Clinical observations and hormone screenings of patients with non-standard hypertrophy of the adrenal cortex

Background: Non-standard hypertrophy of the adrenal cortex is a rare endocrinopathy causing the incidence of hyperandrogenism among women of procreative age. The primary objective of this paper is the specification of the clinical picture and modifications of the concentration of pituitary, ovarian and adrenal hormones in the blood of female patients with the syndrome of non-standard hypertrophy of the adrenal cortex (NPKN). Material and methods: In the Gynaecological Endocrinology Clinic of the Silesian Medical University in Katowice, Poland, 2,353 female patients were hospitalised between 1 January 2003 and 30 June 2009 with symptoms of hyperandrogenism. Of these, 55 were selected for the study. Eventually, 25 female patients with diagnosed NPKN, and 30 randomly selected patients with the polycystic ovarian disease polycystic ovary syndrome (PCOS) were enrolled in the study. Results: Of the 2,353 female patients hospitalised in the Gynaecological Endocrinology Clinic with symptoms of hyperandrogenism between 1 January 2003 and 30 June 2009, NPKN was found in 1.2% of them. Patients with NPKN displayed a strong hirsutism, which was significantly more intense than in the comparative group. Insulin resistance was found more frequently in the group of female patients with PCOS (67%) compared to the group with NPKN (40%). Polycystic ovarian disease was more frequently observed in the group of patients with PCOS (93%), compared to the group with NPKN (72%). The average concentration of androstendione in the blood serum in the group of patients with NPKN amounted to 7.60 ng/ml (SD = 3.57) and was significantly higher than in the group of patients with PCOS where it was 3.46 ng/ml (SD = 1.53). The average concentration of free testosterone in the blood serum in the group of patients with NPKN amounted to 7.30 pg/ml (SD = 4.13) and was significantly higher than in the group of patients with PCOS, where it was 2.90 pg/ml (SD =1.43 ). The average concentration of DHEAS in the blood serum in the group of patients with NPKN accounted for 403.23 μg/dl (SD = 192.59), and in the group with PCOS it was 257.39 μg/dl (SD = 63.67). This concentration was statistically significantly higher in the group with NPKN than in the group with PCOS. The average concentration of estradiole in the blood serum in the group with NPKN amounted to 111.98 pg/ml (SD = 113.68), while in the group with PCOS it was 62.39 pg/ml (SD = 31.18). The difference of concentrations between the groups NPKN and PCOS was statistically significant. We found a positive correlation between the 17-OHP concentration after 60 minutes of the ACTH test and the severity of hirsutism in the group of patients with NPKN (r = 0.77896). In addition, we found a correlation between the free testosterone and the 17-OHP concentration after 60 minutes of the ACTH test in the group of patients with NPKN (r = 0.48149). A positive correlation was also reported between the symptom of hypertrophy of the clitoris and the 17-OHP concentration after 60 minutes of the ACTH stimulation test in the group of patients with NPKN (r = 0.77221). In the comparative group of patients with PCOS, there was no correlation between the free testosterone and 17-OHP concentration after 60 minutes of the ACTH test (r = 0.3059). There was also no correlation between the severity of hirsutism and the concentration of 17-OHP concentration analysed after 60 minutes of the ACTH test. In all female patients from the PCOS group, there was a correct size of clitoris. Conclusions: Analysing the clinical picture of the examined population of patients with NPKN enabled us to specify symptoms of disease which were significant for diagnosis, and which helped differentiate NPKN from other endocrinopathies involving hyperandrogenism, including in particular PCOS. Taking everything into consideration, non-standard hypertrophy of the adrenal cortex is a rare cause of hyperandrogenism in women of procreative age. Intense hirsutism and features of virilisation presenting as hypertrophy of the clitoris predominate in the clinical picture of non-standard hypertrophy of the adrenal cortex. The laboratory confirmation of diagnosis of NPKN constitutes the analysis of the 17-OHP level in blood in the ACTH stimulation test. The analyses of free testosterone and its unbound fraction, androstendione and estradiole, help differentiate NPKN from polycystic ovarian disease. (Pol J Endocrinol 2011; 62 (3): 230–237)Wstęp: Nieklasyczny przerost kory nadnerczy jest rzadką endokrynopatią powodującą wystąpienie hiperandrogenizmu u kobiet w wieku rozrodczym. Celem pracy jest ustalenie obrazu klinicznego i zmian stężeń hormonów przysadkowych, jajnikowych i nadnerczowych we krwi pacjentek z zespołem nieklasycznego przerostu kory nadnerczy (NPKN). Materiał i metody: W Klinice Endokrynologii Ginekologicznej Śląskiego Uniwersytetu Medycznego w Katowicach hospitalizowano 2353 pacjentki z objawami hiperandrogenizmu w okresie od 01.01.2003–01.07.2009 r. Spośród nich do badań zakwalifikowano 55 kobiet. Ostatecznie do badań włączono 25 pacjentek z rozpoznanym NPKN i 30 wybranych losowo pacjentek z zespołem policystycznych jajników (PCOS). Wyniki: W liczbie 2353 pacjentek hospitalizowanych w Klinice Endokrynologii Ginekologicznej z objawami hiperandrogenizmu w okresie od 01.01.2003–01.07.2009 r. NPKN wystąpił u 1,2% z nich. U pacjentek z NPKN odnotowano silny hirsutyzm, istotnie bardziej nasilony niż w grupie porównawczej. Insulinooporność występowała częściej w grupie pacjentek z PCOS (67%) w porównaniu z grupą z NPKN (40%). Obraz policystystyczności jajników częściej obserwowano w grupie pacjentek z PCOS (93%) w porównaniu z grupą z NPKN (72%). Średnie stężenie androstendionu w surowicy krwi w grupie z NPKN wynosiło 7,60 ng/ml (SD = 3,57) i było istotnie wyższe niż w grupie z PCOS, w której wynosiło 3,46 ng/ml (SD = 1,53). Średnie stężenie testosteronu wolnego w surowicy krwi w grupie z NPKN wynosiło 7,30 pg/ml (SD = 4,13) i było istotnie wyższe niż w grupie z PCOS, w której to wynosiło 2,90 pg/ml (SD = 1,43 ). Średnie stężenie DHEAS w surowicy krwi w grupie z NPKN wynosiło 403,23 μg/dl (SD = 192,59), a w grupie z PCOS 257,39 μg/dl (SD = 63,67). Stężenie to było istotnie statystycznie wyższe w grupie z NPKN niż PCOS. Średnie stężenie estradiolu w surowicy krwi w grupie z NPKN wynosiło 111,98 pg/ml (SD = 113,68), a w grupie z PCOS 62,39 pg/ml (SD = 31,18). Różnica stężeń pomiędzy grupami z NPKN i PCOS była istotna statystycznie. Stwierdzono dodatnią korelację pomiędzy stężeniem 17OHP w 60. minucie trwania testu z ACTH a nasileniem hirsutyzmu w grupie pacjentek z NPKN (r = 0,77896). Ponadto stwierdzono korelację pomiędzy stężeniami wolnego testosteronu i 17OHP badanego w 60. minucie trwania testu z ACTH w grupie pacjentek z NPKN (r = 0,48149). Dodatnią korelację wykazano również pomiędzy objawem przerostu łechtaczki a stężeniem 17OHP w 60. minucie trwania testu stymulacyjnego z ACTH w grupie pacjentek z NPKN (r = 0,77221). W grupie porównawczej pacjentek z PCOS nie wykazano korelacji pomiędzy stężeniami wolnego testosteronu i 17OHP badanego w 60. minucie trwania testu z ACTH (r=0,3059). Brak było także korelacji pomiędzy nasileniem hirsutyzmu a stężeniem 17OHP oznaczonego w 60. minucie trwania testu z ACTH. U wszystkich pacjentek z grupy PCOS odnotowano prawidłowe wymiary łechtaczki. Wnioski: Analiza obrazu klinicznego badanej populacji pacjentek z NPKN pozwoliła wytypować istotne dla rozpoznania objawy chorobowe, pomocne w różnicowaniu choroby z innymi endokrynopatiami przebiegającymi z hiperandrogenizmem, w tym głównie z PCOS. Podsumowując, nieklasyczny przerost kory nadnerczy jest rzadką przyczyną hiperandrogenizacji kobiet w okresie rozrodczym. W obrazie klinicznym nieklasycznego przerostu kory nadnerczy dominuje silnie nasilony hirsutyzm oraz cechy wirylizacji pod postacią przerostu łechtaczki. Potwierdzeniem laboratoryjnym rozpoznania nieklasycznego przerostu kory nadnerczy jest oznaczenie stężenia 17-OHP we krwi w teście stymulacyjnym z ACTH. Pomocnymi w różnicowaniu zespołu nieklasycznego przerostu kory nadnerczy z zespołem policystycznych jajników są oznaczenia wolnego testosteronu i jego niezwiązanej frakcji, androstendionu i estradiolu. (Endokrynol Pol 2011; 62 (3): 230–237

Circulating omentin-1 levels and inflammation in polycystic ovary syndrome

Objectives: The aim of the study was to analyze interrelation between plasma omentin-1 levels and nutritional status andinflammation in PCOS.Material and methods: A cross-sectional study involving 86 PCOS (47 obese) and 72 Non-PCOS women (41 obese) determinedanthropometric parameters and body composition. Serum glucose, insulin and omentin-1, TNF-α, sTNFRs, IL-6 andsR-IL6 were measured in the fasting state.Results: Plasma omentin-1 levels were significantly lower in the PCOS than in the Non-PCOS group and both correspondingnormal weight and obese subgroups. In three analyzed least-angle regression (LARS) models the lower plasma omentin-1 levels was associated with PCOS occurrence, higher circulating TNF-α and lower IL-6 levels.Conclusions: Suppressed omentin-1 levels in PCOS are characteristic for this disturbance and proinflammatory cytokinesare factors modifying secretion of this adipokine

Circulating vaspin levels and nutritional status and insulin resistance in polycystic ovary syndrome

Objectives: The study aimed to assess the associations between circulating vaspin levels and nutritional status (assessedon tha basis of BMI) as well as insulin resistance in PCOS.Material and methods: Eighty-seven PCOS women, 48 obese and 39 normal weight, were enrolled in the cross-sectionalstudy. Seventy-two Non-PCOS women, 41 obese and 31 normal weight, constituted a control group. Body mass, height andwaist circumference as well as body composition by bioimpedance were measured. In the morning (16h after the last meal)we determined: serum glucose, insulin, androgens, gonadotropin (LH, FSH) and sex hormone-binding globulin (SHBG) aswell as plasma vaspin levels. Standard HOMA-IR formula was used to assess insulin resistance (IR).Results: Plasma vaspin levels were significantly lower in PCOS, both normal weight and obese, than in Non-PCOSgroups. Vaspin levels were similar in normal weight and obese PCOS subgroups. There was no association between plasmavaspin levels and anthropometric parameters in PCOS group. While in Non-PCOS group a negative correlation betweenplasma vaspin levels and body mass (r = –0.26; p < 0.05) was found. We did not observe correlations between plasma vaspinlevels and serum glucose and insulin concentrations as well as HOMA-IR values, however, in multivariable, stepwise backwardregression waist circumference and HOMA-IR values explained 18.0% of plasma vaspin levels variability in the study subjects.Conclusions: PCOS occurrence is associated with decreased vaspin levels. The influence of nutritional status on vaspin levelobserved in Non-PCOS is abolished in PCOS women, possibly by more severe insulin resistance

A comprehensive use of ultrasound examination in infertility workup

Considering the growing availability of ultrasound diagnostic methods in gynecology, its role in the infertility setting is increasing. In this review, we present an up-to-date ultrasound based diagnostic scheme in infertility workup comprising the evaluation of ovarian anatomy and function, uterine exploration, as well as tubal patency. The possibility of performing the vast majority of infertility diagnostics by ultrasound in the ambulatory settings is not only attractive and beneficial to patients, but also to health care system. Thus, it is vital for gynecologists to implement modern non-invasive ultrasound modalities in their everyday practice

Urazy u kobiet w ciąży – postępowanie

Trauma is the most common non-obstetric cause of death among pregnant women, affecting 5–7% of them. In the case of an accident, all first-aid efforts should take into account both the mother and the fetus. In most cases, treating a pregnant woman does not differ from the ITLS (International Trauma Life Support) principles. However, one has to consider the possibility of pregnancy-characteristic injuries as well as the fact that physiological pregnancy can mask some life and health threatening symptoms.Urazy w ciąży są najczęstszą pozapołożniczą przyczyną zgonów ciężarnych i dotyczą około 5–7% kobiet. Przystępując do udzielania pomocy kobiecie ciężarnej na miejscu wypadku należy pamiętać, że działania ratujące zdrowie i życie muszą obejmować dwie osoby – matkę i jej nienarodzone dziecko. W większości przypadków zaopatrzenie urazów u ciężarnej nie odbiega od schematu ITLS (International Trauma Life Support), należy jednak pamiętać, że może u niej dojść do szczególnych obrażeń typowych tylko dla ciąży. Nie bez znaczenia jest również fakt, że zmiany zachodzące w fizjologicznej ciąży mogą maskować groźne dla zdrowia i życia objawy

Evaluation of Pro/Antioxidant Imbalance in Blood of Women with Polycystic Ovary Syndrome Based on Determination of Oxidized Low-Density Lipoproteins and Ferric Reducing Ability of Plasma Values

We investigated selected pro/antioxidant parameters in a group of women with polycystic ovary syndrome (PCOS) divided according to age, body mass index (BMI), waist-to-hip ratio (WHR), homeostatic model assessment for insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (Quicki). We chose oxidized low-density lipoproteins (oxLDL-C) as a marker of oxidative stress and the ferric reducing ability of plasma (FRAP) as a marker of antioxidant status. In women with PCOS, the values of BMI, WHR, age and concentration of glucose significantly affected oxLDL-C concentration and FRAP values. FRAP correlated with oxLDL-C level in the whole group and in women who were insulin sensitive (HOMA-IR < 2.0). There was a negative relationship between the concentration of Anti-Müllerian hormone and both oxLDL-C and FRAP. Furthermore, the value of FRAP was inversely correlated with luteinizing hormone (LH), follicle-stimulating hormone (FSH) and androstenedione, whereas it was positively correlated with the LH/FSH ratio. The concentration of oxLDL and the value of FRAP are significantly associated with selected metabolic and hormonal parameters in the course of PCOS

Evaluation of Adipokines, Inflammatory Markers, and Sex Hormones in Simple and Complex Breast Cysts’ Fluid

Objective. The aim of the study was to analyze the association between levels of adipokines in the breast cyst fluid and in the circulation in relation to the type of cysts. Material and Measurements. A cross-sectional study involved 86 women with breast cysts (42 with simple cysts and 44 with complex cysts). Plasma and breast cyst fluid leptin, adiponectin, visfatin/NAMPT, resistin, TNF-α, and IL-6 levels, in addition to serum levels of estradiol, progesterone and prolactin, and anthropometric parameters and body composition (by bioimpedance method), were measured. Results. The levels of leptin, adiponectin, and resistin were significantly lower in breast cyst fluid than in plasma regardless of the cyst type. Contrarily, the levels of visfatin/NAMPT and TNF-α were significantly increased, and IL-6 levels were similar in the breast cyst fluid and plasma in both study groups. There was no correlation between corresponding levels of leptin, adiponectin, resistin, visfatin/NAMPT, TNF-α, and IL-6 in breast cyst fluid and plasma. Conclusions. Higher levels of visfatin/NAMPT and TNF-α in the fluid from simple and complex breast cysts than in plasma suggest that their local production is related to inflammation

The Activity of Superoxide Dismutase, Its Relationship with the Concentration of Zinc and Copper and the Prevalence of rs2070424 Superoxide Dismutase Gene in Women with Polycystic Ovary Syndrome—Preliminary Study

Superoxide dismutase (SOD) is a crucial antioxidant enzyme involved in the antioxidant pathway during both normal cellular metabolism and different pathologic processes. We investigated the activity of the copper (Cu)-zinc (Zn) SOD1 as well as the level of Cu and Zn in the serum of women with polycystic ovary syndrome (PCOS) and control group. Moreover, the prevalence of rs2070424 gene polymorphism of the enzyme in the course of PCOS was evaluated. Significantly lower activity of SOD 1 and Cu, Zn concentration was found in the group of women with PCOS than without the syndrome. Insulin resistance in the group of women with PCOS caused a further SOD1 activity decrease, while Cu concentration and the value of Cu/Zn was increased when compared to women with normal insulin levels. Furthermore, we assessed for the first time the rs2070424 polymorphism of SOD1 in the women with PCOS, and in these patients we detected dominant variant AA (93.3%). Due to a small number of other genotypes, it is difficult to state if lower SOD1 activity was strictly associated with the AA variant or if other factors play a crucial role, but this should be taken into account

The levels of adipokines in relation to hormonal changes during the menstrual cycle in young, normal-weight women

Context: The aim of this study was to assess the plasma leptin, adiponectin, resistin, visfatin/NAMPT, omentin-1, vaspin, apelin, TNF-α, IL-6 and RBP4 levels in relation to hormonal changes during the menstrual cycle in young, healthy, normal-weight women. Methods: The study involved 52 young, healthy, normal-weight women. Anthropometric parameters, body composition and levels of plasma leptin, adiponectin, resistin, visfatin/NAMPT, omentin-1, vaspin, apelin, TNF-α, IL-6 and RBP4 in addition to serum FSH, LH, estradiol, progesterone, 17-OH progesterone, androgens, SHBG and insulin concentrations were measured during a morning in fasting state three times: between days 2–4, days 12–14 and days 24–26 of the menstrual cycle. Results: Plasma adiponectin, omentin-1, resistin and visfatin/NAMPT, apelin, TNF-α, IL-6 and RBP4 concentrations were stable during the menstrual cycle, while leptin and vaspin levels were significantly higher in both the midcycle and the luteal phases than those in the follicular phase. Multivariate regression analyses revealed that changes in leptin and vaspin levels between the follicular and the luteal phase are strongly related to changes in total testosterone levels. Conclusions: Our results revealed stable levels of adipokines during the phases of the physiological menstrual cycle, except for leptin and vaspin, which showed increased levels in both the midcycle and the luteal phases. This effect was significantly associated with changes in the secretion of testosterone, 17-OH progesterone and insulin in the luteal phase

Assessment of the menstrual cycle, eating disorders and self-esteem of Polish adolescents

Introduction: Eating disorders are an important factor in menstrual cycle disorders in girls. Moreover, low self-esteem among adolescent girls may be a risk factor for eating disorders. The aim of the study was to assess the menstrual cycle, eating habits and self-esteem of Polish adolescents. Methods: The study was conducted from January 2014 to March 2015 and included 623 girls, aged 15–19, from randomly selected junior high schools in Silesia, Poland, in which their menstrual cycle, risk of eating disorders and self-esteem were evaluated. A five-part questionnaire was used to assess basic demographic data, lifestyle and physical activity, gynecological history, as well as Rosenberg Self-Esteem Scale (SES) and Eating Attitude Test (EAT-26). Results: Irregular menstrual cycles were observed in 236 (37.88%) girls; 5.20% presented secondary amenorrhea. Based on the EAT-26 test, 101 (16.21%) girls were indicated being at risk for an eating disorder. Low self-esteem was observed in 340 (54.57%) study girls on the base of SES. Discussion: Girls with irregular menses had higher scores on the EAT-26 test in subscales: EAT-overall score, EAT-diet and EAT–bulimia, while lower scores on the SES. In our study, we did not observe a significant relationship between exercise intensity, body mass, BMI and menstrual cycle regularity. Low self-esteem among adolescent girls may be a risk factor for eating disorders which could interrupt the menstrual cycle