Polycystic ovary syndrome Archives - Revista Brasileira de Ginecologia e Obstetrícia

  • Original Articles

    Thyroid-stimulating Hormone and Insulin Resistance: Their Association with Polycystic Ovary Syndrome without Overt Hypothyroidism

    Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):224-228

    Summary

    Original Articles

    Thyroid-stimulating Hormone and Insulin Resistance: Their Association with Polycystic Ovary Syndrome without Overt Hypothyroidism

    Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):224-228

    DOI 10.1055/s-0037-1601436

    Views14

    Abstract

    Objective

    This study analyzed the effectiveness of the thyroid-stimulating hormone (TSH) as a predictor of insulin resistance (IR) and its association with the clinical and metabolic parameters of women with polycystic ovary syndrome (PCOS) without overt hypothyroidism.

    Study Design

    A cross-sectional study was performed. Women with PCOS and without overt hypothyroidism (n = 168) were included.

    Methods

    Receiver operating characteristic (ROC) curve was used to determine the cut-off point for TSH that would maximize sensitivity and specificity for a diagnosis of IR using homeostatic model assessment of insulin resistance (HOMA-IR)≥ 2.71. Clinical and metabolic parameters were compared as a function of the TSH cut-off limit and the presence of IR.

    Results

    Thyroid-stimulating hormone ≥ 2.77 mIU/L was associated with a diagnosis of IR, with sensitivity of 47.9% and specificity of 65.3%. There were no differences in clinical, hormonal or metabolic parameters between TSH < 2.77 and TSH of 2.77 - 10 mIU/L.

    Conclusion

    In women with PCOS without overt hypothyroidism, TSH ≥2.77 mIU/L is associated with IR; however, with poor sensibility, showing TSH to be a poor predictor of IR in this population. No clinical or metabolic alterations were found that would justify a change in clinical management. Thus, the IR should be investigated in all women with PCOS irrespective of TSH level.

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    Thyroid-stimulating Hormone and Insulin Resistance: Their Association with Polycystic Ovary Syndrome without Overt Hypothyroidism
  • Original Articles

    Association between Lipid Accumulation Product and Hirsutism in Patients with Polycystic Ovary Syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(2):71-76

    Summary

    Original Articles

    Association between Lipid Accumulation Product and Hirsutism in Patients with Polycystic Ovary Syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(2):71-76

    DOI 10.1055/s-0036-1571423

    Views10

    Objective

    Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause. Clinical hyperandrogenism is the most important diagnostic criterion of the syndrome, which manifests as hirsutism in 70% of cases. Hirsute carriers of PCOS have high cardiovascular risk. Lipid accumulation product (LAP) is an index for the evaluation of lipid accumulation in adults and the prediction of cardiovascular risk. The aim of this study was to evaluate the association between LAP and hirsutism in women with PCOS.

    Methods

    This was a cross-sectional observational study of a secondary database, which included 263 patients who had visited the Hyperandrogenism Outpatient Clinic from November 2009 to July 2014. The exclusion criteria were patients without Ferriman-Gallwey index (FGI) and/or LAP data. We used the Rotterdam criteria for the diagnosis of PCOS. All patients underwent medical assessment followed by measurement and recording of anthropometric data and the laboratory tests for measurement of the following: thyroid-stimulating hormone, follicle-stimulating hormone, prolactin, total testosterone, sex hormone binding globulin, 17-α-hydroxyprogesterone (follicular phase), glycohemoglobin A1c, and basal insulin. In addition, the subjects underwent lipid profiling and oral glucose tolerance tests. Other laboratory measurements were determined according to clinical criteria. LAP and the homeostatic model assessment index (HOMA-IR) were calculated using the data obtained. We divided patients into two groups: the PCOS group with normal LAP (< 34.5) and the PCOS group with altered LAP (> 34.5) to compare the occurrence of hirsutism. For statistical analysis, we used SPSS Statistics for Windows(r) and Microsoft Excel programs, with descriptive (frequencies, percentages, means, and standard deviations) and comparative analyses (Student's t-test and Chi-square test). We considered relations significant when the p-value was≤0.05.

    Results

    LAP was high in most patients (n = 177; 67.3%) and the FGI indicated that 58.5% of the patients (n = 154) had hirsutism. The analysis by LAP quartiles showed a positive correlation (p = 0.04) among patients with a high FGI and an upper quartile LAP (> 79.5) when compared with those with LAP < 29.0 (lower quartile).

    Conclusion

    This study demonstrated an association between high LAP and hirsutism. The FGI could represent a simple and low-cost tool to infer an increased cardiovascular risk in women with PCOS.

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    Association between Lipid Accumulation Product and Hirsutism in Patients with Polycystic Ovary Syndrome
  • Artigos Originais

    Acanthosis nigricans: metabolic interrelations inherent to the polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(9):410-415

    Summary

    Artigos Originais

    Acanthosis nigricans: metabolic interrelations inherent to the polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(9):410-415

    DOI 10.1590/SO100-720320140005078

    Views9

    PURPOSE:

    To establish the prevalence of acanthosis nigricans (AN) within the context of polycystic ovary syndrome (PCOS) and its associations with obesity, insulin resistance, insulinemia, and metabolic syndrome (MS).

    METHODS:

    A cross-sectional prospective study was conducted on 100 patients with PCOS diagnosed according to the Rotterdam Consensus (2003). The skin test included, in addition to the detection of the presence of AN, the presence of hirsutism (score ≥8) and acne. In addition to clinical and biochemical data, we investigated cardiovascular risk factors present in MS such as abdominal circumference, obesity, hypertension and HDL and triglyceride levels. Insulin resistance was determined by the HOMA-IR test.

    RESULTS:

    The prevalence of AN (53%) was significantly correlated with hirsutism (p=0.02), body mass index (p<0.01), basal insulinemia (p<0.01), (HOMA-IR) (p<0.01), and MS (p<0.01). The prevalence of MS reached 36% and was significantly associated only with AN (p<0.01). Although diabetes mellitus was absent, there was a significant association of altered HOMA-IR (p<0.01) with MS (p<5%) and AN (p<0.01).

    CONCLUSION:

    AN is part of the severe phenotypic profile of PCOS as an additional predictable sign of the risks of cardiovascular disease.

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  • Artigos Originais

    Contribution of hyperandrogenism to the development of metabolic syndrome in obese women with polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):562-568

    Summary

    Artigos Originais

    Contribution of hyperandrogenism to the development of metabolic syndrome in obese women with polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):562-568

    DOI 10.1590/S0100-72032013001200006

    Views8

    PURPOSE: To assess the contribution of hyperandrogenism to the development of metabolic syndrome (MetS) in obese women with polycystic ovary syndrome (PCOS). METHODS: Retrospective cross-sectional study conducted on 60 obese women with classic PCOS phenotype - Rotterdam Consensus - and 70 non-PCOS obese women. MetS was diagnosed by the NCEP-ATP III criteria and obesity was defined by body mass index. The Ferriman-Gallwey score (mFG) was used to evaluate hirsutism. The following measurements were performed: total testosterone, dehydroepiandrosterone sulfate (DHEA-S), glucose and insulin, total cholesterol, HDL, and triglycerides. Insulin resistance was measured using the HOMA-IR and insulin sensitivity index of Matsuda and De Fronzo (ISI). Statistical analysis was performed using the Student's t-test, χ² test and multivariate logistic regression analysis (p<0.05). RESULTS: Obese women with PCOS had significantly higher mFG (15.4±6.1), waist circunference (105.6±11.4 cm), DHEA-S (200.8±109.2 µg/dL), testosterone (135.8±71.4 ng/dL), and HOMA-IR (8.4±8.5) values and lower ISI values (2.0±1.8) than non-obese PCOS women (3.2±2.1; 101.4±9.2 cm; 155.0±92.7 µg/dL; 50.0±18.2 ng/dL; 5.1±4.7 and 3.3±2.7, respectively) (p<0.05). The frequency of MetS was higher in PCOS obese (75%) than non-PCOS obese (52.8%) women (p=0.015). Multivariate analysis did not reveal the contribution of the variables IFG, testosterone, and DHEAS to the development of MetS (p>0.05). CONCLUSION: Obese women with PCOS have a higher frequency of metabolic syndrome than non-PCOS obese women, and hyperandrogenism does not contribute to the development of metabolic syndrome in this group of women.

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  • Artigos Originais

    Quality of life and psychosocial aspects of polycystic ovary syndrome: a quali-quantitative approach

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):503-510

    Summary

    Artigos Originais

    Quality of life and psychosocial aspects of polycystic ovary syndrome: a quali-quantitative approach

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):503-510

    DOI 10.1590/S0100-72032013001100005

    Views11

    PURPOSE: To evaluate the quality of life of women with polycystic ovary syndrome (POS) and to learn about the experience of these women regarding the symptoms of their disease. METHODS: The study complementarily employed two methodological approaches - quantitative and qualitative ones. The quality of life of 213 women was evaluated (quantitative approach) using the SF-36 questionnaire. Of these, 109 had POS (Case Group: 26.8±5.4 years of age) and 104 were healthy (Control Group: 23.9±6.7 years of age). Data were analyzed statistically by the Student t-test, the chi-square test and the Pearson correlation test, with the level of significance set at 5%. Fifteen women with POS participated in the quantitative study and were interviewed using a semi-structured questionnaire. The qualitative data were analyzed by the technique of categorical thematic analysis. RESULTS: The women with POS showed impaired quality of life compared to Control (functional capacity: 76.5±20.5 and 84.6±15.9, respectively; physical aspects 56.4±43.3 and 72.6±33.3; general health status: 55.2±21.0 and 62.5±17.2; vitality: 49.6±21.3 and 55.3±21.3; social aspects: 55.3±32.4 and 66.2±26.7; emotional aspects: 34.2±39.7 and 52.9±38.2; mental health: 50.6±22.8 and 59.2±20.2). Regarding the qualitative data, thematic categorical analysis revealed that feelings of "abnormality", sadness, fear and anxiety were associated with the main symptoms of POS, i.e., hirsutism, menstrual irregularity, infertility and obesity. These symptoms affected the social, professional and marital life of these women. CONCLUSION: POS compromises the quality of life of affected women, causing them to feel that they are different from other women. Thus, women with POS do not simply require medical treatment regarding the reproductive, aesthetic and metabolic effects of the disease, but also need multiprofessional care.

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    Quality of life and psychosocial aspects of polycystic ovary syndrome: a quali-quantitative approach
  • Artigo de Revisão

    Heart rate variability as a method of assessing the autonomic nervous system in polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(9):421-426

    Summary

    Artigo de Revisão

    Heart rate variability as a method of assessing the autonomic nervous system in polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(9):421-426

    DOI 10.1590/S0100-72032013000900007

    Views5

    Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with several cardiometabolic risk factors, such as central obesity, insulin resistance, type 2 diabetes, metabolic syndrome, and hypertension. These factors are associated with adrenergic overactivity, which is an important prognostic factor for the development of cardiovascular disorders. Given the common cardiometabolic disturbances occurring in PCOS women, over the last years studies have investigated the cardiac autonomic control of these patients, mainly based on heart rate variability (HRV). Thus, in this review, we will discuss the recent findings of the studies that investigated the HRV of women with PCOS, as well as noninvasive methods of analysis of autonomic control starting from basic indexes related to this methodology.

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    Heart rate variability as a method of assessing the autonomic nervous system in polycystic ovary syndrome
  • Artigos Originais

    Metabolic profile in women of different body mass indices with polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(9):413-420

    Summary

    Artigos Originais

    Metabolic profile in women of different body mass indices with polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(9):413-420

    DOI 10.1590/S0100-72032013000900006

    Views6

    PURPOSE: To characterize and compare clinical, anthropometric and biochemical-metabolic variables in patients with polycystic ovary syndrome (PCOS), stratified according to body mass index (BMI). METHODS: A cross-sectional study conducted on 78 women aged 18 to 45 years with a clinical diagnosis of PCOS by the Rotterdam criteria. Patients were stratified according to BMI. The variables analyzed were: age, marital status, physical inactivity, menstrual irregularity, blood pressure (BP), anthropometric measurements, lipid profile, fasting glucose, and hormone measurements. To compare the variables between the different BMI values we used analysis of variance and the Kruskal-Wallis test. The level of significance was set at 5% for all tests. RESULTS: The patients had a mean age of 26.3 years, 79.5% of them were sedentary and 68% had hyperandrogenism. Waist circumference, waist/hip ratio, waist/height ratio and percentage of body fat were higher in the obese group. The markers of cardiovascular risk (CVR - fasting glucose, systolic and diastolic BP and LDL-cholesterol) were directly proportional to BMI, whereas HDL-cholesterol and SHBG were inversely related to BMI. CONCLUSION: The presence of markers of CVR factors increased proportionally to BMI, indicating that the metabolic profile of obese women with PCOS is more unfavorable than that of non-obese patients.

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  • Article

    Arterial hypertension and metabolic profile in patients with polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(1):21-26

    Summary

    Article

    Arterial hypertension and metabolic profile in patients with polycystic ovary syndrome

    Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(1):21-26

    DOI 10.1590/S0100-72032013000100005

    Views4

    PURPOSE: To evaluate parameters related with arterial pressure and metabolic profile in women with polycystic ovary syndrome (POS). METHODS: This monocentric study at the University Hospital Endocrinology Section included 60 women aged 18-45 years, 42 being diagnosed with POS and acting as 18 controls. All women were subjected to transvaginal ultrasound and monitored for arterial pressure for 24 h in the ambulatory (MAP). Venous blood samples were taken between 07.00 and 09.00, after 12 h fasting. Basal (BG) and fasting glucose concentrations, total cholesterol and its fractions, triglycerides and insulin (to calculate the homeostatic assay insulin-resistance, HOMA-IR) were measured. Collected data were the mean arterial blood pressure (24-h awake/sleep cycle), arterial pressure nocturnal descensus, glycemia and fasting glucose for HOMA-IR, and lipid profile. The Student's t test was used to compare homogeneous variables; the Mann-Whitney test was used to compare non-homogeneous variables; the Pearson's correlation coefficient was used to search for correlation between the variables. The c² test was used for comparison of the absence of nocturnal descensus. Significance was taken as p<0.05. RESULTS: The mean age of the patients with POS was 27.4±5.5 (18-45 years, n=42) and the body mass index (BMI) was 30.2±6.5 kg/m² (18.3-54.9). In the Control Group, the mean age was 31.4±6.1 (18-45 years) and the BMI was 27.1±6.2 kg/m² (18.3-54.9, n=18). No difference in the metabolic parameters and insulin resistance was observed between the two groups. Comparison between these parameters and MAP showed that the only parameter with a correlation was the BMI, independent of the POS diagnosis. This was not seen in nocturnal descensus, which was uncorrelated with POS and any of the other studied parameters. CONCLUSION: POS women do not show higher arterial blood pressure, glycemia, HDL-col, TG, HOMA-IR and BMI compared to non-POS women. However, POS patients showed correlation between arterial pressure and BMI, suggesting that obesity is a primary factor involved in arterial pressure changes in these patients.

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