Phenotypic expression, body mass index and insulin resistance in relation to LH levels in women with polycystic ovary syndrome

Objective: To evaluate LH levels in women with the classic (1990 criteria) and the newer (2003 criteria) PCOS phenotypes, and to examine the impact of BMI and insulin resistance indices on hormone levels. Study design: In this controlled clinical study 936 women with PCOS, classified as classic (n = 729) and newer (n = 207), and 204 controls were included. All women were divided into normal-weight (BMI < 25 kg/m 2 ) and overweight plus obese (BMI ≥ 25 kg/m 2 ). Serum LH, FSH, anthropometrics, androgens, fasting insulin and glucose, HoMA-IR, number of follicles, and ovarian volume were assessed. Results: Women with classic PCOS presented significantly higher LH and LH/FSH ratios, and lower glucose/insulin levels than those with the newer phenotype and controls. Overweight plus obese women of all groups had lower LH levels than normal-weight women. Independent positive correlations between LH and androgens and negative correlation between LH and BMI were found. Conclusions: The higher LH concentrations of the classic phenotypes of PCOS could be attributed to the higher androgen levels, which desensitize the hypothalamus to the negative feedback regulation by progesterone. Moreover, the lower LH levels of overweight plus obese women of all groups could be attributed to the increased peripheral aromatization of androgens to estrogens in adipose tissue leading to suppression of LH secretion. Condensation: Both normal-weight and overweight women with classic PCOS phenotypes present higher LH levels and LH-to-FSH ratios than women with similar BMI but the newer phenotypes. © 2011 Elsevier Ireland Ltd. All rights reserved

Effect of hypocaloric diet plus sibutramine treatment on hormonal and metabolic features in overweight and obese women with polycystic ovary syndrome: A randomized, 24-week study

Objective: To examine the effect of hypocaloric diet plus sibutramine on body composition, hormonal and metabolic parameters in overweight and obese patients with polycystic ovary syndrome (PCOS). Design: Open-label, randomized study at an outpatient clinic. Patients: A total of 59 overweight and obese (18-39 years old) women with PCOS. Measurements: All patients were placed in a hypocaloric diet plus sibutramine (10 mg per day) for the first month and then on a hypocaloric diet plus sibutramine (10 mg per day, group S) or hypocaloric diet only (group D) for the subsequent 6 months. Body composition, hormonal and metabolic features and insulin sensitivity (oral glucose tolerance test, OGTT) were evaluated at baseline and at 3 and 6 months of treatment. Results: Body weight reduced in both groups but the reduction was greater with sibutramine (-15.4±1.1 vs -11.1±1.9% in groups S and D, respectively, P<0.05). At 6 months, a greater percent of patients lost more than 10% of initial body weight in group S than D (81 vs 52.9%). In both groups, all women with abnormal OGTT at baseline presented normal glucose tolerance after 6 months. Free androgen index (FAI), glucose area under the curve and fasting triglyceride (TG) concentration were reduced after 6 months in group S only (P<0.05). No changes in cardiovascular risk factors, prolactin and hepatic enzymes levels were observed in both groups. Conclusion: A hypocaloric diet and a diet plus sibutramine both result in significant weight loss in overweight and obese women with PCOS. Patients who received sibutramine showed a greater weight loss and improvement in hyperandrogenemia and insulin sensitivity after 6 months of treatment. The amelioration of insulin resistance in this group could not be totally explained by weight loss. Total testosterone, FAI and TG levels reduction could be a possible mechanism. Finally, sibutramine increased compliance to diet and it was well tolerated from these patients. © 2008 Nature Publishing Group All rights reserved

Comparative study of the intravenous chemoprophylaxix versus local Sulmycin (R) Implant E Sponge use in vaginal hysterectomy

Objective: The aim of this comparative study was to ascertain the efficacy of the Sulmycin (R) Implant E, an antiseptic sponge, on the incidence of peri-and postoperative morbidity in patients subjected to vaginal hysterectomy. Material and methods: This eleven-year study included 228 patients undergoing vaginal hysterectomy. The patients were divided into two groups. Group A included 169 participants with benign diseases (fibroids, dysfunctional uterine bleeding and prolapse) and group B included 59 patients with early stage endometrial cancer or atypical hyperplasia. Women of both groups were further divided into three subgroups: (a) receiving a single dose of intravenous cefuroxime (2 gr) (group A: 55, group B: 19), (b) receiving three doses of intravenous cefuroxime (2 gr) (group A: 54, group B: 19), and (c) locally placed a collagen sponge containing gentamycin (Sulmycin (R) Implant E) (group A: 60, group B: 21). Results: The number of postoperative infections (mainly urinary tract infections) did not differ between women of the three subgroups of patients in both groups. There were no important differences affecting the postoperative hospitalization, healing procedure and adhesion of the cuff between women of the three subgroups in both groups. Conclusion: The local chemoprophylaxis with Sulmycin (R) Implant E, a collagen sponge containing gentamycin and placed on the vaginal cuff, is well tolerated and equally effective as intravenous antibiotics

Decreased active, total and altered active to total ghrelin ratio in normal weight women with the more severe form of polycystic ovary syndrome

Objective: To assess total, active and active to total serum ghrelin ratio in normal weight women with polycystic ovary syndrome (PCOS) and in healthy ovulatory control women.Study design: The study included 50 normal weight women with PCOS with a mean age of 23.70 +/- 4.99 years and 10 control women with a mean age of 30 +/- 5.80 years. The diagnosis of PCOS was based on the presence of biochemical hyperandrogenemia, chronic anovulation and polycystic ovarian morphology according to the Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Serum total and active ghrelin were measured by RIA, using commercially available kits. Results: A significantly lower serum active/total ghrelin ratio was noted in the more severe form of PCOS with hyperandrogenemia, chronic anovulation and polycystic ovarian morphology. Both total and active serum ghrelin levels were negatively correlated to hirsutism score, to plasma glucose levels and to QUICKI and HOMA-IR indices of Insulin Resistance. A statistically significant difference was detected between the more severe and the milder forms of PCOS, concerning serum levels of total ghrelin (p = 0.017), active ghrelin (p = 0.007) and the active/total ghrelin ratio (p = 0.026). Conclusions: The results of the present study demonstrate an altered active to total ghrelin ratio, as well as a tendency towards lower both total and active fasting serum ghrelin levels in normal weight PCOS, more pronounced in the more severe forms of the syndrome. (C) 2009 Elsevier Ireland Ltd. All rights reserved