The association between 24-hour ambulatory blood pressure measurement and selected biochemical and anthropometric parameters in women with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorders, which may contribute to the development of cardiovascular diseases. The aim of our study was to evaluate the association between of 24-hour ambulatory blood pressure measurement (ABPM) and selected biochemical and anthropometric parameters in women with PCOS. PATIENTS AND METHODS: The study involved 153 Polish, Caucasian women with PCOS hospitalized in the Department of Endocrinology Gynecology from January 2018 to March 2020. All women had stable body mass during the 3-month period. ABPM was performed using a portable lightweight device with oscillometric technology accepted by International Protocol of European Society of Hypertension (ABPM, HolCARD CR-07, Poland). RESULTS: The first factor taken into consideration was the variability phenotypic subgroups of PCOS on the values of 24-hour ABPM. We revealed that the daytime and night-time systolic and diastolic blood pressure values were significantly higher in phenotype A subgroup than in other subgroups. Moreover, daytime and night-time systolic and diastolic blood pressure value as well as day-time heart ratio value were significantly higher in subgroup with than without hyperandrogenemia. The obese women with PCOS were characterized of the highest value of all night-time measurements among women with PCOS and normal weight, overweight or obesity. In addition, insulin resistance in the PCOS subgroup was associated with lower value of systolic, diastolic blood pressure and both at daytime and night-time heart rate value than in insulin sensitive PCOS subgroup. CONCLUSIONS: Hyperandrogenemia and obesity were the crucial influencing factors on 24-hour ABPM in the group of women with PCOS. In addition, hypertension, apart from visceral obesity, hyperinsulinemia and insulin resistance, could be considered as component of metabolic syndrome in women with PCOS.

Mayer-Rokitansky-Küster-Hauser syndrome - case studies, methods of treatment and the future prospects of human uterus transplantation.

OBJECTIVE: We aimed to present patients with the Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) coming from one center and presenting all the possibilities of its treatment, at the forefront with the uterine transplantation. PATIENTS AND METHODS: The presented work is an example of different types of MRKH syndrome diagnosed in 25 women who were diagnosed in the Department of Gynecological Endocrinology due to the primary amenorrhea from 01/2001 to 06/2018. RESULTS: Patients suffering from MRKH syndrome are capable of having genetic offspring but are unable to give birth to their own child, due to an absence of the uterus, blindly terminated vagina, and normal ovaries. Patients suffering from this syndrome have the opportunity to receive treatment in accordance with their current needs. However, there are many medical, technical, and ethical limitations in achieving the most important therapeutic target: uterine transplantation and childbirth. CONCLUSIONS: Until a few years ago, patients with an absolute uterine factor of infertility, including women with MRKH syndrome, had a real choice of only two equally controversial options giving a chance for motherhood - surrogacy and adoption. However, modern transplantation has shown that a third option - a uterine transplant - exists and is available.

The correlation between the concentration of hepcidin in serum and the occurrence of insulin resistance and hyperandrogenemia in women with polycystic ovary syndrome.

OBJECTIVE: Scarce clinical and experimental studies suggest that hepcidin can be a protein participating in the development of metabolic disorders, while its synthesis and concentration in the circulation outside of the iron metabolism parameters can be influenced by hormones. The aim of the present study was to determine the correlation between the concentration of hepcidin in serum and the occurrence of insulin resistance and hyperandrogenemia in women with PCOS. PATIENTS AND METHODS: Five groups of women with PCOS were divided based on: correct body mass (17 without hyperandrogenemia and insulin resistance - G1; 17 with hyperandrogenemia and without insulin resistance - G2; 11 without hyperandrogenemia and with insulin resistance - G3; 10 with hyperandrogenemia and insulin resistance - G4), metabolic and hormonal parameters and selected markers of iron metabolism. RESULTS: Serum glucose levels were significantly higher in the group G3 than G1 and in the group G4 than G1 and G2. Serum insulin levels and HOMA-IR values were significantly higher in the groups G3 and G4 than G1 and G2. Serum androstenedione levels were significantly higher in the group G2 than G1 and G3 than G2. Serum transferrin levels were significantly lower in the group G1 than in the reaming study groups. CONCLUSIONS: It has been demonstrated that insulin resistance and hyperandrogenemia appear to be the factors decreasing the concentration of transferrin circulation, but not the remaining parameters of the iron metabolism in the studied women. No relationship between the concentration of hepcidin circulation and other studied parameters of the iron metabolism and the parameters of the carbohydrate metabolism was discovered. Androstenedione can stimulate hepcidin synthesis in women with PCOS with correct body mass.

Hormonal and metabolic aspects of acne vulgaris in women with polycystic ovary syndrome.

OBJECTIVE: Acne vulgaris in women can indicate a systemic disease, such as polycystic ovary syndrome (PCOS), which is associated with hormonal and metabolic disorders. The aim of this study was to investigate the influence of hormonal and metabolic disorders on acne vulgaris in women with PCOS. PATIENTS AND METHODS: The study included 110 women with PCOS. Women were divided according to their androstenedione concentration: within reference range (n=66) or higher (n=44). All patients were between 17-36 years old. Acne was graded according to the US FDA scale for a five-category global system (acne global severity scale). Hirsutism was defined using a modified Ferriman-Gallwey method. Fasting plasma glucose, insulin, luteinizing hormone, follicle-stimulating hormone, 17α-hydroxyprogesterone, 17-beta-estradiol, sex hormone-binding globulin and androgen (androstenedione, total testosterone, free testosterone, dehydroepiandrosterone sulfate) were assessed, as were prolactin and cortisol concentrations. Thyrotropin and free thyroxine concentrations were also measured. The free androgen index (FAI) and homeostatic model assessment-insulin resistance (HOMA-IR) index were calculated. RESULTS: The average age and rating on the hirsutism scale were similar in both analyzed groups. A higher percentage of severe acne was observed in the group of women with an androstenedione concentration within reference range than in the group with the higher concentration. Meanwhile, the severity of acne in the group of PCOS women with the higher androstenedione concentration was correlated with higher concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate, and cortisol. Increased glucose concentration was also proportional to the severity of acne. We did not observe a statistically significant correlation between the severity of acne and the androstenedione concentration. In the group of PCOS women as a whole, the severity of acne was correlated only with higher dehydroepiandrosterone sulfate concentration; other androgens did not affect the severity. CONCLUSIONS: The acne global severity scale in PCOS women is associated with higher concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate, and FAI value. Higher concentrations of androstenedione did not affect acne severity.

The effect of abdominal obesity in patients with polycystic ovary syndrome on metabolic parameters.

OBJECTIVE: Polycystic ovarian syndrome and obesity contribute to the metabolic complications for women of reproductive age. The aim of present study was to analyze the effect of abdominal obesity expressed using waist/hip ratio (WHR) in patients with polycystic ovary syndrome on metabolic parameters. PATIENTS AND METHODS: The study included 659 women with PCOS with WHR <0.8 and ≥0.8 aged between 17 and 44 years. Patients were tested for follicular stimulating hormone, luteinizing hormone, 17-beta-estradiol, dehydroepiandrosterone sulfate, androstenedione, sex hormone binding globulin, and total lipid profile during the follicular phase (within 3 and 5 days of their menstrual cycle). Also, fasting glucose and insulin concentrations, and after, oral-glucose glucose administration, were determinate. De Ritis and Castelli index I and II were calculated. RESULTS: Women with WHR ≥0.8 had higher concentration of glucose and  insulin (both fasting and after 120 min of oral administration of 75 g glucose), as well as HOMA-IR value, than women with WHR value < 0.8. Also, abdominal obesity disorders hormonal parameters. Higher free androgen index and lower concentration of sex hormone binding globulin and dehydroepiandrosterone sulfate were found in female with WHR ≥ 0.8. Follicular stimulating hormone, luteinizing hormone, androstenedione, and 17-beta-estradiol, were on similar level in both groups. Elevation in triglycerides, total cholesterol, and low-density lipoprotein levels, as well as decrease in high density lipoprotein level in serum of women with WHR value ≥ 0.8, were found when compared to women with WHR < 0.8. A statistically significant correlation was found between WHR value and glucose, insulin, sex hormone binding globulin, free androgen index and lipid profile parameters. CONCLUSIONS: Abdominal obesity causes additional disorders in metabolic and hormonal parameters in PCOS women, which confirmed changes in analyzed parameters between PCOS women with WHR < 0.8 and WHR ≥ 0.8 and statistically significant correlations between WHR value and analyzed parameters.

Thyroid disorders in polycystic ovary syndrome.

OBJECTIVE: Thyroid disorders, especially Hashimoto's thyroiditis (HT), are observed significantly more often in patients with polycystic ovary syndrome (PCOS) than in the general population - approximately 27% and 8%, respectively. This is extremely important in young women, because both disorders are connected with fertility problems. As HT and PCOS occur together, fertility problems may become a serious clinical issue in these patients. MATERIALS AND METHODS: A systematic literature review in PubMed of PCOS- and HT-related articles in English, published until December 2015 was conducted. RESULTS: The reasons for joint prevalence still remain unclear. Genetic and autoimmune backgrounds are recognized to be possible common etiological factors. Three genetic polymorphisms have been described to play a role in PCOS as well as in HT. They are polymorphism of the gene for fibrillin 3 (FBN3) regulating the activity of transforming growth factor-b (TGF-b) and regulatory T cell levels, gonadotropin-releasing hormone receptor (GnRHR) polymorphism and CYP1B1 polymorphism standing for estradiol hydroxylation. High estrogen-to-progesterone ratios owing to anovulatory cycles, as well as high estrogen levels during prenatal life, disrupt development of the thymus and its function in maintaining immune tolerance, and are suspected to enhance autoimmune response in PCOS. Vitamin D deficiency could be also involved in the pathogenesis of HT and PCOS. CONCLUSIONS: The above-mentioned common etiological factors associated with fertility problems in HT and PCOS require further research.