Polycystic ovary syndrome associated with increased adiposity interferes with serum levels of TNF-alpha and IL-6 differently from leptin and adiponectin

ABSTRACT Objective The aim of this study was to investigate polycystic ovary syndrome (PCOS) and to explore the relationship between body fat percentage and metabolic markers. Subjects and methods Sedentary women were assigned to PCOS (N = 60) and CONTROL (N = 60) groups. Each group was subdivided into three subgroups according to body fat percentage (22-27%, 27-32% and 32-37%). The protocol consisted of assessments of glucose, insulin, androgens, follicle stimulating hormone (FSH), luteinizing hormone (LH), 17-hydroxyprogesterone (17-OHP), leptin, adiponectin, tumor necrosis factor (TNF-α) and interleukin-6 (IL-6). Results The PCOS subgroups showed higher concentrations of androgens, LH and 17-OHP. Leptin showed direct relationship with increased body fat percentage, whereas adiponectin showed the inverse effect. However, both were unaffected by PCOS. TNF-α and IL-6 were higher in PCOS women and showed a direct relationship with increased body fat percentage. Glucose showed direct relationship with body fat percentage, whereas insulin presented higher values in PCOS women and direct relationship with increased body fat percentage. Conclusions Our findings indicate that PCOS and body fat percentage directly influence concentrations of insulin, TNF-α and IL-6, whereas leptin and adiponectin are influenced only by the increase in body fat percentage in these women. Arch Endocrinol Metab. 2020;64(1):4-10

Dosages of androgenic hormones in adolescent patients with severe acne

SUMMARY OBJECTIVE Acne vulgaris in female adolescents, when severe or accompanied by other signs of androgenization, may represent a sign of hyperandrogenemia often underdiagnosed, which will have harmful consequences for adult life. The objective of this cross-sectional and retrospective study was to demonstrate the incidence of hormonal changes in the cases of female adolescents with severe or extensive acne, with or without other signs of hyperandrogenism, and propose a hormonal research pattern which should be indicated in order to detect early hyperandrogenemia. METHODS The medical records of 38 female patients aged between 9 and 15 years old with grade II and/or III acne were analyzed. The dehydroepiandrosterone sulfate, dehydroepiandrostenedione, and androstenedione, total testosterone, and dihydrotestosterone sulfate hormones were required prior to initiation of treatment. The hormonal dosages were performed in the serum after at least 3 hours of fasting by means of radioimmunoassay tests. RESULTS Of the 38 patients included, 44.7% presented changes in androgen levels (hyperandrogenemia), and the two most frequently altered hormones were DHEA and androstenedione, with the same incidence (23.6%). CONCLUSIONS The correct and early diagnosis provides an effective and agile approach, including antiandrogen therapy, with the purpose of avoiding the reproductive and metabolic repercussions, besides controlling the inflammatory picture and avoid aesthetic complications.

RESUMO OBJETIVO A acne vulgar em adolescentes do sexo feminino, quando grave ou acompanhada de outros sinais de androgenização, pode representar um sinal de hiperandrogenemia muitas vezes subdiagnosticado, que acarretará consequências danosas para a vida adulta. O objetivo deste estudo transversal e retrospectivo foi demonstrar a incidência das alterações hormonais nos casos de adolescentes do sexo feminino com acne grave ou extensa, acompanhada ou não de outros sinais de hiperandrogenismo e propor um padrão de pesquisa hormonal que deve ser indicado com o intuito de detectar precocemente o quadro de hiperandrogenemia. MÉTODOS Foram analisados os prontuários de 38 pacientes do sexo feminino com idades entre 9 e 15 anos, portadoras de quadro de acne grau II e/ou III. Os hormônios sulfato de dehidroepiandrostenediona, dehidroepiandrostenediona, androstenediona, testosterona total e dehidrotestosterona foram solicitados antes do início do tratamento. As dosagens hormonais foram realizadas no soro após pelo menos 3 horas de jejum por meio de exames de radioimunoensaio. RESULTADOS Das 38 pacientes incluídas, 44,7% apresentaram alterações dos níveis de andrógenos (hiperandrogenemia), sendo que os dois hormônios mais frequentemente alterados foram o DHEA e androstenediona, com a mesma incidência (23,6%). CONCLUSÕES O diagnóstico correto e precoce propicia uma abordagem efetiva e ágil, incluindo a terapia antiandrogênica, com a finalidade de evitar as repercussões reprodutivas e metabólicas, além de controlar o quadro inflamatório e evitar complicações estéticas.

Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Objective To summarize current evidence regarding testosterone treatment for women with low sexual desire. Materials and methods The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. Results Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. Conclusion Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8

Relation between visfatin, insulin resistance and androgen levels in women with polycystic ovary syndrome with and without clinical hyperandrogenism running title: visfatin and polycystic ovary syndrome

Background: Polycyhc ovary syndrome PCOS is the most common cause of infertility due to anovulation. PCOS patients are at a higher risk of developing type 2 diabetes mellitus and cardiovascular disease. Controversial results were reported regarding levels of visfatin among PCOS patients

Objectives: the aim of the present study was to investigate serum visfatin, testosterone and insulin resistance and the association between these parameters in PCOS patients with and without clinical hyperandrogenism

Subjects and Methods: A total of forty PCOS patients and twenty age BMI-matched overweight healthy control subjects were enrolled in this study. PCOS patients were further divided according to the presence or the absence of clinical hyperandrogenism. Serum visfatin, testosterone, insulin and glucose were measured and the homeostasis model assessment of insulin resistance [HOMA-IR] was calculated

Results: PCOS patients had higher levels of visfatin, testosterone and HOMA-IR compared with the controls. Positive correlation was seen between insulin and testosterone in PCOS patients. PCOS patients with clinical hyperandrogenism had relatively higher levels of visfatin, testosterone and HOMA-IR compared with those without clinical hyperandrogenism. Furthermore, serum visfatin positively correlated with serum insulin and testosterone in PCOS patients with clinical hyperandrogenism, but not in those without clinical hvperandrogenism

Conclusion: There are strong relationships between visfatin and hyperinsulinemia, and hyperandrogenism. Further investigation is needed to elucidate the molecular mechanism behind these relationships

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.

[Comparison of serum androgens and progesterone in preeclampsia and normal pregnancy]

Androgens are among the causative factors in preeclampsia. This study was done to compare the serum androgens and progesterone in preeclampsia and normal pregnancy. This case-control study was done on 30 preeclamptic and 30 healthy pregnant women in Gorgan, Iran. Higher or equal to 140/90 mmHg and proteinuria equal or more than +1 in dip stick test in the third trimester of pregnancy were considered as the diagnostic criteria of preeclampsia. Progesterone, free and total testosterone, and dehydroepiandrosterone sulphate [DHEA] were measured by ELISA method. Total testosterone level was 1.8 +/- 0.3 ng/ml and 1.3 +/- 0.9 ng/ml in cases and controls, respectively. This difference was not significant. Progesterone was lower in cases [95 +/- 46.9 ng/ml] than in controls [165.4 +/- 75 ng/ml] [P<0.01]. Free testosterone and DHEA were 5.6 +/- 2.3 ng/ml and 1 +/- 0.5 ng/ml in cases, respectively which was significantly higher than the controls [3.2 +/- 1.5 ng/ml and 0.7 +/- 0.4 ng/ml, respectively] [P<0.045]. Serum level of free testosterone, DHEA and progesterone increased and reduced respectively in preeclampsia

New perspectives in the diagnosis of pediatric male hypogonadism: the importance of AMH as a Sertoli cell marker / Novas perspectivas no diagnóstico do hipogonadismo pediátrico masculino: a importância do AMH como marcador de células de Sertoli

Sertoli cells are the most active cell population in the testis during infancy and childhood. In these periods of life, hypogonadism can only be evidenced without stimulation tests, if Sertoli cell function is assessed. AMH is a useful marker of prepubertal Sertoli cell activity and number. Serum AMH is high from fetal life until mid-puberty. Testicular AMH production increases in response to FSH and is potently inhibited by androgens. Serum AMH is undetectable in anorchidic patients. In primary or central hypogonadism affecting the whole gonad and established in fetal life or childhood, serum AMH is low. Conversely, when hypogonadism affects only Leydig cells (e.g. LHβ mutations, LH/CG receptor or steroidogenic enzyme defects), serum AMH is normal or high. In pubertal males with central hypogonadism, AMH is low for Tanner stage (reflecting lack of FSH stimulus), but high for the age (indicating lack of testosterone inhibitory effect). Treatment with FSH provokes an increase in serum AMH, whereas hCG administration increases testosterone levels, which downregulate AMH. In conclusion, assessment of serum AMH is helpful to evaluate gonadal function, without the need for stimulation tests, and guides etiological diagnosis of pediatric male hypogonadism. Furthermore, serum AMH is an excellent marker of FSH and androgen action on the testis.

As células de Sertoli são a população de células mais ativa nos testículos durante a primeira e segunda infância. Neste período, o hipogonadismo só pode ser evidenciado sem o uso de testes estimulatórios se a função das células de Sertoli for avaliada. O AMH é um marcador útil do número e da atividade das células de Sertoli no período pré-puberal. A concentração sérica de AMH é alta da metade da vida fetal até a metade da puberdade. A produção de AMH pelos testículos aumenta em resposta ao FSH e é potencialmente inibida por androgênios. O AMH sérico não é detectável em pacientes anorquídicos. No hipogonadismo central ou primário afetando a gônada inteira, ou estabelecido na vida fetal ou infância, a concentração de AMH sérica é baixa. Por outro lado, quando o hipogonadismo afeta apenas as células de Leydig (por exemplo, nas mutações, LHβ, defeitos do receptor de LH/CG ou das enzimas esteroidogênicas), a concentração de AMH sérico é normal ou alta. Em meninos púberes com hipogonadismo central, a concentração de AMH é baixa para o estágio na escala de Tanner (refletindo a falta de estímulo pelo FSH), mas alta para a idade (indicando a falta do efeito inibidor da testosterona). O tratamento com FSH provoca um aumento do AMH sérico, enquanto a administração de hCG aumenta os níveis de testosterona, que fazem a downregulation do AMH. Em conclusão, a concentração sérica de AMH é útil na avaliação da função gonadal, excluindo a necessidade de testes estimulatórios, e direciona o diagnóstico etiológico do hipogonadismo pediátrico masculino. Além disso, o AMH sérico é um marcador excelente da ação do FSH e dos androgênios nos testículos.

Thyroid gland dysfunction modulates ovarian response to estrogen and androgen receptors in albino rats

Hypothyroidism and hyperthyroidism are more common in women than in men, and it was reported that thyroid hormones play an essential role in ovarian physiology. This study aimed to simulate the clinical conditions of hypothyroidism and hyperthyroidism in adult female albino rats, and to detect the possible changes in ovarian estrogen and androgen hormone receptors associated with such clinical conditions. This study used 36 adult female albino rats. Rats were divided into three groups, with 1 2 rats each. Rats of the control group received 0.5 ml saline [0.9%] solution once daily. Six rats received the saline orally using a tube, and the other half received it by intraperitoneal injection for 4 weeks. The rats of the hypothyroid group received daily orally a dose of 18.75 mg/kg propylthiouracil dissolved in saline solution for 4 weeks, and the rats of the hyperthyroid group received a daily intraperitoneal dose of 40 microg/kg L-thyroxine dissolved in saline solution for 4 weeks. Vaginal smears were performed at the end of the experiment; only 22 rats coincided the diestrus phase of the cycle, sacrificed and sections were subjected to hematoxylin and eosin and immunohistochemical staining for estrogen and androgen receptors. In the hypothyroid group, few corpora lutea, atretic follicles, and dilated congested blood vessels were clearly seen. In the hyperthyroid group, the ovarian sections showed numerous corpora lutea; atretic follicles and markedly dilated congested blood vessels were also noted. A negative correlation was documented between estrogen receptor and androgen receptor immunoreactivity in the hypothyroid and hyperthyroid groups. This study suggested that thyroid hormones are important to maintain a normal estrous cycle and hence in the regulation of ovarian hormones. The mechanisms by which thyroid hormones influence ovarian function remain to be elucidated. However, it might be through their effect on the aromatase enzyme, which is the key regulator in ovarian hormones production reflected on the level of steroid hormones receptor expression

Effect of thyroid hormone replacement therapy on ovarian volume and androgen hormones in patients with untreated primary hypothyroidism

Primary hypothyroidism may be associated with ovarian enlargement and/ or cyst formation. We evaluated the effect of thyroid hormone replacement therapy on hormonal changes, ovarian volume and sonographic appearance. Open, prospective study of women admitted to university gynecology clinic. The study included 26 patients with untreated hypothyroidism who had polycystic [n=10] or normal-appearing [n=16] ovaries and 20 euthyroidic controls. Basal serum total testosterone, free testosterone, androstenedione, dehydroepiandosterone-sulfate, prolactin, estradiol, luteinizing hormone, follicle-stimulating hormone, free T3, free T4 and thyroid-stimulating horone, together with ovarian volumes, were determined and repeated after euthyroidism was achieved. Ovarian volumes of patients with hypothyroidism were significantly greater compared with controls, and their magnitudes diminished significantly during thyroid hormone replacement therapy. Hypothyroidic patients with polycystic ovaries had significantly higher serum free testosterone and dehydroepiandosterone-sulfate, but lower androstenodione levels compared with those who had normal-appearing ovaries. Serum total testosterone concentrations were significantly higher in hypothyroidic patients without polycystic ovaries, and thyroid hormone replacement therapy achieved a significant reduction in total as well as free testosterone. Severe longstanding hypothyroidism leads to increased ovarian volume and/or cyst formation. A decrease in ovarian volume, resolution of ovarian cysts and reversal of the polycystic ovary syndrome-like appearance, together with improvement in serum hormone levels, occurred after euthyroidism was achieved

Participação dos androgênios adrenais na síndrome dos ovários policísticos / Adrenal androgen participation in the polycystic ovary syndrome

OBJETIVO: reavaliar a função adrenal em pacientes com síndrome dos ovários policísticos, após a introdução dos critérios de Roterdã. MÉTODOS: estudo descritivo de corte transversal, incluindo 53 pacientes com média de idade de 26±5,1 anos. Glicose, hemoglobina glicada, lipídios, estradiol, progesterona, 17-OHP4, DHEAS, FSH, LH, TSH, PRL, androstenediona, tiroxina livre, insulina, testosterona total, SHBG e índice de androgênios livres foram estimados. Resistência à insulina, examinada pelo modelo homeostático, foi admitida com índice >2,8. A resposta adrenal à cortrosina foi avaliada pelo incremento hormonal observado após 60 minutos e área sobre a curva. RESULTADOS: entre as 53 pacientes elegíveis, hiperandrogenismo bioquímico foi encontrado em 43 (81,1 por cento). Trinta e três delas, com idade de 25,1±5,0 anos, apresentaram hiperandrogenismo adrenal (62,2 por cento), pesavam 74,9±14,9 kg; tinham IMC de 28,8±6,0 e razão cintura/quadril de 0,8±0,1. DHEAS foi >6,7 nmol/L em 13 (39,4 por cento) e androstenendiona >8,7 nmol/L em 31 (93,9 por cento). Cortisol, 17-OHP4, A e progesterona tiveram incremento de 153 por cento, 163 por cento, 32 por cento e 79 por cento, respectivamente. O modelo usado para avaliar a resistência á insulina foi >2,8 em 14 (42,4 por cento). Não foi encontrada correlação entre as concentrações de insulina ou estradiol com as de cortisol ou androgênios. CONCLUSÕES: a utilização de múltiplos parâmetros hormonais revela alta prevalência de hiperandrogenismo bioquímico na SOP, sendo que as adrenais têm participação em dois terço dos casos. Níveis de estradiol e insulina não influenciam a secreção adrenal de androgênios e cortisol.

PURPOSE: to reassess the adrenal function of patients with PCOS after the introduction of the Rotterdam's criteria. METHODS: descriptive and cross-sectional study including 53 patients 26±5.1 years old. Glucose, glycosylated hemoglobin, lipids, estradiol, progesterone, 17-OHP4, DHEAS, FSH, LH, TSH, PRL, androstenedione, free thyroxine, insulin, total testosterone, SHBG, and free androgen index were measured. Insulin resistance was considered to be present with a homeostatic model assessment index >2.8. The adrenal response to cortrosyn was assessed by the hormonal rise observed at 60 minutes, and by the area under the response curve. RESULTS: biochemical hyperandrogenism was found in 43 of 53 eligible patients (81.1 percent). Thirty-three women had adrenal hyperandrogenism (62.2 percent). The weight of these 33 women, aging 25.1±5.0 years, was 74.9±14.9 kg, BMI was 28.8±6.0 and the waist/hip ratio was 0.8±0.1. DHEAS was >6.7 nmol/L in 13 (39.4 percent) and androstenendione was >8.7 nmol/L in 31 (93.9 percent). The increments in 17-OHP4, cortisol, A, and progesterone were 163 percent, 153 percent, 32 percent, and 79 percent, respectively. The homeostatic insulin resistance model was >2.8 in 14 (42.4 percent). Insulin and estradiol were not correlated with cortisol or androgens. CONCLUSIONS: the use of multiple endocrine parameters showed a high prevalence of biochemical hyperandrogenism in patients with PCOS. Two thirds of the patients had adrenal hyperandrogenism, and estradiol and insulin did not influence adrenal secretion.

Comparison of metformin and cyproterone-estrodiol compound effect on hs C-reactive protein and serum androgen levels in patients with poly cystic ovary syndrome

The aim of this study was comparison of the effects of Metformin and Cyproterone-estradiol compound on serum androgens and highly sensitive C-reactive protein levels. Sixty patients with Poly Cystic Ovary Syndrome [PCOS] were enrolled in this study conducted during a period of 16 months from December 2004 to March 2006. Thirty subjects were in each group and treated with Metformin one gram per day or Cyproterone-estradiol compound 21 days monthly and at the beginning and after 3 and 6 months, weight, height, testosterone, dehydroepiandrosterone sulfate [DHEA-S] and hs-CRP levels were measured. Mean age of patients was 23.5 +/- 8.7 years with the range of 15 to 49 years. In both groups significant decreases in DHEA-S levels and in Cyproterone-estradiol compound group a significant decrease in testosterone levels were seen after 6 months, but there were no significant decrease on hs-CRP levels. Comparison of two groups showed that there were no significant differences in the effects of these two drugs on serum testosterone, DHEA-S and hs-CRP levels. In our study the level of hs-CRP at the beginning of treatment were significantly higher in patients who were overweight and obese. Also we found that Cyproterone-estradiol compound causes significant decrease at the level of hs-CRP in overweight and obese patients. The results of this study are different from those of previous studies about beneficial effects of Metformin on hs-CRP levels but are similar to the results of studies that revealed probably obesity and overweight has important role in inducing inflammation and increasing CRP levels

Androgênios séricos e densidade mineral óssea em mulheres ooforectomizadas e não ooforectomizadas na pós-menopausa / Serum androgen concentrations and bone mineral density in postmenopausal ovariectomized and non-ovariectomized women

OBJETIVO: Comparar os níveis de androgênios e densidade mineral óssea (DMO) em mulheres ooforectomizadas (OOF) e não ooforectomizadas (NOOF) na pós-menopausa. Quarenta mulheres (53,9 ± 4 anos), 20 OOF e 20 NOOF foram selecionadas. MÉTODOS: Testosterona total (TT), testosterona livre (TL), androstenediona (AN), deidroepiandrosterona (DHEA) e sulfato de deidroepiandrosterona (DHEA-S) foram dosados. DMO foi avaliada em 16 NOOF e 14 OOF. RESULTADOS: Não houve diferença entre os grupos com relação à idade, ao índice de massa corporal (IMC) e ao tempo de menopausa. Concentração média de TT e TL foi duas vezes maior em mulheres NOOF (60,91 versus 30,17 ng/dL, p = 0,0001; 1,00 versus 0,48 pg/mL, p = 0,003). Não houve diferença na DMO. Houve correlação inversamente significativa entre IMC e TT, r = -0,3; p = 0,05, e do tempo de menopausa com AN (r = -0,35; p = 0,02), DHEA, (r = 0,3; p = 0,01). CONCLUSÃO: Ooforectomia bilateral resultou em deficiência androgênica mais severa que a menopausa natural, sem comprometimento da massa óssea.

OBJECTIVE: Compare levels of androgens and bone mineral density (BMD) of ovariectomized (OVX) and non-ovariectomized (NOVX) postmenopausal women. Forty women, 20 OVX and 20 NOVX, (53.9 ± 4 years) were selected. METHODS: Total testosterone (TT), free testosterone (FT), androstenedione (AN), dehidroepiandrostenedione (DHEA) and its sulfate (DHEA-S) were measured. BMD was measured in 14 OVX and 16 NOVX. RESULTS: No differences between groups with regard to age, body mass index (BMI) and time since menopause were found. Mean levels of TT and FT were two-fold higher in NOVX group (60.91 versus 30.17 ng/dL, p = 0.0001; 1.00 versus 0.48 pg/mL, p = 0.003). BMD was not different between groups. Inverse correlations were found between BMI and TT (r = -0.3; p = 0.05); time since menopause and AN (r = -0.35; p = 0.02) and time since menopause and DHEA (r = -0.3; p = 0.01). CONCLUSION: Bilateral ovariectomy leads to a more severe androgen deficiency than natural menopause in postmenopausal women and did not compromise bone mass.

[ effects of hydro alcoholic extract of dorema aucheri on blood concentration of gonadotropin and androgen hormones in adult male rats]

Dorema aucheri [Apieaceae] contains chemical compounds including flavonoids and coumarins. Flavonoids have estrogenic properties and coumarins have antiandrogenic properties. The compounds are very effective on the HPG axis. In the present study, the effect of Dorema aucheri alcoholic extract on LH, FSH, testosterone and DHT hormones on adult male rats were determined. This was an experimental study in which male adult rats were chosen and divided into 5 groups: control group which did not received any extract, sham groups which took distilled water, experimental groups, which orally took 100, 200 and 400 mg per kg of the Dorema aucheri extract for 28 consecutive days. Then the animals were weighed and the blood sample of each group was taken and used for measuring of the serum concentration of FSH, LH, DHT and testosterone. The collected data were analyzed by the SPSS software using ANOVA and t-test. The results revealed no differences in the average weight of the body and concentration of FSH hormone in the experimental group compared with the control and sham group. However significant difference was found between the concentration of LH, testosterone and dihydrotestosterone in the experimental group compared with the rest groups. Concentration of testosterone in the minimum dosage of extracts showed significant increase while significant decrease was seen in the higher dose. Significant increase was seen in the concentration of LH in all doses. DHT serum concentration in the minimum dose showed significant decrease while significant increase was seen in higher dosage. It seems that the flavonoids compound of Dorema aucheri extract caused the LH hormone to increase prolactin. Using the extract increases the LH hormone and inhibition of aromatase and 5 alfa reductase enzymes cause the testosterone and DHT hormone to increase in higher dosage

Laboratory diagnosis of late-onset male hypogonadism andropause / Diagnóstico laboratorial do hipogonadismo masculino tardio (andropausa)

OBJECTIVES: To evaluate which factors influence the laboratorial diagnosis of late-onset male hypogonadism (LOH). METHODS: Total testosterone (TT), SHBG and albumin were measured in 216 men aged 52-84 years. The laboratorial definition of LOH was two values of calculated free testosterone (cFT) <6.5 ng/dl, according to Vermeulen's formula. RESULTS: At the first blood test, cFT was <6.5 ng/dl in 27 percent of the men. Laboratorial LOH (confirmed by two tests) was present in 19 percent, but TT levels were low in only 4.1 percent. Age influenced TT (p=0.0051) as well as BMI; 23.5 percent of patients > 70 years and 38.9 percent of the obese men who had TT within the reference range were, in fact, hypogonadal. CONCLUSION: Especially in obese men and in those > 70 years old, SHBG dosage is important to calculate FT levels and diagnose hypogonadism.

OBJETIVOS: Avaliar os fatores que influenciam o diagnóstico laboratorial do hipogonadismo masculino tardio. MÉTODOS: Avaliamos 216 homens entre 52 e 84 anos. O diagnóstico laboratorial foi definido como dois valores de testosterona livre calculada (TLC) <6,5 ng/dl, segundo a fórmula de Vermeulen, a partir das dosagens de testosterona total (TT), SHBG e albumina. RESULTADOS: Na primeira dosagem, a TLC foi <6.5 ng/dl em 27 por cento da amostra. Hipogonadismo laboratorial (confirmado por duas dosagens) esteve presente em 19 por cento, no entanto a TT foi baixa em apenas 4.1 por cento dos homens. A idade influenciou a TT (p=0.0051) bem como o IMC; 23,5 por cento dos homens > 70 anos e 38,9 por cento dos obesos com TT dentro dos níveis de referência eram, na verdade, hipogonádicos. CONCLUSÃO: Especialmente em homens obesos e nos > 70 anos a dosagem de SHBG é importante para calcular TL e diagnosticar o hipogonadismo.

Sex hormone binding globulin decrease as potential pathogenetic factor for hirsutism in adolescent girls / Disminución de la globulina transportadora de hormonas sexuales como factor patogénico de hirsutismo en la adolescencia

We investigated 252 non-obese female subjects aged 13-39 years to evaluate if an exaggerated descent of sex hormone binding globulin (SHBG) levels during adolescence can play a role in the development of hirsutism. Body hair was assessed according to Ferriman and Gallwey (FG), with a stringent criterion of normality of < 4. In 13-14 years girls, SHBG and free testosterone (FT) levels were similar in "hirsute" girls (FG > 4) and controls (FG < 4, regular menstrual cycles, no acne). In 15-18 years girls, SHBG values were lower in "hirsute" girls, FT levels were similar in both groups, FG correlated inversely with SHBG. In 19-39 yr women, FT levels were higher in "hirsute" subjects, SHBG values were similar in both groups, FG correlated positively with FT. Lowest SHBG values were observed at 15-18 years, but the slope of the decrease from 1314 years values was greater in the "hirsute" group. FT values increased progressively with age, but the increase was greater in the "hirsute" group. Those results suggest an important role of SHBG decrease in adolescence vs. a more accentuated testosterone increase in adults, as factors conditioning the development of hirsutism in these two different periods of life.

Se investigaron 252 mujeres con peso normal, de 13 a 39 años de edad, para evaluar si un descenso exagerado en los niveles de la globulina transportadora de hormonas sexuales ("sex hormone binding globulin"; SHBG) puede tener un rol en el desarrollo de hirsutismo. Este signo fue evaluado con la escala de Ferriman y Gallwey (FG), empleando un criterio riguroso de normalidad < 4. En niñas de 13-14 años, tanto SHBG como la testosterona libre ("free testosterone"; FT) fueron similares en niñas "hirsutas" (FG > 4) y controles (FG < 4, ciclos menstruales regulares, sin acné). En adolescentes de 15-18 años, los valores de SHBG fueron menores en las "hirsutas", los niveles de FT fueron similares en ambos grupos y el índice de FG correlacionó inversamente con SHBG. En las mujeres de 19-39 años, los niveles de FT fueron mayores en las "hirsutas", los valores de SHBG fueron similares en ambos grupos y FG correlacionó positivamente con FT. Los valores más bajos de SHBG se observaron entre 15 y 18 años, pero la pendiente de disminución a partir de los valores de 13-14 años fue mayor en el grupo de "hirsutas". Los valores de FT se incrementaron progresivamente con la edad, pero el aumento fue mayor en el grupo de "hirsutas". Estos resultados sugieren un rol importante del descenso de SHBG en la adolescencia vs. un incremento más acentuado de los niveles de testosterona en las adultas, como factores que condicionan el desarrollo del hirsutismo en esos dos diferentes periodos de la vida.

Serum androgen levels and their relationship to pattern and severity of hair growth in hirsute women presenting at private centre in Hyderabad

To determine the frequency of raised serum androgen levels in hirsute women and their relationship to the pattern and severity of hair growth in patients presenting at private cosmetic center at Hyderabad. In this cross-sectional study, conducted in a private cosmetic and aesthetic centre, Hyderabad, from January, 2007 to December, 2007, 65 consecutive patients of hirsutism attending the centre were enrolled. Twenty normal women of similar ages [mean age 23.60 +/- 2.90 years] without signs of hirsutism and with normal menstrual cycle were also included as control group. Informed consent was obtained from all patients. Duration, pattern, and severity of hair growth [Ferriman-Gallwey score], weight, body mass index, acne and sebhorrhea were also evaluated. Serum testosterone, serum androstenedione and dehydroepiandrosterone sulphate levels were assessed in all patients and controls. Correlation between serum androgen levels and pattern and severity of hair growth was determined. Chisquare test was applied to determine p value. A total of 65 patients were enrolled in study. Their ages ranged from 16 to 45 years [mean age 24.49 +/- 6.44 years]. Thirty nine [60%] patients had normal androgen levels without evidence of significant endocrine abnormality. These were assigned idiopathic category. 26 [40%] patients had modest elevations of serum androgens. Among them, 21 had polycystic ovaries. Patients having modest to greatly elevated androgen levels [serum testosterone] had severe hirsutism with Ferriman-Gallwey scores [F-G score] >/= 8. [p

Mulheres adultas com acne: aspectos comportamentais, perfis hormonal e ultra-sonográfico ovariano / Acne in adult women: behavior, hormone and ovarian ultrasonographic profile

OBJETIVOS: abordar os aspectos comportamentais, o perfil androgênico e as alterações ultra-sonográficas ovarianas de uma amostra de mulheres adultas com acne. MÉTODOS: estudo de série de casos envolvendo uma amostra de 60 mulheres, escolhidas por conveniência. As pacientes foram submetidas a exame clínico, dosagens hormonais e ultra-sonografia para avaliação da morfologia ovariana. Na análise estatística, foi aplicado o Teste de Fischer para análise de correlação entre as variáveis. RESULTADOS: a média de idade foi de 26,5 anos. Todas as pacientes referiram atitudes e sentimentos negativos em relação à acne, sendo os mais freqüentes ansiedade (88,3 por cento) e manipulação constante das lesões (88,3 por cento). O grau de acne mais observado foi o grau II (48,3 por cento). Foram identificados níveis de androgênios fora da faixa de normalidade em 63,3 por cento, com elevação mais freqüente do, dehidroepiandrosterona (57,6 por cento). O padrão ultra-sonográfico mais observado foi o microcístico (74,6 por cento). CONCLUSÕES: as formas clínicas leves de acne predominaram nas mulheres estudadas. Ainda assim, essas apresentaram, com grande freqüência, atitudes e sentimentos negativos em relação à doença. Foram identificados, ainda, modificação dos níveis séricos dos androgênios, bem como do padrão de normalidade do exame ultra-sonográfico.

OBJECTIVES: to assess behavior, androgenic profile and ovarian ultrasound alterations in a sample of adult women with acne. METHODS: case study involving a serie of 60 women selected for convenience. Patients were submitted to clinical exam, hormonal dosages and ultrasound to assess ovarian morphology. Fischer's test for variables correlation analysis was applied. RESULTS: age median was 26.5 years old. All patients attitudes were negative in relation to acne, the more frequent ones were anxiety (88.3 percent) and frequent manipulation of the lesions (88.3 percent). Degree II was the most frequent acne classification determined (48.3 percent). Abnormal androgen levels were identified(63,3 percent), with frequent dehydroepiandrosterone elevation (57 percent.6 percent). The more frequent ultrasound level observed was the monocystic one (74.6 percent). CONCLUSIONS: mild clinical acne was prevalent in the women studied. Nevertheless, they frequently had negative attitudes and feelings related to the disease. Modifications on the circulating androgen levels, as well as on the ovarian ultrasonographic pattern were identifield.

Low-dose glucocorticoids in hyperandrogenism / Efecto de bajas dosis de glucocorticoides en el hiperandrogenismo

To investigate the effect of low-doses of glucocorticoids on androgen and cortisol secretion during the course of the day, we evaluated clinical signs of hyperandrogenism and total, free and bioavailable testosterone, SHBG, and cortisol following two different protocols: A) fourteen patients received betamethasone 0.6 mg/day (n=8) or methylprednisolone 4 mg/day (n=6), as single daily oral dose at 11.00 PM, during 30 days, B) fourteen patients were evaluated under betamethasone 0.3 mg in a single daily dose at 11.00 PM during six months, 11 out of whom were re-evaluated six months later. Twenty eight women with hyperandrogenism were included and seven normal females were used as control. Blood samples were taken in follicular phase at 8 AM and 7 PM to determine SHBG, cortisol, total, free and bioavailable testosterone. In both protocols, a significant morning and evening decrease in cortisol and testosterone (p<0.05 to < 0.01), which was moremarked with betamethasone (p<0.05), was shown. In protocol B, morning SHBG levels showed a significant increase (p<0.05) and betamethasone also improved clinical hyperandrogenism along the trial. Although morning and evening cortisol significantly decreased during treatment, no side effects were reported. The 11 patients reevaluated after therapy withdrawal, showed a rise in serum total testosterone and its fractions to pre-treatment values and a normalization of cortisol levels. It is concluded that glucocorticoids in low-doses effectively normalize serum androgens, independently of their origin. They may be used therapeutically, mainly whenever a hyperandrogenic woman presents with cycle irregularities or seeking fertility.

Con el objetivo de investigar el efecto de bajas dosis de glucocorticoides sobre la secreción de andrógenos y cortisol en el curso del día, evaluamos signos de hiperandrogenismo, testosterona total, libre y biodisponible y cortisol según dos protocolos diferentes: A) catorce pacientes recibieron betametasona 0.6 mg/día (n= 8) o metilprednisolona 4 mg/día (n= 6) en dosis única cotidiana, a las 23 h, durante 30 días, B) catorce pacientes fueron evaluadas bajo betametasona 0.3 mg en dosis única cotidiana a la 23 h, administrada durante 6 meses; de ellas, 11 pacientes fueron re-evaluadas 6 meses más tarde. Se incluyeron 28 mujeres con hiperandrogenismo y 7 controles normales. Se obtuvieron muestras de sangre en fase folicular a las 08:00 y 9:00 h para determinar SHBG, cortisol, testosterona total, libre y biodisponible. En ambos protocolos se observó una disminución significativa de cortisol y testosterona (p<0.05 a <0.01), más importante con betametasona (p<0.05). En el protocolo B, los niveles matutinos de SHBG aumentaron significativamente (p<0.05) y se observó mejoría clínica con el tratamiento. Aunque los niveles matutinos y vespertinos de cortisol disminuyeron significativamente durante el tratamiento, no se observaron efectos secundarios. En las 11 pacientes reevaluadas luego de suspensión de glucocorticoides se observó un aumento de testosterona y sus fracciones a los niveles pre-tratamiento con normalización de las concentraciones de cortisol. Dosis bajas de glucocorticoides normalizaron eficazmente los andrógenos séricos elevados, independientemente de su causa. Pueden emplearse terapéuticamente, en especial cuando una mujer hiperandrogénica presenta alteraciones del ciclo menstrual o busca fertilidad.