Leydig cell tumor of ovary with hyperandrogenism: a case report and literature review / 中华内分泌代谢杂志

Ovarian Leydig cell tumor(LCT), also known as ovarian testicular stromal cell tumor, is a rare sex cord stromal tumor, accounting for about 0.1% of all ovarian tumors. LCT is often accompanied by clinical manifestations of elevated androgen, and the imaging manifestations sometimes lack specificity. The diagnosis requires histopathological examination. Surgery is the primary treatment method, and postoperative prognosis is generally favorable. This paper retrospectively analyzes the diagnosis and treatment of a patient with LCT in our hospital combining relevant literature, explore the clinical characteristics, diagnosis, and treatment progress of LCT, aiming to improve disease management.

Comparison of Clinical, Biochemical, and Sonological Parameters in Adolescents with and without Polycystic Ovarian Syndrome

Objectives?The Pediatric Endocrine Society consensus criteria was developed in 2015 to diagnose adolescent PCOS. There are no Indian studies that use these criteria for diagnosis and then compare the clinical characteristics with those of normal controls. The objective of this study was to compare the clinical and biochemical profile in adolescents with and without PCOS and to study the ovarian morphology in adolescents with and without PCOS. Materials and Methods?We conducted a prospective case–control study on 60 adolescents who attended the outpatient department/adolescent immunization clinic. Group A included 30 adolescent girls with PCOS diagnosed as per the consensus criteria and Group B included 30 adolescents without PCOS. All participants were clinically evaluated and called empty stomach in the follicular phase for metabolic (Serum TSH, prolactin, FSH, LH, and testosterone) and endocrinal workup (2-hour OGTT, lipid profile) followed by ultrasonic examination. Results?In group A, 40% were overweight and 36.7% were obese and in group B, 20% were overweight and 20% were obese. There were no significant differences noted in gonadotropin levels in two groups. Mean testosterone levels were higher in PCO adolescents. The mean ovarian volume and ovarian follicle number were significantly higher in adolescents with PCOS. We found that if ultrasound criteria were added to the diagnosis, there would be about 7% lesser PCOS diagnosis. Conclusion?PCOS alters the fat distribution and lipid distribution in the body. These are features that lead to long-term metabolic alterations and life-threatening diseases. All PCOS adolescents thus be screened for these abnormalities and advised lifestyle modifications to keep these parameters under control

Diagnóstico hormonal del síndrome de ovario poliquístico / Hormonal diagnosis of polycystic ovary syndrome

Introducción: El síndrome de ovario poliquístico es el trastorno endocrino más frecuente en la mujer durante la etapa reproductiva. Se han realizado varios consensos con el fin de definir sus criterios diagnósticos y el hiperandrogenismo siempre ha estado presente dentro, ya sea tipo clínico o humoral. Objetivo: Describir los aspectos relacionados con el diagnostico hormonal en el síndrome de ovario poliquístico. Métodos: Se realizó una revisión bibliográfica sobre aspectos relacionados con el diagnóstico hormonal del síndrome de ovario poliquístico. Se obtuvieron artículos originales en inglés de las bases Pubmed, Google académico, EMBASE y MEDLINE. Se priorizó el término que aparece en el MESH BROWSER de síndrome de ovario poliquístico. Conclusiones: El diagnostico hormonal del síndrome de ovario poliquístico debe demostrar el hiperandrogenismo de manera bioquímica, siempre que sea posible, aunque si existe evidencia clínica basada en los propios criterios diagnósticos no es obligatorio. El método de laboratorio más útil al parecer es la determinación de la testosterona libre o en su lugar el del índice de andrógenos libres, seguido de la testosterona total. Otras determinaciones de andrógenos tienen menos valor como primera línea(AU)

Introduction: Polycystic ovary syndrome is the most common endocrine disorder in women during the reproductive stage. Several consensuses have been made in order to define its diagnostic criteria and hyperandrogenism has always been present, either clinical or mood related. Objective: To describe the aspects related to hormonal diagnosis in polycystic ovary syndrome. Methods: A literature review was performed on aspects related to the hormonal diagnosis of polycystic ovary syndrome. Original articles in English were obtained from Pubmed, Google Scholar, EMBASE and MEDLINE databases. Priority was given to the MESH BROWSER term polycystic ovary syndrome. Results: The hormonal diagnosis of polycystic ovary syndrome should demonstrate hyperandrogenism biochemically, whenever possible, although if there is clinical evidence based on the diagnostic criteria themselves it is not mandatory. The most useful laboratory method appears to be the determination of free testosterone or instead that of the free androgen index, followed by total testosterone. Other androgen determinations are of less value as first line(AU)

Effects of opium alkaloid, noscapine in RU486 induced experimental model of polycystic ovary syndrome

PCOS is a common endocrinopathy among premenopausal women, characterized by hyperandrogenism, anovulation, hirsutism. We evaluated credence of noscapine; in RU486 induced PCOS rat and compared with flutamide, a conventional drug. For 13 days, an oral dose of RU486 [20 mg/kg/day] was administered to Wistar rats exhibiting regular estrous cycle. Varying dosage of noscapine was given to PCOS rats and compared with rats administered flutamide. Cytology of estrous cycle and serum hormone levels (LH, FSH, PRL, estradiol, and testosterone) were measured. Histomorpho-metrical changes, events of apoptosis in theca and granulosa cells were observed using flow cytometry and the mode of cellular death was examined by TUNEL staining. Our findings suggested, normal folliculogenesis in PCOS rats, post noscapine administration (120 mg/kg) in 3-4 days with normal hormonal profile. Theca and granulosa cells undergo massive and marginal cellular degeneration respectively with no G2/M arrest. TUNEL staining confirms the granulosa cells in follicles are major cell type undergo apoptosis in RU486 administered rats. However, low apoptotic DNA fragmentations were found in theca cells. We conclude that the RU486 model is suitable for studies of the metabolic features of PCOS and noscapine appears to be promising therapeutic modality for amelioration of PCOS induced condition.

Case report of pseudoelevated serum testosterone in women and literature review / 中华检验医学杂志

Objective:The characteristics of women with false elevated testosterone were analyze and the literature was reviewed to provide reference for clinical laboratory identification of false elevated testosterone.Methods:The characteristics of three patients with false elevated testosterone in Peking Union Medical College Hospital were analyzed retrospectively, and the results of different detection platforms and methods for the determination of testosterone levels were compared. International and domestic literatures related to false elevation of testosterone and detection methods of testosterone were searched for a comprehensive analysis from PUBMED and CNKI.Results:The levels of testosterone in 3 female patients were elevated by immunoassay and normal by mass spectrometry. They were excluded from the diagnosis of hyperandrogenemia. A total of 38 literatures related to testosterone detection were retrieved, of which 9 case reports of pseudohyperandrogenemia, among which 12 cases of pseudohyperandrogenemia were reported in 2 domestic literatures in 2021. All cases were confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Previous studies have clearly indicated that the result of routine immunoassay in clinical laboratory for the determination of female testosterone have poor correlation with the results of LC-MS/MS, with varying degrees of deviation.Conclusions:Immunoassay tests for female testosterone is susceptible to interference and lead to elevated false results. It is suggested that clinical laboratories evaluate the detection methods used and establish a identification program, and confirm samples with suspected pseudoelevated testosterone elevation using other immune platforms or LC-MS/MS.

Comparative study of laparoscopic ovarian drilling and medical treatment in polycystic ovarian disease

Background: To evaluate the result after medical treatment and laparoscopic ovarian drilling in PCOS patients and to compare the results of these two methods.Methods: In this prospective study 50 women with polycystic ovarian disease, were divided into two group,25 women received medical treatment and 25 women received surgical (laparoscopic ovarian drilling) treatment. Effect of treatment on ovulation, menstruation, fertility and androgen level was determined 3 month after therapy.Results: There was significant increase in ovulation and fertility, decrease in androgen levels and decrease in LH/FSH in individual groups when compared with pretreatment levels but difference between groups A and B was not statistically significant for these parameters.Conclusions: Medical treatment and laparoscopic ovarian drilling are equally effective in treating the women of polycystic ovarian disease. Result of both the treatment are similar in this study. However medical treatment should be the first line therapy, it has significant benefit for use in OPD, low cost, no hospital stays and convenience to the patient.

Level of Betatrophin in PCOS patients

PCOS is known now as an endocrine, metabolic, and chronic inflamatory disorder, with hyperandrogenemia, insulin resistance and obesity being the key factors that influence the expression and symptoms of the condition. Objective: To assess the level of alpha fetoprotein in PCOS women. Patients and method: A case control study conducted at Al-Elwyia. Teaching hospital when 200 women were enrolled in the study and divided into two groups: case group (100) patients with PCOS and control healthy group (100). The patient with PCOS women was diagnosed according to Roterdam criteria. Results: A total of 200 respondents and divided into 2 groups. The mean age of them (27.7 ± 2.3) years, highly significant association (P <0,001) were found between the age group especially (21-30) years in PCOS patients moreover highly significant association were found between the obese patient in PCOS than that in normal group (P<0.001). Betatrophin levels were significantly highly increases in patients than that in control group (P<0.001). Conclusion: the serum betatrophin level was significantly increased in patients with polycystic syndrome (AU)

Insulin resistance and hyperandrogenism / 国际儿科学杂志

Insulin resistance(IR) is a pathological condition in which the body's systemic metabolic response to insulin is impaired,including decreased glucose uptake and utilization,suppression of lipolysis and acceleration of production,and disorders in the synthesis of proteins and glycogen.Hyperandrogenism(hyperandrogenemia,HA) refers to a series of clinical manifestations such as hirsutism,acne and masculinity caused by the increase of the androgen level or the activity in the body.IR and HA are the major hallmarks of diseases such as polycystic ovarian syndrome (PCOS) and insulin resistance syndrome.The role of both in the development of the disease has been a topic of debate.Androgen levels and the severity of IR are closely related,but the exact interaction between the two and the causal relationship is not yet fully understood.In recent years,great progress has been made in the research of these problems.This article gives a review of the research progress on the relationship between insulin resistance and hyperandrogenism..

Analysis on correlation between CYP17 gene polymorphism and hyperandrogenmia in Xinjiang Uyghur patients with polycystic ovary syndrome / 国际检验医学杂志

Objective To investigate the correlation between the CYP17 gene polymorphisms and hyperandrogenemia(HA) in Uygur women patients with polycystic ovary syndrome (PCOS ) .Methods 59 Uygur patients with PCOS were selected as the Uygur PCOS group and re-divided into the Uygur PCOS complicating HA group and Uygur PCOS non-complicating HA group . Meanwhile 18 Han patients with PCOS complicating HA were selected as the Han PCOS group .The polymerasechain reaction-restrictive fragment length polymorphism method was used to examine the basic group polymorphisms in the promoter region of CYP17 gene .Then the correlation between basic group locus polymorphism and Uygur PCOS complicating HA was analyzed .Results There was no statistically significant difference between TT ,TC and CC genotypes and T ,C allele frequencies in the Uygur PCOS non-complicating HA group and Uygur PCOS complicating HA group (P＞ 0 .05) .There was no statistically significant difference between TT ,TC and CC genotypes and T ,C allele frequencies in the Uygur PCOS complicating HA group and Han P-COS group(P＞0 .05) .The serum testosterone level in TT ,TC and CC genotypes patients of the Uygur PCOS complicating HA group was significantly higher than that in the Uygur PCOS non-complicating HA group(P＜0 .05) .Serum testosterone level had no statistically significant difference between TC ,CC genotypes and TT genotype patients of Uygur PCOS group(P＞0 .05) .Conclusion The distribution frequency of CYP17 genotypes does not increase the risk suffering from HA in Uygur women .Single nucleotide polymorphism in CYP17 gene promoter region had no obvious correlation with Uygur PCOS complicating HA occurrence .

Changes and clinical significance of ischemic modified albumin in patients with polycystic ovary syndrome / 中华内分泌外科杂志

Objective To investigate the change of ischemia modified albumin (IMA) in polycystic ovary syndrome (PCOS) women,and to examine the relationship between IMA and metabolic disorder.Methods 31 PCOS women (PCOS group) and 28 age-and BMI-matched healthy women (control group) were recruited.Serum IMA levels and related biochemical indexes were compared between the two groups,and the correlation between IMA and each index was analyzed.Results Serum IMA level in PCOS group was significantly higher than that in the control group (P＜0.05).Correlation analysis showed that serum IMA levels were positively correlated with testosterone levels (r=0.57,P=0.03).Conclusion Serum IMA levels in PCOS patients are significantly elevated and closely related to testosterone,suggesting that oxidative stress may be involved in the pathogenesis and development of hyperandrogenemia.

A cross-sectional study to assess any possible linkage of C/T polymorphism in CYP17A1 gene with insulin resistance in non-obese women with polycystic ovarian syndrome.

Background & objectives: Insulin resistance (IR) is a major confounding factor in polycystic ovarian syndrome (PCOS) irrespective of obesity. Its exact mechanism remains elusive till now. C/T polymorphism in the -34 promoter region of the CYP17 gene is inconsistently attributed to elucidate the mechanism of IR and its link to hyperandrogenemia in obese PCOS patients. In the present study we aimed to evaluate any association of this polymorphism with IR in non-obese women with PCOS. Methods: Polymorphism study was performed by restriction fragment length polymorphism (RFLP) analysis of the Msp A1 digest of the PCR product of the target gene in 75 PCOS cases against 73 age and BMI matched control women. Serum testosterone, BMI and HOMA-IR (homeostatic model of assessment-insulin resistance) were analyzed by standard techniques. A realistic cut-off value for the HOMA-IR was obtained through receiver operating characteristic (ROC) curve for exploring any possible link between IR and T/C polymorphism in the case group. Results: Significant increases in serum testosterone and HOMA-IR values were observed among the case group (P<0.001) without any significant elevation in BMI and FBG compared to controls. Cut-off value for IR in the PCOS patients was 1.40 against a maximum sensitivity of 0.83 and a minimum false positivity of 0.13. The analysis revealed an inconclusive link between the C/T polymorphic distribution and insulin resistant case subjects. Interpretation & conclusions: The results showed that CYP17A1 gene was not conclusively linked to either IR or its associated increased androgen secretion in non-obese women with PCOS. We propose that an increased sensitivity of insulin on the ovarian cells may be the predominant reason for the clinical effects and symptoms of androgen excess observed in non-obese PCOS patients in our region.

The impact of obesity on hyperandrogenemia in Korean girls

PURPOSE: As metabolic complication and polycystic ovarian syndrome due to childhood obesity is rising, the role of hyperandrogenemia (HA) and hyperinsulinism is receiving attention. The aims of this study were to investigate the presence of obvious HA according to pubertal status and to find potential etiologic determinants of HA in Korean obese (OB) girls. METHODS: We analyzed 91 girls aged 6–17 years (prepuberty, n=54; puberty, n=37). Each girl was classified as being either normal weight (NW) or OB. Anthropometric measurements were obtained and blood test was performed early in the morning after at least 8 hours of fasting to measure glucose, insulin, total testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular-stimulating hormone, estradiol, and progesterone. RESULTS: The plasma levels of free testosterone (FT) and DHEAS were markedly higher in OB girls compared to NW girls in puberty (FT, P=0.009; DHEAS, P=0.046) but not in prepuberty (FT, P=0.183; DHEAS, P=0.052). Hyperinsulinemia and high homeostasis model assessment of insulin resistance (HOMA-IR) values were found regardless of pubertal status in OB girls. The significant related factor to HA in puberty was the body mass index Z-score (P=0.003). But HOMA-IR, LH, and progesterone levels were not relevant to HA in pubertal girls. CONCLUSION: OB prepubertal girls did not show HA in the present study but they should be regularly monitored because they already had hyperinsulinemia. OB pubertal girls had significant HA and hyperinsulinemia, and obesity per se was the most important factor for HA.

The impact of obesity on hyperandrogenemia in Korean girls

PURPOSE: As metabolic complication and polycystic ovarian syndrome due to childhood obesity is rising, the role of hyperandrogenemia (HA) and hyperinsulinism is receiving attention. The aims of this study were to investigate the presence of obvious HA according to pubertal status and to find potential etiologic determinants of HA in Korean obese (OB) girls. METHODS: We analyzed 91 girls aged 6–17 years (prepuberty, n=54; puberty, n=37). Each girl was classified as being either normal weight (NW) or OB. Anthropometric measurements were obtained and blood test was performed early in the morning after at least 8 hours of fasting to measure glucose, insulin, total testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular-stimulating hormone, estradiol, and progesterone. RESULTS: The plasma levels of free testosterone (FT) and DHEAS were markedly higher in OB girls compared to NW girls in puberty (FT, P=0.009; DHEAS, P=0.046) but not in prepuberty (FT, P=0.183; DHEAS, P=0.052). Hyperinsulinemia and high homeostasis model assessment of insulin resistance (HOMA-IR) values were found regardless of pubertal status in OB girls. The significant related factor to HA in puberty was the body mass index Z-score (P=0.003). But HOMA-IR, LH, and progesterone levels were not relevant to HA in pubertal girls. CONCLUSION: OB prepubertal girls did not show HA in the present study but they should be regularly monitored because they already had hyperinsulinemia. OB pubertal girls had significant HA and hyperinsulinemia, and obesity per se was the most important factor for HA.

Female hyperandrogenemia and normal serum levels of testosterone and sex hormone binding globulin

It is well known that the reference values usually employed for endocrine biochemical measurements are those suggested by the suppliers of commercial kits despite their advice that each laboratory should set its own reference values. Our objectives were to (i) determine reference ranges for serum testosterone (T) and sex hormone binding globulin (SHBG) appropriate to our laboratory and population, and (ii) to analyze their influence on evaluating hyperandrogenemia. SHBG and T were measured, and free and bioavailable testosterone calculated, in (a) 30 selected non-hyperandrogenic women, (b) 87 non-selected healthy female blood donors, (c) 53 women with hyperandrogenism, and (d) 38 women with hyperandrogenic disorders but without biochemical hyperandrogenemia according to normal ranges suggested by the kit manufacturer. Mean serum SHBG concentrations were significantly different among all four groups. SHBG levels were significantly higher in selected normal women (group a). Using our results for this selected control group as new reference values, 12 out of 38 (31.6%) women with hyperandrogenic disorders without apparent hyperandrogenemia (group d) were recategorized as hyperandrogenemic. Similarly, 4 out of 63 (6.4%) non-selected, normal weight, women (group b), were recategorized as hyperandrogenic. Therefore, the diagnosis of hyperandrogenemia would improve accuracy by using customized reference SHBG values instead of those suggested by the suppliers.

Con frecuencia los valores de referencia utilizados para las evaluaciones bioquímicas endocrinológicas son los sugeridos por los kits utilizados, a pesar de las recomendaciones de que cada laboratorio debiera obtener sus propios valores de normalidad. Nuestros objetivos fueron (i) analizar los rangos de referencia para testosterona (T) y globulina ligadora de esteroides sexuales (SHBG) apropiados para nuestro laboratorio y población, y (ii) analizar su influencia en la evaluación de la hiperandrogenemia. Se midió T y SHBG y se calculó testosterona libre y biodisponible en un grupo (a) control de 30 mujeres no hiperandrogénicas, (b) 87 mujeres no seleccionadas donantes de sangre, (c) 53 mujeres con hiperandrogenismo, y (d) 38 mujeres con desórdenes hiperandrogénicos pero sin hiperandrogenemia de acuerdo a los rangos de normalidad sugeridos por el kit. La concentración media de SHBG fue significativamente diferente entre los cuatro grupos. Los niveles de SHBG fueron significativamente más altos en las mujeres controles seleccionadas (grupo a). Tomando en consideración los resultados obtenidos en este grupo y estableciendo los rangos de referencia adecuados, 12 de 38 mujeres (31.6%) hiperandrogénicas sin hiperandrogenemia (grupo d) fueron recategorizadas como con exceso androgénico bioquímico. De igual manera, al analizar mujeres normopesas no seleccionadas, en edad reproductiva (grupo b), 4 de 63 (6.4%) pudieron ser definidas como hiperandrogénicas. Utilizando valores adecuados de referencia para SHBG, se mejora la precisión del diagnóstico de exceso androgénico.

Polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is a "multispeciality" disorder suspected in patients with irregular menses and clinical signs of hyperandrogenism such as acne, seborrhoea, hirsutism, irregular menses, infertility, and alopecia. Recently, PCOS has been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, acanthosis nigricans, Type 2 diabetes, dyslipidemias, hypertension, non-alcoholic liver disease, and obstructive sleep apnoea. Good clinical examination with hematological and radiological investigations is required for clinical evaluation. Management is a combined effort involving a dermatologist, endocrinologist, gynecologist, and nutritionist. Morbidity in addition includes a low "self image" and poor quality of life. Long term medications and lifestyle changes are essential for a successful outcome. This article focuses on understanding the normal and abnormal endocrine functions involved in the pathogenesis of PCOS. Proper diagnosis and management of the patient is discussed.

Association of obesity and hyperandrogenemia with insulin resistance in women with polycystic ovary syndrome / 中华内分泌代谢杂志

Thirty healthy women and 101 patients with polycystic ovary syndrome (PCOS) were recruited. According to serum testosterone (T) level and homeostasis model assessment for insulin resistance (HOMA-IR) ,the correlation of T and body mass index (BMI) with insulin resistance was analyzed. The results showed that there were 39. 8％ normal,24. 5％ overweight,and 35.7％ obese among 101 PCOS patients. However,there were no significantly differences in BMI, fasting plasma glucose ( FPG ), triglyceride ( TG ), total cholesterol ( TC), low-density lipoprotein-cholesterol ( LDL-C), high-density lipoprotein-cholesterol ( HDL-C ), and HOMA-IR levels between PCOS patients with hyperandrogenemia ( T ≥ 0. 51 μg/L) and normal androgenemia ( T ＜ 0. 51 μg/L). BMI, FPG, TG, TC, and LDL-C levels were higher and HDL-C level was lower in patients with insulin resistance( HOMA-IR ≥ 2. 29 ) than in patients without insulin resistance ( HOMA-IR ＜ 2. 29, P＜0. 05 or P＜ 0. 01 ). Serum T levels were not significantly different between two groups. HOMA-IR was significantly correlated with BMI(P＜0. 01 ), not with serum T, suggesting that the gain of body weight is correlated with insulin resistance independent of serum T level.

Molecular & genetic factors contributing to insulin resistance in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of unknown etiology. Insulin resistance is very common and plays a central pathogenic role in PCOS. During last decade several studies have been conducted to understand the mechanisms contributing to the state of insulin resistance and insulin-induced hyperandrogenemia in PCOS. Insulin signaling pathways have been dissected in different insulin responsive tissues such as skeletal muscles, adipose tissues, fibroblasts as well as ovaries to elucidate the mechanism. These studies suggest a post receptor signaling defect where metabolic action of insulin is affected but not the steroidogenic and mitogenic actions. Despite advancement in these studies gaps exist in our understanding of the mechanism of insulin resistance as well as insulin-induced steroidogenesis in PCOS. The syndrome is now considered as a complex multigenic disorder. Efforts are ongoing to dissect the variants of genes from multiple logical pathways which are involved in pathophysiology of the syndrome. But still today no gene has been emerged as universally accepted susceptibility gene for PCOS. This review briefly describes the lacunae along with the current status of molecular events underlying insulin resistance and the contribution of insulin signaling pathway genes in pathogenesis of PCOS along with future researchable areas.

The polycystic ovary syndrome / 대한산부인과학회지

The polycystic ovary syndrome (PCOS) is a heterogeneous disorder that is characterized principally by oligomenorrhea or amenorrhea with clinical or laboratory evidence of hyperandrogenemia. Furthermore, it is now recognized that a significant proportion of overweight women with PCOS have hyperinsulinemia. Three features are generally recognized to compose this syndrome, including androgen excess, ovulatory dysfunction, and polycystic ovaries. Because its etiology and natural history are poorly understood, there is controversy about the diagnostic criteria and clinical evaluation of the syndrome. But the diagnosis of PCOS entails two principal steps: (a) to determine whether features suggestive of PCOS are present and (b) to exclude related androgen excess or ovulatory disorders. The PCOS results in a number of immediate and long-term morbidities that are associated with a significant impact on quality of life and on economic costs. Immediate morbidities include menstrual dysfunction and abnormal uterine bleeding, subfertility and infertility, and androgen excess-related dermatologic abnormalities including hirsutism, acne, and androgenic alopecia, and an increased risk of obstetrical complications such as pregnancy-induced hypertension and gestational diabetes. However, PCOS is also associated with an increased risk of various other long-term complications or morbidities including cancer, type 2 diabetes mellitus, the metabolic syndrome, and possibly cardiovascular disease. For the management of PCOS, we should consider not only immediate but also the long-term morbidities.

Testosterona séiica en trastornos hipertensivos del embarazo / Serum testosterone in hypertensive disorders of pregnancy

OBJETIVO: Se ha comunicado asociación de hiperandrogenemia y preeclampsia; además de confirmarlo se pretende dilucidar si también hay esa asociación con embarazadas con hipertensión arterial crónica esencial (HACE). MÉTODOS: 45 mujeres con gestación de tercer trimestre separadas en 3 grupos: 1) 15 normotensas, 2) 16 preeclámpticas, 3) 14 HACE. Se registró edad, paridad, índice de masa corporal (IMC), presión arterial sistólica y diastólica (mm de Hg), proteinuria en 24 horas, semanas de gestación, y niveles séricos de testosterona total (Tt), RIA de testosterona libre (Tl), proteína ligante sexual (SHBG), índice de andrógenos libres (IAL). RESULTADOS: Los 3 grupos estudiados, normotensas, preeclámpticas y HACE, presentaron los siguientes valores séricos, respectivamente: Tt (nmol/L) 2,3±1,4; 5,2±3,0; 1,9±1,5 (p=0,001). IAL (pmol/L) 0,5±0,3; 1,1±0,9; 0,4±0,2 (p=0,001). No hubo diferencias significativas en Tl (pmol/L) 7,2±4,7; 7,39±4,5; 4,5±2,6; ni en SHBG (nmol/L) 468±112; 503±134; 512±96. CONCLUSIONES: Las embarazadas con HACE presentaron niveles séricos de Tt y de IAL similares a las embarazadas normotensas. En cambio, las mujeres con preeclampsia presentaron niveles de Tt sérica e IAL claramente aumentados en comparación con las embarazadas normotensas. Se concluye que existiría una asociación de hiperandrogenemia con preeclampsia; asociación que no fue encontrada en embarazadas con HACE.

OBJECTIVE: Association between hyperandrogenemia and preeclampsia was communicated. This study was designed to explain if also there is association between hyperandrogenemia and pregnant with essential chronic arterial hypertension (HACE). METHODS: To 45 women with gestation of third trimester were separated in 3 groups: 1) normal arterial pressure (n=15), 2) preeclampsia (n=16), 3) HACE (n=14). It was registered age, parity, body mass index (IMC), systolic and diastolic arterial pressure (mm of Hg), proteinuria in 24 h, weeks of gestation, and seric level of total testosterone (Tt), free testosterone (Tl), free androgen index (IAL). RESULTS: The studied groups, normal arterial pressure, preeclampsia, and HACE, displayed the following serics values, respectively: Tt (nmol/L) 2.3±1.4; 5.2±3.0; 1.9±1.5; (p=0.001). IAL (pmol/L) 0.5±0.3; 1.1±0.9; 0.4±0.2; (p=0.001). Not significant differences were found in: Tl (pmol/L) 7.2±4.7; 7.4±4.5; 4.5±2.6. SHBG (nmol/L) 468±112; 503±134; 512±96. CONCLUSIONS: The pregnant women with HACE presented similar seric level of T than pregnant women with normal arterial pressure. However, the women with preeclampsia displayed significant increased levels of seric Tt and increased IAL. We conclude that the association observed of hyperandrogenemia with preeclampsia was not found in pregnant with HACE.

A case of hyperinsulinemic obese female adolescent with virilization

BACKGROUND: Being obese during adolescence leads to undue physical or psychological problems and may increase the incidence of cardiovascular disease or endocrinological disorders. Recently authors have experienced a case of hyperinsulinemic obese girl with virilization. We report it with a review of the literature. CASE: A 17-year old female came into 'obesity clinic' of Asan Medical Center due to weight gain. She had virilizing feature, hirsutism, underdeveloped female sexual characteristics, and acanthosis nigricans. Work-up by laboratory tests and imaging studies showed very severe obesity with metabolic disturbances, and hyperandrogenism with hyperinsulinemia. Treatment for obesity was multidisciplinary method including behavior modification, calorie restriction, exercise, and medication with fluoxetine 40mg po qd, and for hyperandrogenism, provera 10mg po qd was described. CONCLUSIONS: Severe hyperinsulinemia in obese female leads to male-type hirsutism, disturbance of menstrual cycle, abdominal obesity, and cardiovascular disorders. One of the physical findings of hyperinsulinemia or insulin resistance is acanthosis nigricans. So, if an female obese patient have acanthosis nigricans with hyperinsulinemia, should be assessed and treated for risk factors of cardiovascular disorders and hormonal disturbances.