Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our c...Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our context. Patients and Methods: This was an observational, cross-sectional cohort study of 19 patients of reproductive age followed for hyperandrogenism at the Medical Clinic II of Abass Ndao Hospital, from November 1<sup>st</sup>, 2019 to August 31<sup>st</sup>, 2021. Results: Our cohort consisted of women with an average age of 25.3 years, single (73.7%), with a low socioeconomic level (42.1%). A family history of hirsutism was found in 31.6% of cases. The main reasons for consultation were a menstrual cycle disorder in 94.7% of cases, and hirsutism in 78.9% of cases. The latter was post-pubertal (66.7%), with a slow or progressive evolution. The physical examination revealed: hirsutism (100%) with an average modified Ferriman Gallwey score (mFG) of 8.9 ± 5.8, acne (36.8%), hyperseborrhea (57.9%), major signs of virilization (10.5%), acanthosis nigricans (47.4%) and galactorrhea (5.3%). Hormonal explorations revealed an elevation of: testosterone (31.6%), 17-hydroxyprogesterone (5.3%), dihydrotestosterone (31.6%), and prolactin (10.5%). The ovarian morphology was micropolycystic (84.2%). The etiological profile corresponded to polycystic ovarian syndrome or PCOS (68.4%), ovarian hyperthecosis (10.5%), hyperprolactinemia (10.5%), congenital adrenal hyperplasia or CAH (5.3%). Idiopathic hirsutism was found in 5.3% of cases. Conclusion: Female hyperandrogenism is a less frequent reason for consultation in endocrinology. It deserves to be further evaluated in a large-scale study focused on epidemiological, clinico-biological and etiological investigation, in order to assess its prevalence and better define its profile in our context.展开更多
Summary: To determine the (tttta) n repeat polymorphisms at the promoter region of CYP11α gene, and study its linkage to hyperandrogenism of polycystic ovary syndrome (PCOS) in Chinese women, a case-control study w...Summary: To determine the (tttta) n repeat polymorphisms at the promoter region of CYP11α gene, and study its linkage to hyperandrogenism of polycystic ovary syndrome (PCOS) in Chinese women, a case-control study was conducted in the Reproductive Medical Center of the Second Affiliated Hospital of Zhengzhou University (Zhengzhou, China). 96 PCOS patients and 78 healthy control women were included. CYP11α (tttta) n repeat-polymorphism genotyping analysis was performed by using polymerase chain reaction (PCR). Serum pituitary hormone and total testosterone levels were measured by ELISA. 4 different CYP11α (tttta) n allelles were identified, corresponding to 4-, 6-, 8-, and 9-repeat-unit alleles. The frequency and distribution of these alleles are 0.16, 0.33, 0.38, and 0.13 respectively in PCOS patients, as compared with 0.20, 0.34, 0.35, and 0.11 respectively in healthy controls. There were no significant differences between these two groups. Moreover, no correlation between the polymorphism of CYP11α gene and serum testosterone level of patients with PCOS and controls was observed. It is concluded that microsatellite polymorphism (tttta) n of gene CYP11α exists in Chinese women and the polymorphism of CYP11α gene does not play an important role in the pathogenesis of Chinese patients with PCOS, especially in patients with hyperandrogenism.展开更多
Polycystic ovary syndrome（PCOS） is a common reproductive disease with high heterogeneity. The role of excess androgen in PCOS etiology remains disputed, since around 20%-50% of PCOS women do not display hyperandroge...Polycystic ovary syndrome（PCOS） is a common reproductive disease with high heterogeneity. The role of excess androgen in PCOS etiology remains disputed, since around 20%-50% of PCOS women do not display hyperandrogenemia. The microenvironment of the ovary critically influences follicular development. In the present study, we assessed the role of androgen in PCOS by investigating whether excessive follicular fluid androgen was present in PCOS patients with normal serum androgen levels and influenced by follicular fluid insulin resistance（IR）.Follicular fluid samples of 105 women with PCOS and 105 controls were collected. Levels of steroid hormones,glucose and insulin in the follicular fluid were examined and compared with data from serum biochemistry tests. We found that 64.9%（63/97） of PCOS patients with normal serum androgen levels displayed abnormally high follicular fluid androgen level. The follicular fluid androgen level was positively correlated with follicular fluid IR within a certain range and follicular fluid estrogen-to-testosterone（E2/T） ratio was significantly reduced in these patients.These results indicated that there existed a subgroup of PCOS patients who displayed excessive follicular fluid androgen and IR despite their normal circulating testosterone（T） levels. Our study highlights the importance of ovary hyperandrogenism and IR in the etiology of PCOS.展开更多
Women with both type 1 diabetes and polycystic ovarian syndrome (PCOS) represent a unique population, with long term implications on fertility and diabetic complications, which need to be addressed. The studies review...Women with both type 1 diabetes and polycystic ovarian syndrome (PCOS) represent a unique population, with long term implications on fertility and diabetic complications, which need to be addressed. The studies reviewed herein address the increased incidence of PCOS in women with type 1 diabetes. The leading theories suggest that the underlying pathophysiology is related to intensive insulin therapy and resulting ovarian hyperandrogenism. We have searched the literature to determine what studies have been done to address the role of insulin resistance and insulin sensitizers for reduction of hyperandrogenism in these patients. According to the available evidence, we conclude that metformin may have a role in reducing the androgenic picture in type 1 patients with PCOS and insulin resistance.展开更多
Background：Polycystic ovary syndrome （PCOS） is the commonest endocrinopathy in women of reproductive age.The patients often develop insulin resistance （IR） or hyperinsulinemia despite manifesting anovulation and ...Background：Polycystic ovary syndrome （PCOS） is the commonest endocrinopathy in women of reproductive age.The patients often develop insulin resistance （IR） or hyperinsulinemia despite manifesting anovulation and signs of hyperandrogenism.The cause and effect relationship of hyperinsulinemia and hyperandrogenemia （HA） is still debated.Micro-ribonucleic acids （miRNAs） have recently been shown to play a role in regulation of ovarian function.Our current study focused on the altered expression of miRNAs with PCOS.Methods：Ovarian theca intema tissues were obtained from 10 PCOS patients and 8 controls that were non-PCOS and had normal insulin sensitivity undergoing laparoscopy and/or ovarian wedge resection.Total RNA of all samples was extracted.We studied the repertoire of miRNAs in both PCOS and non-PCOS women by microarray hybridization.Bioinformatic analysis was performed for predicting targets of the differentially expressed miRNAs.Furthermore,selected miRNAs were validated by quantitative reverse transcriptase polymerase chain reaction （qRT-PCR）.Results：A total of 27 miRNAs were differentially expressed in PCOS patients with respect to the controls in our discovery evaluationand two （miR-92a and miR-92b） of them were significantly downregulated in PCOS women in followed validation （P 〈 0.05）.Targets prediction revealed that miR-92a targeted both GATA family of zinc finger transcription factor GATA-binding factor 6 （GATA6） and insulin receptor substrate proteins 2 （IRS-2）.Conclusions：MiRNAs are differentially expressed between PCOS patients and controls.We identified and validated two miRNAs-miR-92a and miR-92b.They are significantly downregulated and may be involved in the pathogenesis of PCOS.展开更多
OBJECTIVE: To observe the efficacy and safety of different dosages of modified Zhibaidihuang decoction(MZBDD) on polycystic ovary syndrome(PCOS) hyperandrogenism(HA) patients.METHODS: Ninety PCOS HA patients and 30 in...OBJECTIVE: To observe the efficacy and safety of different dosages of modified Zhibaidihuang decoction(MZBDD) on polycystic ovary syndrome(PCOS) hyperandrogenism(HA) patients.METHODS: Ninety PCOS HA patients and 30 infertile patients due to tubal factor were selected. Ninety PCOS HA patients were randomly divided into three groups: low dosage group(LDG), medium dosage group(MDG) and high dosage group(HDG) and infertile patients were selected as normal control group(NCG). PCOS HA patients were treated with different dosage of MZBDD for 4 weeks. For HA patients, serum total testosterone(T), estrodial(E2), follicle stimulating hormone(FSH), luteinizing hormone(LH), prolatin(PRL), alanine aminotransferase(AST), aspartate amino transferase(AST) were determined before and after treatment, while acne scores(Rosenfield) were signed. Basal body temperatures(BBT) were asked to be measured every day. And for the else, T, E2,FSH, LH, PRL, AST, and AST were determined before treatment.RESULTS: Totally 111 patients completed the clinical research. There were no differences among the four groups on serum T before treatment(P =0.221). Serum T concentration of both MDG and HDG after treatment significantly were lower than that of before treatment(P = 0.039, P = 0.000),while there was no obvious difference in LDG(P =0.829). Serum T concentration of both MDG and HDG were significantly lower than that of LDG after treatment(P = 0.048, P = 0.006). To compared with before treatment, there were no differences in Serum FSH, LH, E2, P and PRL among the three groups(LDG, MDG, HDG)(as for FSH, P = 0.136, P = 0.503,P = 0.062; as for LH, P = 0.473, P = 0.513, P = 0.096;as for E2, P = 0.206, P = 0.927, P = 0.076; as for PRL,P = 0.120, P = 0.903, P = 0.407, as for P, P = 0.308, P =0.866, P = 0480). Acne scores of all the three groups were obviously lower than that of before treatment(P = 0.031; P = 0.033; P = 0.002). 39.5% of the patients had biphasic BBT, but there were no differences among the three groups(P = 0.510). There were no differences with ALT and AST between after and before treatment among the three groups(LDG, MDG, HDG)(as for ALT, P = 0.742, P = 0.383,P = 0.053; as for AST, P = 0.732, P = 0.519, P = 0.120).CONCLUSION: Different dosage of MZBDD has dose-effect relationship in treating PCOS HA.展开更多
Objective:To explore the effect of curcuminon the insulin receptor substrate1(IRS1)/phosphatidylinositol-3-kinase(PI3K)/endometrial expression of glucose 4(GLUT4)signalling pathway and its regulator,phosphatase and te...Objective:To explore the effect of curcuminon the insulin receptor substrate1(IRS1)/phosphatidylinositol-3-kinase(PI3K)/endometrial expression of glucose 4(GLUT4)signalling pathway and its regulator,phosphatase and tensin homolog(PTEN),in a rat model of polycystic ovarian syndrome(PCOS).Methods:PcoS model was induced by letrozole intragastric administration.Sprague-Dawleyrats were randomized into 4groups according to a random number table:(1)control group;(2)PcoS group,which was subjected to PCOS and received vehicle;(3)curcumin group,which was subjected to PCoS and treated with curcumin(200 mg/kg for 2 weeks);and(4)curcumin+LY294002 group,which was subjected to PCOS,and treated with curcumin and LY294002(a specific PI3K inhibitor).Serum hormone levels(17β-estradiol,follicle stimulating hormone,luteinizinghormone,progesterone,and testosterone)were measured by enzyme linked immunosorbentassay,and insulin resistance(IR)was assessed using the homeostasismodel assessment of IR.Ovarian tissues were stained with haematoxylin and eosin for pathological and apoptosis examination.Expression levels of key transcriptional regulators and downstream targets,including IRS1,Pl3K,protein kinase B(AKT),GLUT4,and PTEN,were measured via reverse transcription polymerase chain reaction and Western blot,respectively.Results:The Pcos group showed impaired ovarian morphology and function.Compared with the PCoS group,curcumin treatment exerted ovarioprotective effects,down-regulated serum testosterone,restored IR,inhibited inflammatory cell infiltration in ovarian tissues,decreased IRS1,PI3K,and AKT expressions,and up-regulated GLUT4 and PTEN expressions in PCOS rats(P<0.05orP<0.01).In contrast,IRS1,PI3K,AKT,and PTEN expression levelswerenot significantly different between PCOS and curcumin+LY294002 groups(P>0.05).Conclusion:The beneficial effects of curcumin on PCOS rats included the alteration of serum hormone levels and recovery of morphological ovarian lesions,in which,PTEN,a new target,may play a role in regulating the IRS1/PI3K/GLUT4 pathway.展开更多
BACKGROUND Polycystic ovary syndrome(PCOS)is closely related to obesity,and weight loss can significantly improve the metabolic,endocrine and reproductive functions of obese individuals with PCOS.However,the efficacy ...BACKGROUND Polycystic ovary syndrome(PCOS)is closely related to obesity,and weight loss can significantly improve the metabolic,endocrine and reproductive functions of obese individuals with PCOS.However,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are unclear.AIM The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.METHODS A retrospective analysis was performed on 32 obese patients with PCOS who received LSG treatment at the Third Hospital of Shanxi Medical University from 2013 to 2020.The changes in anthropometric indices,insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH),menstrual cycle and LH/FSH ratio before and 1 mo,3 mo,6 mo and 12 mo after the operation were statistically analyzed.RESULTS At 1 mo,3 mo,6 mo and 12 mo after surgery,the anthropometric indices,such as body weight and body mass index,of all patients were lower than those before the operation.The percentage excess weight loss(EWL%)at 1 mo,3 mo,6 mo and 1 year of follow-up were 25,40,46 and 65,respectively.The PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying degrees.During the 1-year follow-up,the average serum testosterone decreased from preoperative 0.72 ng/mL to 0.43 ng/mL(P<0.05),average fasting insulin level(9.0 mIU/mL,preoperative 34.2 mil,LH level,4.4 mIU/mL,preoperative 6.1 mIU/mL).The level of FSH(3.8 U/L,4.8 U/p0.05)and the ratio of LH/FSH(0.7,1.3/p0.05)were more relieved than those before surgery.During the postoperative follow-up,it was found that the menstrual cycle of 27 patients(nasty 27)returned to normal,and 6 patients(18%)who intended to become pregnant became pregnant within 1 year after surgery.CONCLUSION The weight loss effect of LSG is obvious and affirmative,and the endocrine index of obese patients with PCOS is also improved to some extent,although the mechanism is not clear.Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.展开更多
Objective:To observe the clinical effect of electroacupuncture on improving polycystic ovary syndrome(PCOS)of kidney deficiency and phlegm dampness type and serum oxidative stress level.Methods:There were 68 patients ...Objective:To observe the clinical effect of electroacupuncture on improving polycystic ovary syndrome(PCOS)of kidney deficiency and phlegm dampness type and serum oxidative stress level.Methods:There were 68 patients with polycystic ovary syndrome were randomly divided into observation group(34 cases)and the control group(34 cases),The observation group was treated by electroacupuncture,while the control group was treated by placebo electroacupuncture.Combined with the evaluation of menstrual cycle,menstrual color,quality,quantity and TCM symptom integral index,the difference of curative effect between the two groups was observed,and the levels of peripheral blood,sex hormones,insulin resistance and oxidative stress were detected before and after treatment for 3 months.Results:The total effective rate in the observation group was better than that in the control group(P<0.01);After intervention,serum LH,FSH,E_(2) and LH/FSH in the observation group were significantly different from those before intervention.The D values of serum LH,FSH,LH/FSH and E_(2) before and after intervention were significantly different between the two groups(P<0.01);Comparing the level of androgen,the serum A4 and T in the observation group were significantly different from those before intervention(P<0.01);After intervention,there was a significant difference in serum A4 and T between the two groups(P<0.01),and there was a significant difference in D value between the two groups before and after intervention;There was a difference in insulin resistance in the observation group before and after intervention(P<0.05),and there was a significant difference in D value between the two groups before and after intervention(P<0.01);After the intervention,the serum SOD,MDA,ROS in the observation group were significantly different from those before the intervention;After intervention,the results of serum SOD and ROS in the observation group were significantly different from those in the control group;There was no significant difference in serum MDA results.There were significant differences in SOD,MDA,ROS between the two groups before and after intervention.Conclusion:Electroacupuncture can improve oxidative stress injury,insulin resistance and hyperandrogenism in PCOS patients.展开更多
Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease in the Western world comprising a spectrum of liver damage from fatty liver infiltration to end-stage liver disease,in patients ...Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease in the Western world comprising a spectrum of liver damage from fatty liver infiltration to end-stage liver disease,in patients without significant alcohol consumption.Increased prevalence of NAFLD has been reported in patients with polycystic ovary syndrome(PCOS),one of the most common endocrinopathies in premenopausal women,which has been redefined as a reproductive and metabolic disorder after the recognition of the important role of insulin resistance in the pathophysiology of the syndrome.Obesity,in particular central adiposity and insulin resistance are considered as the main factors related to NAFLD in PCOS.Moreover,existing data support that androgen excess,which is the main feature of PCOS and is interrelated to insulin resistance,may be an additional contributing factor to the development of NAFLD.Although the natural history of NAFLD remains unclear and hepatic steatosis seems to be a relatively benign condition in most patients,limited data imply that advanced stage of liver disease is possibly more frequent in obese PCOS patients with NAFLD.PCOS patients,particularly obese patients with features of the metabolic syndrome,should be submitted to screening for NAFLD comprising assessment of serum aminotransferase levels and of hepatic steatosis by abdominal ultrasound.Lifestyle modifications including diet,weight loss and exercise are the most appropriate initial therapeutic interventions for PCOS patients with NAFLD.When pharmacologic therapy is considered,metformin may be used,although currently there is no medical therapy of proven benefit for NAFLD.Long-term follow up studies are needed to clarify clinical implications and guide appropriate diagnostic evaluation,follow-up protocol and optimal treatment for PCOS patients with NAFLD.展开更多
Insulin has complex effects on cell growth,metabolism and differentiation,and these effects are mediated by a cell-surface bound receptor and eventually a cascade of intracellular signaling events.Among the several me...Insulin has complex effects on cell growth,metabolism and differentiation,and these effects are mediated by a cell-surface bound receptor and eventually a cascade of intracellular signaling events.Among the several metabolic and growth-promoting effects of insulin,insulin resistance is defined as an attenuated effect of insulin on glucose metabolism,primarily the limited export of blood glucose into skeletal muscle and adipose tissue.On the other hand,not all the signaling pathways and insulin-responsive tissues are equally affected,and some effects other than the metabolic actions of insulin are overexpressed.Ovaries and the adrenal glands are two examples of tissues remaining sensitive to insulin actions where insulin may contribute to increased androgen secretion.Polycystic ovary syndrome(PCOS)is the most common form of androgen excess disorder(AED),and its pathogenesis is closely associated with insulin resistance.Patients with idiopathic hirsutism also exhibit insulin resistance,albeit lower than patients with PCOS.Although it is not as evident as in PCOS,patients with congenital adrenal hyperplasia may have insulin resistance,which may be further exacerbated with glucocorticoid overtreatment and obesity.Among patients with severe insulin resistance syndromes,irrespective of the type of disease,hyperinsulinemia promotes ovarian androgen synthesis independently of gonadotropins.It is highly debated in whom and how insulin resistance should be diagnosed and treated among patients with AEDs,including PCOS.It is not suitable to administer an insulin sensitizer relying on only some mathematical models used for estimating insulin resistance.Instead,the treatment decision should be based on the constellation of the signs,symptoms and presence of obesity;acanthosis nigricans;and some laboratory abnormalities such as impaired glucose tolerance and impaired fasting glucose.展开更多
Hyperandrogenism and hyperinsulinemia have resulted from dysfunction of the theca cell of the ovary and adipose tissue and each one potentiates the other in patients with androgen excess disorders e.g.,polycystic ovar...Hyperandrogenism and hyperinsulinemia have resulted from dysfunction of the theca cell of the ovary and adipose tissue and each one potentiates the other in patients with androgen excess disorders e.g.,polycystic ovary disease and idiopathic hirsutism.Possible external and/or internal triggers can produce such cellular dysfunction.There is evidence that sodium valproate acts as a trigger of cellular dysfunction and produces both hyperinsulinemia and hyperandrogenism.Therefore,the elimination of these triggers can help the patients to recover from hyperinsulinemia,insulin resistance and hyperandrogenism.展开更多
The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence...The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.展开更多
Ovarian Leydig cell tumor, a sub-type of ovarian steroid cell tumor, accounts for less than 0.1% of all ovarian tumors. It can affect women of any age group but is most common in postmenopausal women. We here report a...Ovarian Leydig cell tumor, a sub-type of ovarian steroid cell tumor, accounts for less than 0.1% of all ovarian tumors. It can affect women of any age group but is most common in postmenopausal women. We here report a case of virilizing ovarian Leydig cell tumor with multiple non-functional endocrine neoplasias (pituitary and adrenal adenomas) in a 48-year-old woman. She first presented with sub-abdominal pain and hirsutism since menopause three years ago. Subsequently, she had slight facial acne, voice deepening, breast atrophy, and a prominent Adam’s apple. Her hormone profile showed an elevated level of testosterone, high free androgen index, low levels of luteinizing hormone and follicle stimulating hormone, and normal levels of random cortisol, androstenedione, 17-hydroxyprogesterone and dehydroepiandrosterone sulfate. A pelvic enhanced magnetic resonance imaging (MRI) scan showed nodules in the right ovary, and a pituitary enhanced MRI revealed a microadenoma. An enhanced computerized tomography scan of the adrenal gland revealed left adrenal nodules, possibly adenomas. After a right cystectomy and right fallopian tube resection, her testosterone level declined to 0.38 nmol/L and the symptoms associated with hyperandrogenism improved. This is a rare case of virilizing ovarian Leydig cell tumor with multiple non-functional endocrine neoplasias. We believe our findings will be helpful in the clinical diagnosis and treatment of hyperandrogenism.展开更多
Introduction: Polycystic Ovarian Syndrome (PCOS), also known as Stein Leventhal Syndrome, is one of the common endocrine diseases affecting women of childbearing age and the leading cause of anovulatory infertility wo...Introduction: Polycystic Ovarian Syndrome (PCOS), also known as Stein Leventhal Syndrome, is one of the common endocrine diseases affecting women of childbearing age and the leading cause of anovulatory infertility worldwide. The aim of this study was to describe the clinical, paraclinical and therapeutic aspects of PCOS at the University Clinic of Obstetrics and Gynaecology of the National Hospital and University Centre Hubert Koutoukou MAGA of Cotonou (CNHU). Patients and Method: The study was doing in the University Clinic of Gynecology and Obstetrics of the CNHU-HKM. This was a descriptive and analytical longitudinal study with retrospective and prospective data collection over a period of 7 years from January 2015 to December 2021. It focused on women of childbearing age seen in gynecological consultation. Results: The frequency of PCOS was 2.53%. The mean age of the patients was 27.28 ± 6.55 years. They were educated for the most part with a university level in 43.8% of cases. Obstetrically they were nulligest (45.63%) and nulliparous in 60% of cases. The history of spontaneous miscarriages was found in 61.11%. The main reasons for consultation were menstrual disorders (51%) followed by the desire for pregnancy (40.6%). Clinically, obesity (30%), overweight (33.1%), high blood pressure (20.63%), hirsutism (24%) and acne (27%) were noted. All the women had micropolycystic ovaries in ultrasound. Testosterone was elevated in 61% of cases. Phenotype D was found in 45.63% of patients. All these patients were put under lifestyle and dietary measures, Metformin (13.80%) and estrogen-progestogen (18.80%). The outcome of the treatment was assessed by cycle regularity, regression of hirsutism, weight loss, fertility and fertility. The cycle was normalised in most cases with notable regression of physical signs of hyperandrogenism. The cycle was normalized in most cases with the notable regression of physical signs of hyperandrogenism. We had recorded 25 pregnancies including one miscarriage. The occurrence of pregnancy was obtained in 50% of these women after 12 months and in less than 20% after 24 months. Conclusion: PCOS was common in the CUGO of the CNHU-HKM. A population-based epidemiological study seems necessary to better appreciate the risk factors of this endocrine syndrome and its repercussions on fertility and metabolic diseases such as type 2 diabetes, obesity and hypertension.展开更多
Background: Hirsutism is a clinical situation in Cameroon which is poorly elucidated due to a paucity of clinical and biological data;hence our interest in this study. The aim of this work was to describe the clinical...Background: Hirsutism is a clinical situation in Cameroon which is poorly elucidated due to a paucity of clinical and biological data;hence our interest in this study. The aim of this work was to describe the clinical, psycho-social and metabolic profile of women with hirsutism in Yaoundé. Materials and Methods: This was a descriptive cross-sectional study carried out from May 2013 to December 2013. Participants were recruited by announcement through social media. Our study included women at least 18 years old, not in menopausal, not pregnant, not breastfeeding, with hirsutism regardless of severity. They were assessed through an interrogation, anthropometric parameters, a physical examination using the modified Ferriman and Gallwey score, the measurement of fasting capillary blood glucose and a lipid profile. The psycho-social assessment was carried out using a pre-designed questionnaire on the participant’s perception and daily experience with hirsutism. The metabolic syndrome was established according to the criteria of the International Diabetes Federation of 2005 and the National Cholesterol Education Program-third adult treatment panel of 2001. Results: We recruited 60 women aged 27.6 ± 7.0 years. The median Ferriman and Gallwey score was 12. The mean duration of evolution was 9 years. A family history of hirsutism was found in 88.8% of the participants, especially in the mother. Signs of virilization were found in 3.3% of the participants. Association was found between menstrual cycle abnormalities and severity of hirsutism (p = 0.023). Psycho-socially, 58.8% of women found hirsutism normal. The metabolic syndrome was found in 21.7% and 18.3% according to the IDF and NCEP-ATP III, respectively. Conclusion: Hirsutism in our context seems normal to most of our participants. It is, however, associated with menstrual irregularities, signs of virilization and metabolic syndrome. As a result, hirsutism merits further study on a large-scale with emphasis on etiology.展开更多
Introduction: This study aims to describe the outcome of adrenocortical cancer in children through observation. Observation: A 10-year-old girl with no previous pathological history. She presented headaches and severe...Introduction: This study aims to describe the outcome of adrenocortical cancer in children through observation. Observation: A 10-year-old girl with no previous pathological history. She presented headaches and severe hypertension with clinical and biological signs of hyperandrogenism for 6 months. An abdominal CT scan showed an encapsulated left adrenal mass without local or regional invasion or secondary location. A pheochromocytoma or adrenal neuroblastoma was first suspected. The blood pressure was stable at 130/65 mmHg under antihypertensive drugs. She underwent a complete tumor resection without any intraoperative incident. The pathologic study confirmed the adrenocortical carcinoma scored Weiss 7. The severe high blood pressure reappeared 2-year later despite antihypertensive drugs. The thoracic abdominal and pelvic CT scan showed a locally advanced tumor recurrence in the left adrenal gland with parenchymal nodes in the lungs and liver. The outcome was fatal despite medical and surgical management. Conclusion: Adrenocortical cancer is a rare tumor. It is important to hormonal testing in the presence of Cushing’s syndrome in children. It can give a strong indication of the diagnostic possibilities. Histology confirms the diagnosis. The evolution is covered by complications, in particular recurrence with life-threatening metastases.展开更多
Polycystic ovary syndrome(PCOS)is a condition in which a woman has increased levels of male hormones(androgens).Many problems occur as a result of this increase of hormones,including:Menstrual irregularitiesInfertilit...Polycystic ovary syndrome(PCOS)is a condition in which a woman has increased levels of male hormones(androgens).Many problems occur as a result of this increase of hormones,including:Menstrual irregularitiesInfertility,Skin problems such as acne and increased hair growth,Increased number of small cysts in the ovaries.展开更多
Polycystic ovary syndrome(PCOS),a common endocrine disorder with metabolic and reproductive consequences,affects a significant percentage of women of reproductive age.Because of its complexity and impact on the qualit...Polycystic ovary syndrome(PCOS),a common endocrine disorder with metabolic and reproductive consequences,affects a significant percentage of women of reproductive age.Because of its complexity and impact on the quality of life,PCOS requires timely diagnosis and screening for complications.The most common clinical manifestations of PCOS are hirsutism,hyperandrogenism,acne,irregular cycles,amenorrhea,and anovulation.Although PCOS has different clinical manifestations in women,hyperandrogenism,and anovulation are the most common symptoms.A good medical history,examination,blood tests,and ultrasound findings facilitate the diagnosis of PCOS.Novel treatments have also undergone clinical trials to improve the symptoms of PCOS.However,comprehensive review articles investigating the different communities of this disease are limited,and this review aimed to collect data on the different etiologies of PCOS along with the latest diagnostic methods and the most common and up-to-date treatments for this disease.展开更多
Objective To investigate the differences of endocrine and metabolic characteristics in PCOS women among different subtypes. Methods A total of 249 PCOS women were classified into 4 subtypes by Rotterdam criteria： hyp...Objective To investigate the differences of endocrine and metabolic characteristics in PCOS women among different subtypes. Methods A total of 249 PCOS women were classified into 4 subtypes by Rotterdam criteria： hyperandrogenism （HA） and oligo-ovulation/anovulation （0） and PCO ultrasonography （P） （HA＋O＋P, group A, 111 women）; HA＋O （group B, 9 women）; HA＋P （group C, 22 women） and O＋P （group D, 107 women）. Another 110 infertii＇e women with tubal defects constituted a control group. Endocrine and metabolic characteristics were compared among the 5 groups. PCOS women were then reclassified into 2 groups, according to whether they have hyperandrogenism or not. Endocrine ond metabolic characteristics were then compared again. Results The levels of androstenedione （A）, testosterone （T） and LH/FSH were the highest in group A and group C, secondly in group D, the lowest was in control group. A, T and LH/FSH were the highest in hyperandrogenism group, secondly in non- hyperandrogenism group, whereas the control was the lowest. Menstrual cycle and BMI correlated with glucose and lipid metabolism but showed no correlateion with T and A. Hyperandrogenism group had higher fasting glucose （FG）, glucose at 60 min （G60） and glucose levels under the curve （GLUAUC） and lower disposition index （DI） than non-hyperandrogenism group, however, menstrual cycle, BMI and the lipid indicators had no difference. Conclusion Hyperandrogenism is an important characteristic in F＇COS women. Thus it might be used to classify PCOS into 2 subgroups. Hyperandrogenism and lipid disorders for the formation of PCOS often coexist but each has individual pathogenesis.展开更多
文摘Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our context. Patients and Methods: This was an observational, cross-sectional cohort study of 19 patients of reproductive age followed for hyperandrogenism at the Medical Clinic II of Abass Ndao Hospital, from November 1<sup>st</sup>, 2019 to August 31<sup>st</sup>, 2021. Results: Our cohort consisted of women with an average age of 25.3 years, single (73.7%), with a low socioeconomic level (42.1%). A family history of hirsutism was found in 31.6% of cases. The main reasons for consultation were a menstrual cycle disorder in 94.7% of cases, and hirsutism in 78.9% of cases. The latter was post-pubertal (66.7%), with a slow or progressive evolution. The physical examination revealed: hirsutism (100%) with an average modified Ferriman Gallwey score (mFG) of 8.9 ± 5.8, acne (36.8%), hyperseborrhea (57.9%), major signs of virilization (10.5%), acanthosis nigricans (47.4%) and galactorrhea (5.3%). Hormonal explorations revealed an elevation of: testosterone (31.6%), 17-hydroxyprogesterone (5.3%), dihydrotestosterone (31.6%), and prolactin (10.5%). The ovarian morphology was micropolycystic (84.2%). The etiological profile corresponded to polycystic ovarian syndrome or PCOS (68.4%), ovarian hyperthecosis (10.5%), hyperprolactinemia (10.5%), congenital adrenal hyperplasia or CAH (5.3%). Idiopathic hirsutism was found in 5.3% of cases. Conclusion: Female hyperandrogenism is a less frequent reason for consultation in endocrinology. It deserves to be further evaluated in a large-scale study focused on epidemiological, clinico-biological and etiological investigation, in order to assess its prevalence and better define its profile in our context.
基金This project was supported by a grant of Henan Provincial Bureau of Science and Technology (No. 0424410097).
文摘Summary: To determine the (tttta) n repeat polymorphisms at the promoter region of CYP11α gene, and study its linkage to hyperandrogenism of polycystic ovary syndrome (PCOS) in Chinese women, a case-control study was conducted in the Reproductive Medical Center of the Second Affiliated Hospital of Zhengzhou University (Zhengzhou, China). 96 PCOS patients and 78 healthy control women were included. CYP11α (tttta) n repeat-polymorphism genotyping analysis was performed by using polymerase chain reaction (PCR). Serum pituitary hormone and total testosterone levels were measured by ELISA. 4 different CYP11α (tttta) n allelles were identified, corresponding to 4-, 6-, 8-, and 9-repeat-unit alleles. The frequency and distribution of these alleles are 0.16, 0.33, 0.38, and 0.13 respectively in PCOS patients, as compared with 0.20, 0.34, 0.35, and 0.11 respectively in healthy controls. There were no significant differences between these two groups. Moreover, no correlation between the polymorphism of CYP11α gene and serum testosterone level of patients with PCOS and controls was observed. It is concluded that microsatellite polymorphism (tttta) n of gene CYP11α exists in Chinese women and the polymorphism of CYP11α gene does not play an important role in the pathogenesis of Chinese patients with PCOS, especially in patients with hyperandrogenism.
基金supported by the Key Project of Chinese National Programs for Fundamental Research and Development (973 Program, 2012CBA01306)the National Natural Science Foundation of China (81471429)
文摘Polycystic ovary syndrome（PCOS） is a common reproductive disease with high heterogeneity. The role of excess androgen in PCOS etiology remains disputed, since around 20%-50% of PCOS women do not display hyperandrogenemia. The microenvironment of the ovary critically influences follicular development. In the present study, we assessed the role of androgen in PCOS by investigating whether excessive follicular fluid androgen was present in PCOS patients with normal serum androgen levels and influenced by follicular fluid insulin resistance（IR）.Follicular fluid samples of 105 women with PCOS and 105 controls were collected. Levels of steroid hormones,glucose and insulin in the follicular fluid were examined and compared with data from serum biochemistry tests. We found that 64.9%（63/97） of PCOS patients with normal serum androgen levels displayed abnormally high follicular fluid androgen level. The follicular fluid androgen level was positively correlated with follicular fluid IR within a certain range and follicular fluid estrogen-to-testosterone（E2/T） ratio was significantly reduced in these patients.These results indicated that there existed a subgroup of PCOS patients who displayed excessive follicular fluid androgen and IR despite their normal circulating testosterone（T） levels. Our study highlights the importance of ovary hyperandrogenism and IR in the etiology of PCOS.
文摘Women with both type 1 diabetes and polycystic ovarian syndrome (PCOS) represent a unique population, with long term implications on fertility and diabetic complications, which need to be addressed. The studies reviewed herein address the increased incidence of PCOS in women with type 1 diabetes. The leading theories suggest that the underlying pathophysiology is related to intensive insulin therapy and resulting ovarian hyperandrogenism. We have searched the literature to determine what studies have been done to address the role of insulin resistance and insulin sensitizers for reduction of hyperandrogenism in these patients. According to the available evidence, we conclude that metformin may have a role in reducing the androgenic picture in type 1 patients with PCOS and insulin resistance.
基金This work was supported by grants from the National Natural Science Foundation of China （No. g1370680）, Key-projects of Clinical Research of Ministry of Health （No. WGCH[2010]439）, The Specialized Research Fund for the Doctoral Program of Chinese Minis- try of Education （No. 20130171130009）, and Science and Technology Project of Guangdong Province （No. 2013020012660）.. Conflict of Interest： None declared.
文摘Background：Polycystic ovary syndrome （PCOS） is the commonest endocrinopathy in women of reproductive age.The patients often develop insulin resistance （IR） or hyperinsulinemia despite manifesting anovulation and signs of hyperandrogenism.The cause and effect relationship of hyperinsulinemia and hyperandrogenemia （HA） is still debated.Micro-ribonucleic acids （miRNAs） have recently been shown to play a role in regulation of ovarian function.Our current study focused on the altered expression of miRNAs with PCOS.Methods：Ovarian theca intema tissues were obtained from 10 PCOS patients and 8 controls that were non-PCOS and had normal insulin sensitivity undergoing laparoscopy and/or ovarian wedge resection.Total RNA of all samples was extracted.We studied the repertoire of miRNAs in both PCOS and non-PCOS women by microarray hybridization.Bioinformatic analysis was performed for predicting targets of the differentially expressed miRNAs.Furthermore,selected miRNAs were validated by quantitative reverse transcriptase polymerase chain reaction （qRT-PCR）.Results：A total of 27 miRNAs were differentially expressed in PCOS patients with respect to the controls in our discovery evaluationand two （miR-92a and miR-92b） of them were significantly downregulated in PCOS women in followed validation （P 〈 0.05）.Targets prediction revealed that miR-92a targeted both GATA family of zinc finger transcription factor GATA-binding factor 6 （GATA6） and insulin receptor substrate proteins 2 （IRS-2）.Conclusions：MiRNAs are differentially expressed between PCOS patients and controls.We identified and validated two miRNAs-miR-92a and miR-92b.They are significantly downregulated and may be involved in the pathogenesis of PCOS.
基金Supported by National Natural Science Foundation of China(Molecular Mechanism Research on Intervention Polycystic Ovary Syndrome of Infertility with Chinses Medicine Based on Androgen-Androgen Receptor Pathway,No.81072839)
文摘OBJECTIVE: To observe the efficacy and safety of different dosages of modified Zhibaidihuang decoction(MZBDD) on polycystic ovary syndrome(PCOS) hyperandrogenism(HA) patients.METHODS: Ninety PCOS HA patients and 30 infertile patients due to tubal factor were selected. Ninety PCOS HA patients were randomly divided into three groups: low dosage group(LDG), medium dosage group(MDG) and high dosage group(HDG) and infertile patients were selected as normal control group(NCG). PCOS HA patients were treated with different dosage of MZBDD for 4 weeks. For HA patients, serum total testosterone(T), estrodial(E2), follicle stimulating hormone(FSH), luteinizing hormone(LH), prolatin(PRL), alanine aminotransferase(AST), aspartate amino transferase(AST) were determined before and after treatment, while acne scores(Rosenfield) were signed. Basal body temperatures(BBT) were asked to be measured every day. And for the else, T, E2,FSH, LH, PRL, AST, and AST were determined before treatment.RESULTS: Totally 111 patients completed the clinical research. There were no differences among the four groups on serum T before treatment(P =0.221). Serum T concentration of both MDG and HDG after treatment significantly were lower than that of before treatment(P = 0.039, P = 0.000),while there was no obvious difference in LDG(P =0.829). Serum T concentration of both MDG and HDG were significantly lower than that of LDG after treatment(P = 0.048, P = 0.006). To compared with before treatment, there were no differences in Serum FSH, LH, E2, P and PRL among the three groups(LDG, MDG, HDG)(as for FSH, P = 0.136, P = 0.503,P = 0.062; as for LH, P = 0.473, P = 0.513, P = 0.096;as for E2, P = 0.206, P = 0.927, P = 0.076; as for PRL,P = 0.120, P = 0.903, P = 0.407, as for P, P = 0.308, P =0.866, P = 0480). Acne scores of all the three groups were obviously lower than that of before treatment(P = 0.031; P = 0.033; P = 0.002). 39.5% of the patients had biphasic BBT, but there were no differences among the three groups(P = 0.510). There were no differences with ALT and AST between after and before treatment among the three groups(LDG, MDG, HDG)(as for ALT, P = 0.742, P = 0.383,P = 0.053; as for AST, P = 0.732, P = 0.519, P = 0.120).CONCLUSION: Different dosage of MZBDD has dose-effect relationship in treating PCOS HA.
基金Supported by the Joint Funds for Innovation of Science and Technology of Fujian Province(No.2018Y9046)the Qihang Foundation Project of Fujian Medical University of China(No.2018QH1023)。
文摘Objective:To explore the effect of curcuminon the insulin receptor substrate1(IRS1)/phosphatidylinositol-3-kinase(PI3K)/endometrial expression of glucose 4(GLUT4)signalling pathway and its regulator,phosphatase and tensin homolog(PTEN),in a rat model of polycystic ovarian syndrome(PCOS).Methods:PcoS model was induced by letrozole intragastric administration.Sprague-Dawleyrats were randomized into 4groups according to a random number table:(1)control group;(2)PcoS group,which was subjected to PCOS and received vehicle;(3)curcumin group,which was subjected to PCoS and treated with curcumin(200 mg/kg for 2 weeks);and(4)curcumin+LY294002 group,which was subjected to PCOS,and treated with curcumin and LY294002(a specific PI3K inhibitor).Serum hormone levels(17β-estradiol,follicle stimulating hormone,luteinizinghormone,progesterone,and testosterone)were measured by enzyme linked immunosorbentassay,and insulin resistance(IR)was assessed using the homeostasismodel assessment of IR.Ovarian tissues were stained with haematoxylin and eosin for pathological and apoptosis examination.Expression levels of key transcriptional regulators and downstream targets,including IRS1,Pl3K,protein kinase B(AKT),GLUT4,and PTEN,were measured via reverse transcription polymerase chain reaction and Western blot,respectively.Results:The Pcos group showed impaired ovarian morphology and function.Compared with the PCoS group,curcumin treatment exerted ovarioprotective effects,down-regulated serum testosterone,restored IR,inhibited inflammatory cell infiltration in ovarian tissues,decreased IRS1,PI3K,and AKT expressions,and up-regulated GLUT4 and PTEN expressions in PCOS rats(P<0.05orP<0.01).In contrast,IRS1,PI3K,AKT,and PTEN expression levelswerenot significantly different between PCOS and curcumin+LY294002 groups(P>0.05).Conclusion:The beneficial effects of curcumin on PCOS rats included the alteration of serum hormone levels and recovery of morphological ovarian lesions,in which,PTEN,a new target,may play a role in regulating the IRS1/PI3K/GLUT4 pathway.
基金Shanxi Province“136”Revitalization Medical Project Construction Funds,No.2019XY003.
文摘BACKGROUND Polycystic ovary syndrome(PCOS)is closely related to obesity,and weight loss can significantly improve the metabolic,endocrine and reproductive functions of obese individuals with PCOS.However,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are unclear.AIM The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.METHODS A retrospective analysis was performed on 32 obese patients with PCOS who received LSG treatment at the Third Hospital of Shanxi Medical University from 2013 to 2020.The changes in anthropometric indices,insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH),menstrual cycle and LH/FSH ratio before and 1 mo,3 mo,6 mo and 12 mo after the operation were statistically analyzed.RESULTS At 1 mo,3 mo,6 mo and 12 mo after surgery,the anthropometric indices,such as body weight and body mass index,of all patients were lower than those before the operation.The percentage excess weight loss(EWL%)at 1 mo,3 mo,6 mo and 1 year of follow-up were 25,40,46 and 65,respectively.The PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying degrees.During the 1-year follow-up,the average serum testosterone decreased from preoperative 0.72 ng/mL to 0.43 ng/mL(P<0.05),average fasting insulin level(9.0 mIU/mL,preoperative 34.2 mil,LH level,4.4 mIU/mL,preoperative 6.1 mIU/mL).The level of FSH(3.8 U/L,4.8 U/p0.05)and the ratio of LH/FSH(0.7,1.3/p0.05)were more relieved than those before surgery.During the postoperative follow-up,it was found that the menstrual cycle of 27 patients(nasty 27)returned to normal,and 6 patients(18%)who intended to become pregnant became pregnant within 1 year after surgery.CONCLUSION The weight loss effect of LSG is obvious and affirmative,and the endocrine index of obese patients with PCOS is also improved to some extent,although the mechanism is not clear.Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.
基金The Budget Project of Shanghai University of Traditional Chinese Medicine(2020LK083)General Project of Traditional Chinese Medicine Research of Shanghai Hongkou District Health Association(HKQ-ZYY-2021-15)+2 种基金Shanghai Natural Science Foundation Project(19ZR1451700)Shanghai Young Science and Technology Talents Sailing Program Project(20YF1445800)Chinese Medicine Research Project of Shanghai Health and Wellness Committee(2020JQ004)。
文摘Objective:To observe the clinical effect of electroacupuncture on improving polycystic ovary syndrome(PCOS)of kidney deficiency and phlegm dampness type and serum oxidative stress level.Methods:There were 68 patients with polycystic ovary syndrome were randomly divided into observation group(34 cases)and the control group(34 cases),The observation group was treated by electroacupuncture,while the control group was treated by placebo electroacupuncture.Combined with the evaluation of menstrual cycle,menstrual color,quality,quantity and TCM symptom integral index,the difference of curative effect between the two groups was observed,and the levels of peripheral blood,sex hormones,insulin resistance and oxidative stress were detected before and after treatment for 3 months.Results:The total effective rate in the observation group was better than that in the control group(P<0.01);After intervention,serum LH,FSH,E_(2) and LH/FSH in the observation group were significantly different from those before intervention.The D values of serum LH,FSH,LH/FSH and E_(2) before and after intervention were significantly different between the two groups(P<0.01);Comparing the level of androgen,the serum A4 and T in the observation group were significantly different from those before intervention(P<0.01);After intervention,there was a significant difference in serum A4 and T between the two groups(P<0.01),and there was a significant difference in D value between the two groups before and after intervention;There was a difference in insulin resistance in the observation group before and after intervention(P<0.05),and there was a significant difference in D value between the two groups before and after intervention(P<0.01);After the intervention,the serum SOD,MDA,ROS in the observation group were significantly different from those before the intervention;After intervention,the results of serum SOD and ROS in the observation group were significantly different from those in the control group;There was no significant difference in serum MDA results.There were significant differences in SOD,MDA,ROS between the two groups before and after intervention.Conclusion:Electroacupuncture can improve oxidative stress injury,insulin resistance and hyperandrogenism in PCOS patients.
文摘Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease in the Western world comprising a spectrum of liver damage from fatty liver infiltration to end-stage liver disease,in patients without significant alcohol consumption.Increased prevalence of NAFLD has been reported in patients with polycystic ovary syndrome(PCOS),one of the most common endocrinopathies in premenopausal women,which has been redefined as a reproductive and metabolic disorder after the recognition of the important role of insulin resistance in the pathophysiology of the syndrome.Obesity,in particular central adiposity and insulin resistance are considered as the main factors related to NAFLD in PCOS.Moreover,existing data support that androgen excess,which is the main feature of PCOS and is interrelated to insulin resistance,may be an additional contributing factor to the development of NAFLD.Although the natural history of NAFLD remains unclear and hepatic steatosis seems to be a relatively benign condition in most patients,limited data imply that advanced stage of liver disease is possibly more frequent in obese PCOS patients with NAFLD.PCOS patients,particularly obese patients with features of the metabolic syndrome,should be submitted to screening for NAFLD comprising assessment of serum aminotransferase levels and of hepatic steatosis by abdominal ultrasound.Lifestyle modifications including diet,weight loss and exercise are the most appropriate initial therapeutic interventions for PCOS patients with NAFLD.When pharmacologic therapy is considered,metformin may be used,although currently there is no medical therapy of proven benefit for NAFLD.Long-term follow up studies are needed to clarify clinical implications and guide appropriate diagnostic evaluation,follow-up protocol and optimal treatment for PCOS patients with NAFLD.
文摘Insulin has complex effects on cell growth,metabolism and differentiation,and these effects are mediated by a cell-surface bound receptor and eventually a cascade of intracellular signaling events.Among the several metabolic and growth-promoting effects of insulin,insulin resistance is defined as an attenuated effect of insulin on glucose metabolism,primarily the limited export of blood glucose into skeletal muscle and adipose tissue.On the other hand,not all the signaling pathways and insulin-responsive tissues are equally affected,and some effects other than the metabolic actions of insulin are overexpressed.Ovaries and the adrenal glands are two examples of tissues remaining sensitive to insulin actions where insulin may contribute to increased androgen secretion.Polycystic ovary syndrome(PCOS)is the most common form of androgen excess disorder(AED),and its pathogenesis is closely associated with insulin resistance.Patients with idiopathic hirsutism also exhibit insulin resistance,albeit lower than patients with PCOS.Although it is not as evident as in PCOS,patients with congenital adrenal hyperplasia may have insulin resistance,which may be further exacerbated with glucocorticoid overtreatment and obesity.Among patients with severe insulin resistance syndromes,irrespective of the type of disease,hyperinsulinemia promotes ovarian androgen synthesis independently of gonadotropins.It is highly debated in whom and how insulin resistance should be diagnosed and treated among patients with AEDs,including PCOS.It is not suitable to administer an insulin sensitizer relying on only some mathematical models used for estimating insulin resistance.Instead,the treatment decision should be based on the constellation of the signs,symptoms and presence of obesity;acanthosis nigricans;and some laboratory abnormalities such as impaired glucose tolerance and impaired fasting glucose.
文摘Hyperandrogenism and hyperinsulinemia have resulted from dysfunction of the theca cell of the ovary and adipose tissue and each one potentiates the other in patients with androgen excess disorders e.g.,polycystic ovary disease and idiopathic hirsutism.Possible external and/or internal triggers can produce such cellular dysfunction.There is evidence that sodium valproate acts as a trigger of cellular dysfunction and produces both hyperinsulinemia and hyperandrogenism.Therefore,the elimination of these triggers can help the patients to recover from hyperinsulinemia,insulin resistance and hyperandrogenism.
文摘The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.
文摘Ovarian Leydig cell tumor, a sub-type of ovarian steroid cell tumor, accounts for less than 0.1% of all ovarian tumors. It can affect women of any age group but is most common in postmenopausal women. We here report a case of virilizing ovarian Leydig cell tumor with multiple non-functional endocrine neoplasias (pituitary and adrenal adenomas) in a 48-year-old woman. She first presented with sub-abdominal pain and hirsutism since menopause three years ago. Subsequently, she had slight facial acne, voice deepening, breast atrophy, and a prominent Adam’s apple. Her hormone profile showed an elevated level of testosterone, high free androgen index, low levels of luteinizing hormone and follicle stimulating hormone, and normal levels of random cortisol, androstenedione, 17-hydroxyprogesterone and dehydroepiandrosterone sulfate. A pelvic enhanced magnetic resonance imaging (MRI) scan showed nodules in the right ovary, and a pituitary enhanced MRI revealed a microadenoma. An enhanced computerized tomography scan of the adrenal gland revealed left adrenal nodules, possibly adenomas. After a right cystectomy and right fallopian tube resection, her testosterone level declined to 0.38 nmol/L and the symptoms associated with hyperandrogenism improved. This is a rare case of virilizing ovarian Leydig cell tumor with multiple non-functional endocrine neoplasias. We believe our findings will be helpful in the clinical diagnosis and treatment of hyperandrogenism.
文摘Introduction: Polycystic Ovarian Syndrome (PCOS), also known as Stein Leventhal Syndrome, is one of the common endocrine diseases affecting women of childbearing age and the leading cause of anovulatory infertility worldwide. The aim of this study was to describe the clinical, paraclinical and therapeutic aspects of PCOS at the University Clinic of Obstetrics and Gynaecology of the National Hospital and University Centre Hubert Koutoukou MAGA of Cotonou (CNHU). Patients and Method: The study was doing in the University Clinic of Gynecology and Obstetrics of the CNHU-HKM. This was a descriptive and analytical longitudinal study with retrospective and prospective data collection over a period of 7 years from January 2015 to December 2021. It focused on women of childbearing age seen in gynecological consultation. Results: The frequency of PCOS was 2.53%. The mean age of the patients was 27.28 ± 6.55 years. They were educated for the most part with a university level in 43.8% of cases. Obstetrically they were nulligest (45.63%) and nulliparous in 60% of cases. The history of spontaneous miscarriages was found in 61.11%. The main reasons for consultation were menstrual disorders (51%) followed by the desire for pregnancy (40.6%). Clinically, obesity (30%), overweight (33.1%), high blood pressure (20.63%), hirsutism (24%) and acne (27%) were noted. All the women had micropolycystic ovaries in ultrasound. Testosterone was elevated in 61% of cases. Phenotype D was found in 45.63% of patients. All these patients were put under lifestyle and dietary measures, Metformin (13.80%) and estrogen-progestogen (18.80%). The outcome of the treatment was assessed by cycle regularity, regression of hirsutism, weight loss, fertility and fertility. The cycle was normalised in most cases with notable regression of physical signs of hyperandrogenism. The cycle was normalized in most cases with the notable regression of physical signs of hyperandrogenism. We had recorded 25 pregnancies including one miscarriage. The occurrence of pregnancy was obtained in 50% of these women after 12 months and in less than 20% after 24 months. Conclusion: PCOS was common in the CUGO of the CNHU-HKM. A population-based epidemiological study seems necessary to better appreciate the risk factors of this endocrine syndrome and its repercussions on fertility and metabolic diseases such as type 2 diabetes, obesity and hypertension.
文摘Background: Hirsutism is a clinical situation in Cameroon which is poorly elucidated due to a paucity of clinical and biological data;hence our interest in this study. The aim of this work was to describe the clinical, psycho-social and metabolic profile of women with hirsutism in Yaoundé. Materials and Methods: This was a descriptive cross-sectional study carried out from May 2013 to December 2013. Participants were recruited by announcement through social media. Our study included women at least 18 years old, not in menopausal, not pregnant, not breastfeeding, with hirsutism regardless of severity. They were assessed through an interrogation, anthropometric parameters, a physical examination using the modified Ferriman and Gallwey score, the measurement of fasting capillary blood glucose and a lipid profile. The psycho-social assessment was carried out using a pre-designed questionnaire on the participant’s perception and daily experience with hirsutism. The metabolic syndrome was established according to the criteria of the International Diabetes Federation of 2005 and the National Cholesterol Education Program-third adult treatment panel of 2001. Results: We recruited 60 women aged 27.6 ± 7.0 years. The median Ferriman and Gallwey score was 12. The mean duration of evolution was 9 years. A family history of hirsutism was found in 88.8% of the participants, especially in the mother. Signs of virilization were found in 3.3% of the participants. Association was found between menstrual cycle abnormalities and severity of hirsutism (p = 0.023). Psycho-socially, 58.8% of women found hirsutism normal. The metabolic syndrome was found in 21.7% and 18.3% according to the IDF and NCEP-ATP III, respectively. Conclusion: Hirsutism in our context seems normal to most of our participants. It is, however, associated with menstrual irregularities, signs of virilization and metabolic syndrome. As a result, hirsutism merits further study on a large-scale with emphasis on etiology.
文摘Introduction: This study aims to describe the outcome of adrenocortical cancer in children through observation. Observation: A 10-year-old girl with no previous pathological history. She presented headaches and severe hypertension with clinical and biological signs of hyperandrogenism for 6 months. An abdominal CT scan showed an encapsulated left adrenal mass without local or regional invasion or secondary location. A pheochromocytoma or adrenal neuroblastoma was first suspected. The blood pressure was stable at 130/65 mmHg under antihypertensive drugs. She underwent a complete tumor resection without any intraoperative incident. The pathologic study confirmed the adrenocortical carcinoma scored Weiss 7. The severe high blood pressure reappeared 2-year later despite antihypertensive drugs. The thoracic abdominal and pelvic CT scan showed a locally advanced tumor recurrence in the left adrenal gland with parenchymal nodes in the lungs and liver. The outcome was fatal despite medical and surgical management. Conclusion: Adrenocortical cancer is a rare tumor. It is important to hormonal testing in the presence of Cushing’s syndrome in children. It can give a strong indication of the diagnostic possibilities. Histology confirms the diagnosis. The evolution is covered by complications, in particular recurrence with life-threatening metastases.
文摘Polycystic ovary syndrome(PCOS)is a condition in which a woman has increased levels of male hormones(androgens).Many problems occur as a result of this increase of hormones,including:Menstrual irregularitiesInfertility,Skin problems such as acne and increased hair growth,Increased number of small cysts in the ovaries.
文摘Polycystic ovary syndrome(PCOS),a common endocrine disorder with metabolic and reproductive consequences,affects a significant percentage of women of reproductive age.Because of its complexity and impact on the quality of life,PCOS requires timely diagnosis and screening for complications.The most common clinical manifestations of PCOS are hirsutism,hyperandrogenism,acne,irregular cycles,amenorrhea,and anovulation.Although PCOS has different clinical manifestations in women,hyperandrogenism,and anovulation are the most common symptoms.A good medical history,examination,blood tests,and ultrasound findings facilitate the diagnosis of PCOS.Novel treatments have also undergone clinical trials to improve the symptoms of PCOS.However,comprehensive review articles investigating the different communities of this disease are limited,and this review aimed to collect data on the different etiologies of PCOS along with the latest diagnostic methods and the most common and up-to-date treatments for this disease.
文摘Objective To investigate the differences of endocrine and metabolic characteristics in PCOS women among different subtypes. Methods A total of 249 PCOS women were classified into 4 subtypes by Rotterdam criteria： hyperandrogenism （HA） and oligo-ovulation/anovulation （0） and PCO ultrasonography （P） （HA＋O＋P, group A, 111 women）; HA＋O （group B, 9 women）; HA＋P （group C, 22 women） and O＋P （group D, 107 women）. Another 110 infertii＇e women with tubal defects constituted a control group. Endocrine and metabolic characteristics were compared among the 5 groups. PCOS women were then reclassified into 2 groups, according to whether they have hyperandrogenism or not. Endocrine ond metabolic characteristics were then compared again. Results The levels of androstenedione （A）, testosterone （T） and LH/FSH were the highest in group A and group C, secondly in group D, the lowest was in control group. A, T and LH/FSH were the highest in hyperandrogenism group, secondly in non- hyperandrogenism group, whereas the control was the lowest. Menstrual cycle and BMI correlated with glucose and lipid metabolism but showed no correlateion with T and A. Hyperandrogenism group had higher fasting glucose （FG）, glucose at 60 min （G60） and glucose levels under the curve （GLUAUC） and lower disposition index （DI） than non-hyperandrogenism group, however, menstrual cycle, BMI and the lipid indicators had no difference. Conclusion Hyperandrogenism is an important characteristic in F＇COS women. Thus it might be used to classify PCOS into 2 subgroups. Hyperandrogenism and lipid disorders for the formation of PCOS often coexist but each has individual pathogenesis.
