Cardiovascular Risk Factors in Bulgarian Patients with Polycystic Ovary Syndrome and/or Obesity

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disturbances in women of reproductive age. Besides its well-known effects on reproductive health, it is also linked to increased cardiovascular risk in later life. The aim of this study is to investigate some classical cardiovascular risk factors in a crossectional study of Bulgarian women with PCOS and/or obesity. We performed a retrospective medical chart review of 375 women from an university endocrine clinic. We found significant differences in the indices of carbohydrate metabolism, blood pressure, lipid profile, rate of liver steatosis, and the levels liver enzymes and hematological results between the lean and obese PCOS women. Obese women without PCOS did not show significantly different results in their OGGT form obese PCOS women. Waist-to-stature-ratio (WSR) correlated better with the baseline IRI levels and lipid profile than waist-to-hip-ratio (WHR) that makes it a better marker for unfavorable metabolic profile

Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistance

Background: Insulin resistance plays a key role in the pathogenesis of polycystic ovarian syndrome (PCOS). One of the methods for correcting insulin resistance is using myo-inositol. Aim: The aim of the present study is to evaluate the effectiveness of myo-inositol alone or in combination with clomiphene citrate for (1) induction of ovulation and (2) pregnancy rate in anovulatory women with PCOS and proven insulin resistance. Patients and methods: This study included 50 anovulatory PCOS patients with insulin resistance. All of them received myo-inositolduring three spontaneous cycles. If patients remained anovulatory and/or no pregnancy was achieved, combination of myo-inositol and clomiphene citrate was used in the next three cycles. Ovulation and pregnancy rate, changes in body mass index (BMI) and homeostatic model assessment (HOMA) index and the rate of adverse events were assessed. Results: After myo-inositol treatment, ovulation was present in 29 women (61.7%) and 18 (38.3%) were resistant. Of the ovulatory women, 11 became pregnant (37.9%). Of the 18 myo-inositol resistant patients after clomiphene treatment, 13 (72.2%) ovulated. Of the 13 ovulatory women, 6 (42.6%) became pregnant. During follow-up, a reduction of body mass index and HOMA index was also observed. Conclusion: Myo-inositol treatment ameliorates insulin resistance and body weight, and improves ovarian activity in PCOS patients

[Reviews] Endocrine aspects of obstructive sleep apnea

[Abstract] Obstructive sleep apnea (OSA) is a common clinical condition that has variety of adverse effects on human health. Studies suggest that OSA increases the cardiovascular risk, and a link between OSA and glucose metabolism has been described. Some endocrine and metabolic conditions (obesity, acromegaly, hypothyroidism, polycystic ovary disease, etc.) can be associated with OSA that may be improved by treatment of underlying endocrine disorders like hypothyroidism and acromegaly, where OSA is mainly related to upper airways narrowing due to reversible thickening of the pharyngeal walls. In other cases proper treatment of OSA has a beneficial effect on different endocrine disturbances. Central obesity is an important risk factor both in diabetes and sleep apnea, and recent evidence supports the direct association between them. There may be a positive feed back circle between the two disorders : sleep problems may affect endocrine function and metabolic conditions, while metabolic abnormalities potentially interfere with sleep regulation

[Reviews] Endocrine aspects of obstructive sleep apnea

publisher[Abstract] Obstructive sleep apnea (OSA) is a common clinical condition that has variety of adverse effects on human health. Studies suggest that OSA increases the cardiovascular risk, and a link between OSA and glucose metabolism has been described. Some endocrine and metabolic conditions (obesity, acromegaly, hypothyroidism, polycystic ovary disease, etc.) can be associated with OSA that may be improved by treatment of underlying endocrine disorders like hypothyroidism and acromegaly, where OSA is mainly related to upper airways narrowing due to reversible thickening of the pharyngeal walls. In other cases proper treatment of OSA has a beneficial effect on different endocrine disturbances. Central obesity is an important risk factor both in diabetes and sleep apnea, and recent evidence supports the direct association between them. There may be a positive feed back circle between the two disorders : sleep problems may affect endocrine function and metabolic conditions, while metabolic abnormalities potentially interfere with sleep regulation

Relationship of serum Fetuin-A with metabolic and vascular parameters in patients with prediabetes and type 2 diabetes mellitus

Background: Fetuin-A is a multifunctional liver-derived glycoprotein that is associated with insulin resistance and might play a role in the pathogenesis of prediabetes and type 2 diabetes (T2DM). Objective: This study evaluated the relationship of Fetuin-A with metabolic and vascular parameters in patients with prediabetes and T2DM. Materials and methods: total 120 obese patients were included. They were divided into three groups: group 1 – without carbohydrate disturbances, group 2 – with prediabetes and group 3 – with type 2 diabetes mellitus. Results: Higher Fetuin-A serum levels were observed in patients with prediabetes and T2DM compared to those with normoglycemia. Fetuin-A ≥821 mcg/ml increased the risk for T2DM 32-fold. Additionally, we found positive correlations between Fetuin-A, vibration perception threshold and toe-brachial index and a negative correlation with neuropathy disability score. Conclusion: Fetuin-A could be predictive for incidents of prediabetes and T2DM

Serum anti-α-crystallin antibodies in women with endocrine disorders

There is a distinct group among the patients with unexplained infertility who are found to have enhanced humoral immune response. Recent studies focus on the expression of stress proteins being an important factor in the stages of gametogenesis, fertilization, implantation, early embryonic development and pregnancy. Increased expression of stress proteins and immune response against them was found in tissues exposed to stress. There is not enough data linking infertility to expression and immunity of α-crystallins in patients with endocrine diseases. The aim of this work was to study anti-α-crystallin antibodies in patients with polycystic ovary syndrome (PCOS), Graves’ disease, autoimmune thyroiditis, diabetes mellitus and obesity. Sera samples from 169 women with endocrine disorders (PCOS (n = 68); Graves’ disease (n = 26); autoimmune thyroiditis (n = 32); diabetes mellitus (n = 10); and obesity (n = 33)) were tested by ELISA. The statistical analysis was performed using SPSS program. The concentration of anti-α-crystallin antibodies is significantly elevated in the PCOS group compared to the control group (p = 0.021). The frequency of positive sera in the same group of patients is significantly higher compared to the control group (p = 0.029). In all other groups, no statistically significant elevation was observed. Elevated concentrations of anti-α-crystallin antibodies found in patients with PCOS suggest that the increased production of anti-α-crystallin antibodies in women with PCOS is most probably caused by failure of the immune tolerance and the induction of immune response. This is most likely due to an increased expression of this stress protein as a result of oxidative stress and chronic inflammation