higher in women with T2DM than in women with normal glucose tolerance, and SHBG levels were significantly lower in women with prediabetes or T2DM than in women with normal glucose tolerance. Overweight/obesity was found in 55.6% of PCOS women. Data on the prevalence of prediabetes and T2DM according to the ADA criteria (American Diabetes Association, 2013) and elevated HbA1c and FG levels stratified by BMI status as well as hyperandrogenism are shown in Table II. We present data on sensitivity, specificity and level of agreement of prediabetes and T2DM diagnosed by the ADA criteria (elevated FG and/or 2-h glucose and/or HbA1c) and HbA1c elevation alone in Table III. In PCOS women with prevalent T2DM, we found a good level of agreement, whereas the level of agreement of elevated HbA1c in women with prediabetes was poor. We reanalyzed our data comparing elevated HbA1c with elevated FG and/or 2 h glucose for definition of prediabetes and T2DM and found similar results (data not shown). Table IV shows sensitivity, specificity and levels of agreement of elevated FG alone with prediabetes and T2DM. When comparing elevated FG alone with the ADA definition of prediabetes and T2DM, we found again good levels of agreement when diagnosing T2DM and very poor k-indices when analyzing prediabetes. When prediabetes and T2DM were defined by elevated FG and/or 2 h glucose and compared with FG elevation alone, we found a good level of agreement with prediabetes and an excellent k-index for T2DM (data not shown). We found at least one AES risk factor (Wild et al., 2010) in 51.7% of all PCOS women. In women with prediabetes (according to the ADA criteria), 69.6% had at least one risk factor and 30.4% had no risk factor (P ¼ 0.001; k ¼ 0.10).InwomenwithT2DM(accordingtotheADA criteria), 75% had at least one risk factor and 25% had no risk factor (P ¼ 0.183, k ¼ 0.01). Discussion We present evidence that HbA1c and FG are not suitable as screening tools for prediabetes in a large cohort of PCOS women. In contrast, when evaluating T2DM, HbA1c and FG were both suitable screening tools showing a good level of agreement. Further, the performance of OGTT only in PCOS women with obesity or at least one risk factor as suggested by the AES (Wild et al., 2010) would also underestimate the prevalence of prediabetes and T2DM. We want to stress that it is very important to detect a disturbed glucose metabolism at an early stage in these young women in order to start lifestyle intervention and/or metformin treatment as soon as possible in order to prevent the progression to T2DM. HbA1c is a commonly used marker of chronic glycemia, and it reflects the average blood glucose levels over a 2 3-month period. HbA1c has been suggested as a screening tool by the ADA (American Diabetes Association, 2013) due to its advantages over FG and OGTT such as greater convenience (fasting is not required) and less day-to-day variability during periods of stress or illness. Our findings suggest, however, that HbA1c is an inappropriate screening tool in women with PCOS, in particular regarding the detection of prediabetes. Our findings are in line with a previous smaller study of 252 PCOS women from Turkey showing that HbA1c is an insufficient screening tool for women with PCOS (Celik et al., 2013). Our data further suggest that FG is an insufficient screening tool for prediabetes but shows good agreement with T2DM. Previously, it has been shown that FG rather than OGTT underestimates the prevalence of T2DM in PCOS by.50% (Legro et al., 1999). In that study, 3.2% of women were diagnosed with T2DM compared with 7.5% using the OGTT criteria. We have, however, to acknowledge that in our Austrian cohort, T2DM prevalence was relatively low, which might, at least in part, explain those differences. As the majority of PCOS women who are affected by a disturbed glucose metabolism present with prediabetes and not with T2DM, our data suggest that FG is an insufficient screening test, which is in linewith the conclusion of a recent systematic review conducted in 2010 (Tomlinson et al., 2010). One possible explanation for the failure of FG as a screening tool might be the fact that insulin secretory defects have been suggested to be present in PCOS (Holte et al., 1994), and this may explain why
4 Table I Baseline characteristics of PCOS women according to their glucose status according to the ADA definition (normal versus prediabetes versus T2DM). All women (n 5 603) Normal glucose tolerance Prediabetes (n 5 76) T2DM (n 5 9) P-value (Kruskal Wallis (n 5 518) test) Median Interquartile range Median Interquartile range Median Interquartile range Median Interquartile range... Age (years) BMI (kg/m 2 ) * **, ***,0.001 WC (cm) * **, ***,0.001 HC (cm) * **, *** Waist-to-hip ratio * **, ***,0.001 Systolic blood pressure (mmhg) * **, *** Diastolic blood pressure (mmhg) * **,0.001 FG (mg/dl) * **, ***, h glucose (mg/dl) * **, ***,0.001 HbA1c (%) * **, ***,0.001 Total cholesterol (mg/dl) **, *** LDL cholesterol (mg/dl) **, *** Total cholesterol/hdl ratio * **, ***,0.001 HDL (mg/dl) * **,0.001 Triglycerides (mg/dl) * **, ***,0.001 Triglycerides/HDL ratio * **, ***,0.001 Total testosterone (ng/ml) ** SHBG (nmol/l) * **, ***,0.001 Free testosterone (ng/ml) **, *** FAI **, *** 0.06 Biochemical hyperandrogenism a (%) *** Clinical hyperandrogenism (%) *** Menstrual irregularities (%) **, *** Polycystic ovaries (%) Obesity (BMI.30 kg/m 2 ) (%) * 77.8**, *** Family history of T2DM (%) * 44.4 Personal history of GDM (%) * 0 Age.40 years (%) Differences between groups were calculated by the Kruskal Wallis test, Mann Whitney U test or x 2 -test. ADA, American DiabetesAssociation; PCOS, polycysticovarysyndrome; T2DM, type2diabetes; LDL, low-densitylipoproteincholesterol; HDL, high-densitylipoproteincholesterol; SHBG, sexhormone-binding globulin; FAI, freeandrogenindex; GDM, gestational diabetes; FG, fasting glucose; WC, waist circumference; HC, hip circumference. *P, 0.05 for prediabetes versus normal glucose tolerance. ** P, 0.05 for T2DM versus normal glucose tolerance. *** P, 0.05 for prediabetes versus T2DM. a Elevated total testosterone and/or free testosterone and/or DHEAS (dehydroepiandrosterone) Lerchbaum et al. Downloaded from at Pennsylvania State University on February 20, 2016
5 HbA1c, FG and OGTT as screening methods in PCOS 2541 Table II Prevalence of prediabetes and T2DM in PCOS women stratified by BMI and hyperandrogenism. Overweight/ obese 1 hyperandrogenism Clinical hyperandrogenism Biochemical hyperandrogenism Overweight/obese (BMI 25 kg/m 2 ) All women Normal weight (BMI < 25 kg/m 2 )... Prediabetes 76 (12.8%) 24 (7.2%) 52 (19.4%) 32 (12.9%) 43 (12.6%) 35 (20.3%) Elevated HbA1c ( %) 19 (3.2%) 1 (0.3%) 18 (6.7%) 13 (5.2%) 9 (2.6%) 11 (6.4%) Elevated FG ( mg/dl) 31 (5.2%) 12 (3.6%) 19 (7.1%) 15 (6.0%) 23 (6.6%) 17 (9.7%) T2DM 9 (1.5%) 0 9 (3.2%) 6 (2.3%) 5 (1.4%) 6 (4.5%) Elevated HbA1c ( 6.5%) 6 (0.9%) 0 6 (2.1%) 4 (1.5%) 4 (1.1%) 4 (2.9%) Elevated FG ( 126 mg/dl) 7 (1%) 0 7 (2.5%) 4 (1.4%) 5 (1.3%) 4 (2.7%) Prediabetes and T2DM were defined according to the ADA criteria (American Diabetes Association, 2013). Biochemical hyperandrogenism was defined as elevated total testosterone and/or free testosterone and/or DHEAS (dehydroepiandrosterone). T2DM, type 2 diabetes; PCOS, polycystic ovary syndrome; FG, fasting glucose. postprandial glucose rather than FG is more indicative of prediabetes risk. This notion is supported by the fact that several studies report normal FG levels despite elevated postprandial glucose levels in PCOS women (reviewed by Tomlinson et al. (2010)). Further, it has been suggested that HbA1c and glucose levels reflect different aspects of glucose metabolism (Cowie et al., 2010) and the respective contribution of preprandial and postprandial glucose alterations to the HbA1c levels is controversial. Indeed, HbA1c has been shown to underestimate T2DM risk not only in women with PCOS (Celik et al., 2013) but also in non-pcos populations such as NHANES (Cowie et al., 2010). Further, HbA1c has been shown to have low sensitivity when screening women after delivery with previous GDM (Picón et al., 2012). The ADA recommendation suggesting that a 75 g 2-h OGTT, FG or HbA1c can be used for the screening for prediabetes and T2DM (American Diabetes Association, 2013) is in contrast to the AES guidelines from 2007 (Salley et al., 2007). In those PCOS-specific guidelines, performing an OGTT is recommended in all PCOS women, which is highly supported by our data. T2DM is a major risk factor for cardiovascular disease in women (Huxley et al., 2006). As women with PCOS have an increased prevalence of cardiovascular risk factors and probably a consequent high risk of cardiovascular disease (Wild et al., 2010), early detection and treatment of prediabetes is of high importance. Moreover, it has been shown that a high percentage of PCOS women with prediabetes and without adequate treatment will develop T2DM in the following few years (Tomlinson et al., 2010). In women with PCOS, the annual progression rate to T2DM has been found to be 2 3% (Legro et al., 1999; Norman et al., 2001). In 2010, a consensus statement by the AES recommended that a 2-h OGTT should be performed in PCOS women with a BMI of.30 kg/m 2, or alternatively in lean or overweight PCOS women with advanced age (.40 year), a personal history of GDM or a family history of T2DM (Wild et al., 2010). We found a significant difference in the prevalence of obesity, a personal history of GDM and in family history of T2DM between women with normal glucose tolerance and prediabetes or T2DM and no significant difference regarding age. Nevertheless, in our study, 30.4% of PCOS women with prediabetes and 25.0% of PCOS women with T2DM had none of the suggested risk factors. Thus, screening only women with at least one risk factor as suggested by the AES 2010 (Wild et al., 2010) would also lead to an underestimation of the prevalence of prediabetes and T2DM. Interestingly, we found significantly higher FAI and free testosterone levels in PCOS women with T2DM compared with PCOS women with prediabetes or normal glucose tolerance. Nevertheless, our results suggest that overweight/obesity seems to be a more important risk factor of prediabetes and T2DM than hyperandrogenism. This notion is supported by the fact that the prevalence of prediabetes and T2DM was similar in women with and without hyperandrogenism. Our data are of high clinical importance as strategies such as lifestyle intervention and metformin use exist to prevent T2DM (Knowler et al., 2002; Tomlinson et al., 2010). The ADA recommends a weight loss of 7% and increasing physical activity to at least 150 min/week of moderate activity (American Diabetes Association, 2013). Lifestyle changes and treatment with metformin both reduced the incidence of T2DM in persons at high risk by 58 and 31%, respectively (Knowler et al., 2002). Although long-term studies of the reduction of T2DM incidence in PCOS by weight reduction are missing, previous short-term
6 2542 Lerchbaum et al. Table III Sensitivity, specificity and level of agreement for prediabetes (elevated FG and/or elevated 2-h glucose and/or elevated HbA1c) and T2DM (elevated FG and/or elevated 2 h glucose and/or elevated HbA1c) with HbA1c elevation alone in PCOS women. Prediabetes... Yes No Sensitivity (%) Specificity (%) k-index P-value... All PCOS HbA1c % Yes ,0.001 No BMI, 25 kg/m 2 HbA1c % Yes ,0.001 No BMI 25 kg/m 2 HbA1c % Yes ,0.001 No T2DM All PCOS women HbA1c 6.5% Yes ,0.001 No Data available for 612 PCOS women. Levels of agreement were analyzed using sensitivity, specificity and the k-index. P-values are given for k-statistics. FG, fasting glucose; T2DM, type 2 diabetes; PCOS, polycystic ovary syndrome. studies suggest that hypocaloric diets and exercise improve parameters of metabolic syndrome (Thomson et al., 2008). Obesity, and central obesity in particular, suggesting intra-abdominal fat accumulation is associated with an increased risk of prediabetes and T2DM (Wehr et al., 2011; Lerchbaum et al., 2013). These findings are supported by our data showing a higher prevalence of prediabetes in overweight/obese women compared with normal weight women and that none of the normal weight had T2DM. Of note, we found prediabetes in 7% of normal weight PCOS women. According to the ADA guidelines, in asymptomatic adults, diabetes screening should be performed only in PCOS women with BMI 25 kg/m 2. As we found prediabetes in 7% of normal weight PCOS women, in those women, their prediabetes would remain undiagnosed. A previous study among specialists in obstetrics and gynecology and in reproductive endocrinology and infertility suggests that 57 71% of PCOS women are screened for T2DM; OGTT was the most common test used for screening (68%), while 8 22% used FG and 19 20% used HbA1c (Abdel-Rahman et al., 2012). Screening frequency in other specialities might be even lower. Considering the high prevalence of prediabetes and T2DM in women with PCOS and the poor performance of FG and HbA1c as well as the risk factors suggested by the AES in 2010 (Wild et al., 2010), the AES 2007 recommendation (Salley et al., 2007) to perform an OGTT in all PCOS women might be considered the best approach. So far, there is no consensus regarding rescreening of PCOS women for glucose disturbances. Some authors (Tomlinson et al., 2010) suggested performing annual OGTTs in women with PCOS and at least one additional risk factor, which might be a reasonable approach. In contrast, the AES suggests that PCOS women with normal glucose tolerance should be rescreened every 2 years or sooner if additional risk factors are identified and those with prediabetes should be screened annually for developing T2DM (Salley et al., 2007; Wild et al., 2010). Our study has limitations that should be noted. First, our findings are restricted to a cohort of young and lean PCOS women and might not be generalizable to other cohorts including older or more obese women. As PCOS was diagnosed according to the Rotterdam criteria, our findings might differ from other PCOS cohorts diagnosed by different criteria (AES or NIH). Of note, the efficacy of screening tools might be different in PCOS cohorts diagnosed by AES or NIH criteria. Further, HbA1c levels were not available for all women. As we have no follow-up data on PCOS women, we cannot answer the question how many PCOS women with currently normal glucose tolerance will develop prediabetes or T2DM in the following years and which risk factors will predict this conversion. The strength of our study is the large sample size and the performance of OGTT in all women. In conclusion, we present evidence from a large cohort of PCOS women that HbA1c and FG are insufficient screening tools for prediabetes. Further, performing OGTT only in PCOS women with risk factors as suggested by the AES in 2010 was not sufficient in our large PCOS cohort. Our data strongly suggest that OGTTs should be
7 HbA1c, FG and OGTT as screening methods in PCOS 2543 Table IV Sensitivity, specificity and level of agreement for prediabetes (elevated FG and/or elevated 2-h glucose and/or elevated HbA1c) and T2DM (elevated FG and/or elevated 2 h glucose and/or elevated HbA1c) with FG elevation alone in PCOS women. Prediabetes... Yes No Sensitivity (%) Specificity (%) k-index P-value... All PCOS women FG mg/dl Yes ,0.001 No BMI,25 kg/m 2 FG mg/dl Yes ,0.001 No BMI 25 kg/m 2 FG mg/dl Yes ,0.001 No T2DM All PCOS women FG 126 mg/dl Yes ,0.001 No Data available for 612 PCOS women. Levels of agreement were analyzed using sensitivity, specificity and the k-index. P-values are given for k-statistics. FG, fasting glucose; T2DM, type 2 diabetes; PCOS, polycystic ovary syndrome. performed in all women with PCOS, which is in line with the 2007 AES recommendation. Acknowledgements The authors have nothing to acknowledge. Authors roles E.L. contributed to study conception and design, acquisition, analysis and interpretation of data and drafting of the article. V.S. contributed to acquisition of data and revising the article critically for important intellectual content. A.G. contributed to study conception, acquisition of data and revising the article critically for important intellectual content. B.O.-P. contributed to study conception and design and revising the article for important intellectual content. All the authors approved the final version of the manuscript. Funding The authors declare no funding. Conflict of interest The authors declare no conflict of interest. References Abdel-Rahman MY, Jackson L, Rodewald KJ, Abdellah MA, Ismail SA, Hurd WW. Polycystic ovary syndrome and diabetes screening: a survey of gynecologists and reproductive endocrinologists. Eur J Obstet Gynecol Reprod Biol 2012;162: American Diabetes Association. Standards of medical care in diabetes Diabetes Care 2013;36:S11 S66. Celik C, Abali R, Bastu E, Tasdemir N, Tasdemir UG, Gul A. Assessment of impaired glucose tolerance prevalence with hemoglobin A1c and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study. Hum Reprod 2013; 28: CowieCC, Rust K, Byrd-Holt DD, GreggEW, Ford ES, Geiss LS, Bainbridge KE, Fradkin JE. Prevalence of diabetes andhigh risk for diabetesusinga1c criteria in the U.S. population in Diabetes Care 2010;33: Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352: Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord 2002;26: Holte J, BerghT, Berne C, BerglundL, Lithell H. Enhanced early insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance. J Clin Endocrinol Metab 1994; 78: Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. Br Med J 2006;332:73 78.
8 2544 Lerchbaum et al. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346: Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84: Lerchbaum E, Schwetz V, Giuliani A, Obermayer-Pietsch B. Hypertriglyceridemic waist is associated with impaired glucose tolerance in polycystic ovary syndrome. Nutr Metab Cardiovasc Dis 2013;23:e15 e16. Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod 2001;16: Picón MJ, Murri M, Muñoz A, Fernández-García JC, Gomez-Huelgas R, Tinahones FJ. Hemoglobin A1c versus oral glucose tolerance test in postpartum diabetes screening. Diabetes Care 2012;35: Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007;92: The Rotterdam ESHRE/ASRM-Sponsored consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19: Thomson RL, Buckley JD, Noakes M, Clifton PM, Norman RJ, Brinkworth GD. The effect of a hypocaloric diet with and without exercise training on body composition, cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2008;93: Tomlinson J, Millward A, Stenhouse E, Pinkney J. Type 2 diabetes and cardiovascular disease in polycystic ovary syndrome: what are the risks and can they be reduced? Diabet Med 2010;27: Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999;84: Wehr E, Gruber HJ, Giuliani A, Möller R, Pieber TR, Obermayer-Pietsch B. The lipid accumulation product is associated with impaired glucose tolerance in PCOS women. J Clin Endocrinol Metab 2011;96:E986 E990. Wild RA CE, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010;95: Williams CM. Lipid metabolism in women. Proc Nutr Soc 2004;63: Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod 2012;27:
Polycystic Ovary Syndrome
International Journal of Advanced Research in Biological Sciences ISSN: 2348-8069 www.ijarbs.com DOI: 10.22192/ijarbs Coden: IJARQG(USA) Volume 5, Issue 7-2018 Research Article DOI: http://dx.doi.org/10.22192/ijarbs.2018.05.07.004
More informationDetermining the insulin resistance rate in Polycystic Ovary Syndrome patients (PCOs)
Abstract: Determining the insulin resistance rate in Polycystic Ovary Syndrome patients (PCOs) Ashraf Olabi, Ghena Alqotini College of medicine, Aleppo University Hospital Obstetrics and Gynacology, Syria.
More informationDiabetes and Cardiovascular Risks in the Polycystic Ovary Syndrome
Diabetes and Cardiovascular Risks in the Polycystic Ovary Syndrome John E. Nestler, M.D. William Branch Porter Professor of Medicine Chair, Department of Internal Medicine Virginia Commonwealth University
More informationMETABOLIC RISK MARKERS IN WOMEN WITH POLYCYSTIC OVARIAN MORPHOLOGY
Vuk Vrhovac University Clinic Dugi dol 4a, HR-10000 Zagreb, Croatia Original Research Article Received: February 18, 2010 Accepted: March 3, 2010 METABOLIC RISK MARKERS IN WOMEN WITH POLYCYSTIC OVARIAN
More informationCREATING A PCOS TREATMENT PLAN. Ricardo Azziz, M.D., M.P.H., M.B.A. Georgia Regents University
CREATING A PCOS TREATMENT PLAN Ricardo Azziz, M.D., M.P.H., M.B.A. Georgia Regents University PCOS: CREATING A TREATMENT PLAN Good treatment plans are based on sound and complete evaluations History of
More informationPolycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018
Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018 Learning Objectives At the conclusion of this lecture, learners should: 1) Know the various diagnostic
More informationPolycystic Ovary Syndrome (PCOS):
Polycystic Ovary Syndrome (PCOS): Current diagnosis and treatment Anatte E. Karmon, MD Disclosures- Anatte Karmon, MD No financial relationships to disclose 2 Objectives At the end of this presentation,
More informationComparative study of metabolic profile of women presenting with polycystic ovary syndrome in relation to body mass index
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Akshaya S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2561-2565 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationPolycystic ovary syndrome
ORIGINAL ARTICLES: REPRODUCTIVE ENDOCRINOLOGY Opposing effects of dehydroepiandrosterone sulfate and free testosterone on metabolic phenotype in women with polycystic ovary syndrome Elisabeth Lerchbaum,
More informationClinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes
POLYCYSTIC OVARY SYNDROME Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes Ettore Guastella, M.D., a Rosa Alba Longo, M.D., b and Enrico Carmina, M.D. b a Department
More informationASSOCIATION OF INSULIN RESISTANCE AND SERUM 25 OH VITAMIN-D IN INDIAN WOMEN WITH POLYCYSTIC OVARY SYNDROME
RESEARCH ARTICLE ASSOCIATION OF INSULIN RESISTANCE AND SERUM 25 OH VITAMIN-D IN INDIAN WOMEN WITH POLYCYSTIC OVARY SYNDROME Amar Nagesh Kumar 1, Jupalle Nagaiah Naidu 2, Uppala Satyanarayana 3, Medabalmi
More informationComparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome
Comparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome William W. Hurd, M.D., M.Sc., M.P.H., a Mohamed Y. Abdel-Rahman, M.D., a,d Salah A. Ismail,
More informationUpdate on Polycystic Ovary Syndrome What Dermatology Nurses and Nurse Practitioners Need to Know
FEATURE ARTICLE Update on Polycystic Ovary Syndrome What Dermatology Nurses and Nurse Practitioners Need to Know Rebecca Carron 2.0 Contact Hours ABSTRACT Purpose: Polycystic ovary syndrome is the most
More informationCase Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation
Polycystic Ovarian Syndrome: Treatment Goals and Options Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes Colorado Center for Health and Wellness University of Colorado School of Medicine
More informationPrevalence of polycystic ovarian syndrome in the Buraimi region of Oman
Original Article Brunei Int Med J. 2012; 8 (5): 248-252 Prevalence of polycystic ovarian syndrome in the Buraimi region of Oman Usha VARGHESE 1 and Shaji VARUGHESE 2, 1 Department of Internal Medicine
More informationStandards of Medical Care in Diabetes Adult/Pediatric Inpatient/Ambulatory Clinical Practice Guideline
Standards of Medical Care in Diabetes Adult/Pediatric Inpatient/Ambulatory Clinical Practice Guideline Note: Active Table of Contents Click to follow link EXECUTIVE SUMMARY... 2 SCOPE... 3 METHODOLOGY...
More informationVitamin D Levels in Women with Polycystic Ovary Syndrome
The 6th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2016), Volume 2016 Conference Paper Vitamin D Levels in Women with Polycystic Ovary Syndrome Elida Sidabutar 1, Binarwan Halim 2,
More information12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman
Polycystic Ovarian Syndrome (PCOS) for the Family Physician Barbara S. Apgar MD, MS Professor or Family Medicine University of Michigan Ann Arbor, Michigan Important references for PCOS Endocrine Society
More informationPolycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks
Polycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks Kate D. Schoyer, M.D. May 6, 2016 Objectives To review how to make the diagnosis of Polycystic Ovarian Syndrome (PCOS)
More informationThe prevalence of polycystic ovary syndrome in Iranian women based on different diagnostic criteria
Prace oryginalne/original papers Endokrynologia Polska/Polish Journal of Endocrinology Tom/Volume 62; Numer/Number 3/2011 ISSN 0423 104X The prevalence of polycystic ovary syndrome in Iranian women based
More informationMetabolic syndrome in females with polycystic ovary syndrome and International Diabetes Federation criteria
doi:10.1111/j.1447-0756.2007.00685.x J. Obstet. Gynaecol. Res. Vol. 34, No. 1: 62 66, February 2008 Metabolic syndrome in females with polycystic ovary syndrome and International Diabetes Federation criteria
More informationRotterdam Criteria 9/30/2017. A Changing Paradigm in PCOS. Polycystic Ovary Syndrome - Is the Cardiometabolic Risk Increased After Menopause?
Disclosure Polycystic Ovary Syndrome - Is the Cardiometabolic Risk Increased After Menopause? Fractyl laboratories, Inc Anuja Dokras, MD., Ph.D. Professor of Obstetrics and Gynecology Director PENN PCOS
More informationDr Stella Milsom. Endocrinologist Fertility Associates Auckland. 12:30-12:40 When Puberty is PCO
Dr Stella Milsom Endocrinologist Fertility Associates Auckland 12:30-12:40 When Puberty is PCO Puberty or Polycystic Ovary Syndrome? Stella Milsom Endocrinologist Auckland DHB, University of Auckland,
More informationROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU)
ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU) In 1935, Stein and Leventhal described 7 women with bilateral enlarged PCO, amenorrhea or irregular menses, infertility and masculinizing
More informationWEIGHT CHANGE AND ANDROGEN LEVELS DURING CONTRACEPTIVE TREATMENT OF WOMEN AFFECTED BY POLYCYSTIC OVARY
ENDOCRINE REGULATIONS, VOL. 40, 119-123, 2006 119 WEIGHT CHANGE AND ANDROGEN LEVELS DURING CONTRACEPTIVE TREATMENT OF WOMEN AFFECTED BY POLYCYSTIC OVARY J. VRBIKOVA, K. DVORAKOVA, M. HILL, L. STARKA Institute
More informationPolycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks. Kate D. Schoyer, M.D. May 6, 2016
Polycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks Kate D. Schoyer, M.D. May 6, 2016 Objectives To review how to make the diagnosis of Polycystic Ovarian Syndrome (PCOS)
More informationWHY NEW DIAGNOSTIC CRITERIA FOR DIFFERENT PCOS PHENOTYPES ARE URGENTLY NEEDED
WHY NEW DIAGNOSTIC CRITERIA FOR DIFFERENT PCOS PHENOTYPES ARE URGENTLY NEEDED Ricardo Azziz, M.D., M.P.H., M.B.A. Chief Officer of Academic Health & Hospital Affairs State University of New York (SUNY)
More informationWhat every dermatologist should know about Polycystic Ovary Syndrome (PCOS)
What every dermatologist should know about Polycystic Ovary Syndrome (PCOS) Kanade Shinkai, MD PhD University of California, San Francisco Associate Professor of Dermatology I have no conflicts of interest
More informationCORRELATION OF OBESITY, INSULIN RESISTANCE AND LIPID PROFILE IN WOMEN WITH PCOS IN KIMS HOSPITAL BANGALORE Shashikala H. Gowda 1, Mansi Dhingra 2
CORRELATION OF OBESITY, INSULIN RESISTANCE AND LIPID PROFILE IN WOMEN WITH PCOS IN KIMS HOSPITAL BANGALORE Shashikala H. Gowda 1, Mansi Dhingra 2 HOW TO CITE THIS ARTICLE: Shashikala H. Gowda, Mansi Dhingra.
More informationIntroduction. Original Article
Iran J Reprod Med Vol. 10. No. 4. pp: 307-314, July 2012 Original Article Correlation of biochemical markers and clinical signs of hyperandrogenism in women with polycystic ovary syndrome (PCOS) and women
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome Kathleen Colleran, MD Professor of Medicine University of New Mexico HSC Presented for COMM-TC May 4, 2012 Objectives Understand the pathophysiology of PCOS Understand how to
More informationCan Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome?
www.ijpm.in www.ijpm.ir Can Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome? Ferdous Mehrabian, Maryam Afghahi Department
More informationClinical Study Hyperandrogenism Does Not Influence Metabolic Parameters in Adolescent Girls with PCOS
International Endocrinology Volume 2012, Article ID 434830, 5 pages doi:10.1155/2012/434830 Clinical Study Hyperandrogenism Does Not Influence Metabolic Parameters in Adolescent Girls with PCOS Kim Forrester-Dumont,
More informationClinical Profile Polycystic Ovarian Syndrome Cases
ORIGINAL RESEARCH www.ijcmr.com - 100 Cases Himabindu Sangabathula 1, Neelima Varaganti 1 ABSTRACT Introduction: Polycystic ovary syndrome (PCOS) is most common endocrine disorders of reproductive age
More informationTitle of Guideline (must include the word Guideline (not protocol, policy, procedure etc)
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Guideline for the Investigation and Management of Polycystic Ovary Syndrome Author: Contact Name and Job Title
More informationEuropean Journal of Endocrinology (2006) ISSN
European Journal of Endocrinology (2006) 154 141 145 ISSN 0804-4643 CLINICAL STUDY Metabolic syndrome in polycystic ovary syndrome (PCOS): lower prevalence in southern Italy than in the USA and the influence
More informationObjectives 1. Be able to describe the classic presentation and diagnostic criteria 2. Be able to explain long-term health concerns associated with the diagnosis 3. Understand what basic treatment options
More informationJMSCR Vol 05 Issue 05 Page May 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i5.14 Hyperinsulinemia in Polycystic Ovary Syndrome
More informationNitasha Garg 1 Harkiran Kaur Khaira. About the Author
https://doi.org/10.1007/s13224-017-1082-4 ORIGINAL ARTICLE A Comparative Study on Quantitative Assessment of Blood Flow and Vascularization in Polycystic Ovary Syndrome Patients and Normal Women Using
More informationX/06/$15.00/0 The Journal of Clinical Endocrinology & Metabolism 91(1):2 6 Copyright 2006 by The Endocrine Society doi: /jc.
0021-972X/06/$15.00/0 The Journal of Clinical Endocrinology & Metabolism 91(1):2 6 Printed in U.S.A. Copyright 2006 by The Endocrine Society doi: 10.1210/jc.2005-1457 EXTENSIVE CLINICAL EXPERIENCE Relative
More informationPolycystic ovary syndrome (PCOS) Polycystic ovary syndrome: Why are women at increased risk of type 2 diabetes? Article.
Article Polycystic ovary syndrome: Why are women at increased risk of type 2 diabetes? Julie Tomlinson Citation: Tomlinson J (2016) Polycystic ovary syndrome: Why are women at increased risk of type 2
More informationPrevalence of Polycystic Ovarian Syndrome among urban adolescent girls and young women in Mumbai
Prevalence of Polycystic Ovarian Syndrome among urban adolescent girls and young women in Mumbai Principal Investigator Co- Investigators Consultant Collaborating Hospital Dr. Beena Joshi Dr. Srabani Mukherji
More informationPOLYCYSTIC OVARIAN SYNDROME Laura Tatpati, MD Reproductive Endocrinology and Infertility. Based on: ACOG No. 108 Oct 2009; reaffirmed 2015
POLYCYSTIC OVARIAN SYNDROME Laura Tatpati, MD Reproductive Endocrinology and Infertility Based on: ACOG No. 108 Oct 2009; reaffirmed 2015 NO DISCLOSURES PATIENT 26 years old presents with complaint of
More informationAmenorrhoea: polycystic ovary syndrome
There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've
More informationPolycystic ovary syndrome
The Role of Polycystic Ovary Syndrome in Reproductive and Metabolic Health: Overview and Approaches for Treatment Carrie C. Dennett 1 and Judy Simon 2,3 1 Northwest Natural Health, Seattle, WA 2 University
More information3. Metformin therapy for PCOS
1. Introduction The key clinical features of polycystic ovary syndrome (PCOS) are hyperandrogenism (hirsutism, acne, alopecia) and menstrual irregularity with associated anovulatory infertility. 1 The
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome Definition: the diagnostic criteria Evidence of hyperandrogenism, biochemical &/or clinical (hirsutism, acne & male pattern baldness). Ovulatory dysfunction; amenorrhoea; oligomenorrhoea
More informationCARDIOVASCULAR RISK FACTORS. Harpal S Randeva. Warwick Medical School University of Warwick, UK
NORDIC FEDERATION OF SOCIETIES OF OBSTETRICS AND GYNAECOLOGY November, 2010 POLYCYSTIC OVARY SYNDROME THROUGH LIFE CARDIOVASCULAR RISK FACTORS Harpal S Randeva Warwick Medical School University of Warwick,
More informationInvestigation of adrenal functions in patients with idiopathic hyperandrogenemia
European Journal of Endocrinology (26) 155 37 311 ISSN 84-4643 CLINICAL STUDY Investigation of adrenal functions in patients with idiopathic hyperandrogenemia Hulusi Atmaca, Fatih Tanriverdi 1, Kursad
More informationThoughts on PCOS Female Androgenization Syndrome FAS
Thoughts on PCOS Female Androgenization Syndrome FAS Stan Korenman, M.D. Distinguished Professor of Medicine-Endocrinology and Associate Dean - Ethics David Geffen School of Medicine at UCLA Conflicts
More informationThe Relation between Diverse Phenotypes of PCOS with Clinical Manifestations, Anthropometric Indices and Metabolic Characteristics
ORIGINAL ARTICLE The Relation between Diverse Phenotypes of PCOS with Clinical Manifestations, Anthropometric Indices and Metabolic Characteristics Seyedeh Hajar Sharami 1, Zahra Abbasi Ranjbar 2, Forozan
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome An Individualized Approach Alice Y. Chang, MD, MSc Assistant Professor Mayo Clinic Division of Endocrinology, Diabetes, Nutrition and Metabolism Learning Objectives: To Individualize
More informationPCOS. Reproductive Gynaecology and Infertility. Dr.Renda Bouzayen MD.FRCSC GREI,OBGYN Dalhousie University
Reproductive Gynaecology and Infertility PCOS Dr.Renda Bouzayen MD.FRCSC GREI,OBGYN Dalhousie University Dr.Hussein Sabban MD. FRCSC PGY6 GREI Dalhousie University Disclosure No conflict of interest Pilot
More informationPolycystic ovary syndrome in Central Australia
Polycystic ovary syndrome in Central Australia Diagnosis and screening of cardiometabolic risk and emotional wellbeing Emma Ellis, Melanie Gibson-Helm, Jacqueline A Boyle Background and objectives Polycystic
More informationORIGINAL ARTICLE Establishing the cut off values of androgen markers in the assessment of polycystic ovarian syndrome
Malaysian J Pathol 2018; 40(1) : 33 39 ORIGINAL ARTICLE Establishing the cut off values of androgen markers in the assessment of polycystic ovarian syndrome R N Dineshinee NADARAJA MBBS, Pavai STHANESHWAR
More informationThe Severity of Menstrual Dysfunction as a Predictor of Insulin Resistance in PCOS
JCEM ONLINE Brief Report Endocrine Research The Severity of Menstrual Dysfunction as a Predictor of Insulin Resistance in PCOS Meredith Brower, Kathleen Brennan, Marita Pall, and Ricardo Azziz Department
More informationMETABOLIC SYNDROME IN REPRODUCTIVE FEMALES
METABOLIC SYNDROME IN REPRODUCTIVE FEMALES John J. Orris, D.O., M.B.A Division Head, Reproductive Endocrinology & Infertility, Main Line Health System Associate Professor, Drexel University College of
More informationPolycystic Ovary Disease: A Common Endocrine Disorder in Women
Polycystic Ovary Disease: A Common Endocrine Disorder in Women Paul Kaplan, M.D. Clinical Professor of Reproductive Endocrinology - OHSU Courtesy Senior Research Associate, Human Physiology University
More informationOverview of Reproductive Endocrinology
Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,
More informationMetabolic Syndrome Among Infertile Women with Polycystic Ovary Syndrome
Med. J. Cairo Univ., Vol. 82, No. 2, September: 75-79, 2014 www.medicaljournalofcairouniversity.net Metabolic Syndrome Among Infertile Women with Polycystic Ovary Syndrome HANY AYASH, M.D.* and AMRO ABO
More information16 YEAR-OLD OBESE FEMALE WITH OLIGOMENORRHEA
16 YEAR-OLD OBESE FEMALE WITH OLIGOMENORRHEA Katie O Sullivan, MD Adult/Pediatric Endocrinology Fellow University of Chicago ENDORAMA Thursday, September 4th, 2014 Disclosures No financial interests. Will
More informationStudy on the Prevalence and Characteristics of Metabolic Syndrome in Women of Reproductive Age Group with Polycystic Ovarian Syndrome
Research ARTICLE Study on the Prevalence and Characteristics 10.5005/jp-journals-10006-1526 of Syndrome in Women Study on the Prevalence and Characteristics of Syndrome in Women of Reproductive Age Group
More informationThe Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 63-69
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (1), Page 63-69 Effect of Metformin Only versus Effect of Metformin and Corticosteroids after Laparoscopic Ovarian Drilling on Ovulation
More informationPolycystic ovary syndrome, or PCOS,
PART 2 OF A 4-PART E-SERIES Polycystic ovary syndrome: How are obesity and insulin resistance involved? Which of my patients with PCOS do I screen for insulin sensitivity? What screening tests are available,
More informationPolycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners. M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017
Polycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017 Case of S.R. S.R. is a 39 year old female referred for suspected obstructive
More informationCOMPARISION OF MYO-INOSITOL VERSUS METFORMIN ON ANTHROPOMETRIC PARAMETERS IN POLYCYSTIC OVARIAN SYNDROME IN WOMEN
International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 9, Issue 4, 2017 COMPARISION OF MYO-INOSITOL VERSUS METFORMIN ON ANTHROPOMETRIC PARAMETERS IN POLYCYSTIC OVARIAN SYNDROME
More informationJMSCR Vol 05 Issue 04 Page April 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i4.228 Study of Cutaneous Manifestations of
More informationPCOS Awareness Symposium Atlanta September 24 th, Preventing Diabetes & Cardiovascular Disease in PCOS
PCOS Awareness Symposium Atlanta September 24 th, 2016 Preventing Diabetes & Cardiovascular Disease in PCOS Katherine Sherif, MD Professor & Vice Chair, Department of Medicine Director, Jefferson Women
More informationResearch. Suitability of recommended limits for fasting glucose tests in women with polycystic ovary syndrome
Suitability of recommended limits for fasting glucose tests in women with polycystic ovary syndrome Claudia Gagnon, Jean-Patrice Baillargeon @ See related article page 951 DOI:10.1503/cmaj.060607 Abstract
More informationClinical and biochemical presentation of polycystic ovary syndrome in women between the ages of 20 and 40
Human Reproduction, Vol.26, No.12 pp. 3443 3449, 2011 Advanced Access publication on September 16, 2011 doi:10.1093/humrep/der302 ORIGINAL ARTICLE Reproductive endocrinology Clinical and biochemical presentation
More informationMetfornim and Pioglitazone in polycystic ovarian syndrome: A comparative study
Original Research Article Metfornim and Pioglitazone in polycystic ovarian syndrome: A comparative study Allanki Suneetha Devi 1, Jalem Anuradha 2* 1 Associate Professor, Department of Obstetrics and Gynecology,
More informationUNDERSTANDING PCOS AND ITS DIAGNOSIS
UNDERSTANDING PCOS AND ITS DIAGNOSIS Anuja Dokras MD, PhD Director PENN PCOS CENTER President, AE-PCOS Society Professor of Obstetrics & Gynecology University of Pennsylvania, Philadelphia, USA is an international
More informationChanges and clinical significance of serum vaspin levels in patients with type 2 diabetes
Changes and clinical significance of serum vaspin levels in patients with type 2 diabetes L. Yang*, S.J. Chen*, G.Y. Yuan, D. Wang and J.J. Chen Department of Endocrinology, Affiliated Hospital of Jiangsu
More informationPrevalence of metabolic syndrome in women with polycystic ovary syndrome attending an infertility clinic in a tertiary care hospital in south India
Original Article Prevalence of syndrome in women with polycystic ovary syndrome attending an infertility clinic in a tertiary care hospital in south India Kavita Mandrelle, Mohan S Kamath, Dian J Bondu
More informationMetabolic Phenotype in the Brothers of Women with Polycystic Ovary Syndrome
Cardiovascular and Metabolic Risk O R I G I N A L A R T I C L E Metabolic Phenotype in the Brothers of Women with Polycystic Ovary Syndrome SUSAN SAM, MD 1 ANDREA D. COVIELLO, MD 2 YEON-AH SUNG, MD 3 4
More information13 th Annual Women s Health Day PCOS. Saturday 02/09/2017 Dr Mathias Epee-Bekima O&G Consultant KEMH
13 th Annual Women s Health Day PCOS Saturday 02/09/2017 Dr Mathias Epee-Bekima O&G Consultant KEMH Learning objectives Perform the appropriate investigations in women where there is a clinical suspicion
More informationEstimation of serum 25 hydroxy vitamin D level and its correlation with metabolic and endocrine dysregulation in women with PCOS
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Solanki V et al. Int J Reprod Contracept Obstet Gynecol. 2017 Jul;6(7):3085-3090 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172939
More informationReproductive Health in Non Alcoolic Fatty Liver Disease (NAFLD)
Reproductive Health in Non Alcoolic Fatty Liver Disease (NAFLD) Pr Sophie Christin-Maitre Reproductive Endocrine Unit, Hôpital Saint-Antoine, AP-HP Université Pierre et Marie Curie INSERM U933 Paris, France
More informationCan high serum anti-müllerian hormone levels predict the phenotypes of polycystic ovary syndrome (PCOS) and metabolic disturbances in PCOS patients?
ORIGINAL ARTICLE http://dx.doi.org/1.5653/cerm.213.4.3.135 pissn 2233-8233 eissn 2233-8241 Clin Exp Reprod Med 213;4(3):135-14 Can high serum anti-müllerian hormone levels predict the phenotypes of polycystic
More informationClinical and biochemical characteristics of polycystic ovary syndrome in Korean women
Human Reproduction Vol.23, No.8 pp. 1924 1931, 2008 Advance Access publication on June 24, 2008 doi:10.1093/humrep/den239 Clinical and biochemical characteristics of polycystic ovary syndrome in Korean
More informationAbnormal Uterine Bleeding Case Studies
Case Study 1 Abnormal Uterine Bleeding Case Studies Abigail, a 24 year old female, presents to your office complaining that her menstrual cycles have become a problem. They are now lasting 6 7 days instead
More informationUniversity of Cape Town
P a g e 1 The Polycystic Ovary Syndrome a comparison of the presentation in adolescents compared to women aged 35 years and older attending the Gynaecological Endocrine clinic at Groote Schuur Hospital.
More informationManagement of polycystic ovarian syndrome
14 Disorders of male and female sex hormones Management of polycystic ovarian syndrome LI-WEI CHO AND STEPHEN L. ATKIN Patients with polycystic ovarian syndrome can be challenging as they usually present
More informationCase. 24 year old female presented to your office complaining of excess hair growth on her face and abdomen. Questions?
Hirsutism Case 24 year old female presented to your office complaining of excess hair growth on her face and abdomen Questions? Started around puberty with gradual progression Irregular menstrual cycle
More informationMetformin and Pioglitazone in Polycystic Ovarian Syndrome: A Comparative Study
The Journal of Obstetrics and Gynecology of India (September-October 2012) 62(5):551 556 DOI 10.1007/s13224-012-0183-3 ORIGINAL ARTICLE Metformin and Pioglitazone in Polycystic Ovarian Syndrome: A Comparative
More informationINSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME An Overview
INSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME An Overview University of PNG School of Medicine & Health Sciences Division of Basic Medical Sciences PBL MBBS III VJ Temple 1 Insulin Resistance: What is
More informationMetabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology
Metabolic Syndrome Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Disclosure No conflict of interest No financial disclosure Does This Patient Have Metabolic Syndrome? 1. Yes 2. No Does This Patient
More informationHemoglobin A1C and diabetes diagnosis: The Rancho Bernardo Study
Diabetes Care Publish Ahead of Print, published online October 16, 2009 Hemoglobin A1c and diabetes Hemoglobin A1C and diabetes diagnosis: The Rancho Bernardo Study Running Title: Hemoglobin A1c and diabetes
More informationAbstract. Introduction. RBMOnline - Vol 10. No Reproductive BioMedicine Online; on web 15 November 2004
RBMOnline - Vol 10. No 1. 2005 100-104 Reproductive BioMedicine Online; www.rbmonline.com/article/1484 on web 15 November 2004 Article Metformin monotherapy in lean women with polycystic ovary syndrome
More informationArticle PCOS in lesbian and heterosexual women treated with artificial donor insemination
RBMOnline - Vol 17. No 3. 2008 398-402 Reproductive BioMedicine Online; www.rbmonline.com/article/3252 on web 22 July 2008 Article PCOS in lesbian and heterosexual women treated with artificial donor insemination
More informationResearch Article Does Polycystic Ovary Syndrome Itself Have Additional Effect on Apelin Levels?
Obstetrics and Gynecology International, Article ID 536896, 4 pages http://dx.doi.org/10.1155/2014/536896 Research Article Does Polycystic Ovary Syndrome Itself Have Additional Effect on Apelin Levels?
More informationClinical Manifestations of the Polycystic Ovary Syndrome at Menopausal Age
American Journal of Medicine and Medical Sciences 2019, 9(1): 35-39 DOI: 10.5923/j.ajmms.20190901.06 Clinical Manifestations of the Polycystic Ovary Syndrome at Menopausal Age Gafurova F. A. Assistant
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome What is Polycystic Ovarian Syndrome? Polycystic Ovarian Syndrome (PCOS) is characterized by the presence of multiple ovarian cysts and excess androgen production. Clinical Features
More informationFemale Reproductive Endocrinology
Female Reproductive Endocrinology Dr. Channa Jayasena PhD MRCP FRCPath Clinical Senior Lecturer & Consultant Endocrinologist Department of Gynaecology, Hammersmith Hospital Anovulation is a common cause
More informationAntim ullerian hormone and polycystic ovary syndrome
Antim ullerian hormone and polycystic ovary syndrome Yi-Hui Lin, M.D., a Wan-Chun Chiu, Ph.D., c Chien-Hua Wu, Ph.D., b,e Chii-Ruey Tzeng, M.D., d Chun-Sen Hsu, M.D., a and Ming-I Hsu, M.D. a a Department
More informationPolycystic Ovary Syndrome Therapy Dr. Pilar Vigil MD, PhD, FACOG
Polycystic Ovary Syndrome Therapy Dr. Pilar Vigil MD, PhD, FACOG What is an ovulatory dysfunction? Mrs. Susana Godoy, Nurse-Midwife San José, Costa Rica Abril 2018 PONTIFICIA UNIVERSIDAD CATÓLICA DE CHILE
More informationPolycystic Ovarian Syndrome (PCOS) LOGO
Polycystic Ovarian Syndrome (PCOS) Ma qianhong Ob/Gyn Department LOGO Contents Epidemiology and Definition Pathophysiology, Endocrinological Features Diagnostic Criteria Treatment Prognosis Introduction
More informationSerum insulin patterns and the relationship between insulin sensitivity and glycaemic profile in women with polycystic ovary syndrome
DOI: 10.1111/j.1471-0528.2009.02360.x www.bjog.org Fertility and reproductive medicine Serum insulin patterns and the relationship between insulin sensitivity and glycaemic profile in women with polycystic
More informationPolycystic ovary syndrome
Jon Havelock, MD, FRCSC Polycystic ovary syndrome Therapy for this reproductive and metabolic disorder remains focused on managing symptoms, including infertility caused by anovulation, and reducing long-term
More information