Τομέας Υγείας - Μητέρας - ΠαιδιούLibrary of the School of Health Sciences
Χατζηαγγελάκη Εριφύλη, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Κασσάνος Δημήτριος, Καθηγητής,Ιατρική, ΕΚΠΑ
Χρέλιας Χαράλαμπος, Αναπληρωτής Καθηγητής,Ιατρική, ΕΚΠΑ
Παπαντωνίου Νικόλαος, Καθηγητής,Ιατρική, ΕΚΠΑ
Δημητριάδης Γεώργιος, Καθηγητής,Ιατρική, ΕΚΠΑ
Χαλβατσιώτης Παναγιώτης, Επίκουρος Καθηγητής ,Ιατρική, ΕΚΠΑ
Παναγόπουλος Περικλής, Επίκουρος Καθηγητής ,Ιατρική, ΕΚΠΑ
Μελέτη του επιπολασμού της υπερανδρογοναιμίας σε Ελληνίδες γυναίκες με Σύνδρομο Πολυκυστικών Ωοθηκών με βάση τα δύο διαφορετικά κριτήρια διάγνωσης (ΝΙΗ 1990, Rotterdam 2004)
Stydy of the prevalence of hyperandrogenemia in Greek women with Polycystic Ovary Syndrome based on two different diagnostic criteria ( ΝΙΗ 1990, Rotterdam 2004)
Backgraund: Polycystic ovarian syndrome (PCOS) has been described as a major endocrinopathy problem that affects approximately 5%–9% of women of reproductive age. Clinical or biochemical hyperandrogenism, ovarian dysfunction in the form of oligo-ovulation or anovulation and polycystic ovaries on ultrasound are the parameters used for defining PCOS according to the Rotterdam criteria, after excluding other androgen excess disorders. Hyperandrogenemia is one of the major diagnostic features for the diagnosis of polycystic ovary syndrome. The predominant clinical manifestations of hyperandrogenemia are hirsutism, acne, oily skin, alopecia, menstrual cycle disturbances and infertility or subfertility. The most frequent androgen is testosterone (T), total, unbound, or free (FT) form. Δ4-Androstenedione (Δ4-A), dehydroepiandrosterone (DHEA), and its metabolite DHEAsulfate (DHEAS) have been also described in association with PCOS. Many studies have been based only on T measurement for the detection of biochemical hyperandrogenism in PCOS. Free testosterone levels may support the diagnosis, especially in a nonhirsute women with other symptoms of PCOS. Hyperandrogenemia also might be established by elevated serum levels of DHEAS and Δ4-A.
Purpose: The purpose of this study is to investigate the prevalence of hyperandrogenemia in Greek women diagnosed with polycystic ovary syndrome according to the criteria of the NIH 1990 and the Rotterdam criteria 2003 and examine the clinical characteristics and hormonal and biochemical parameters of hyperandrogenism in this population. Part of the study is also the body mass index correlation (BMI) in the presence of hyperandrogenemia and differences in clinical and biochemical parameters in relation to BMI.
Methods: We studied 266 women diagnosed with PCOS according to the criteria of the NIH 1990 and the Rotterdam criteria 2003. Hyperandrogenemia was defined by testosterone (T) and/or free testosterone (FT) and/or Δ4 androstenedione (Δ4-A) higher than 75% of the upper limits of each hormone. Patients were stratified in two groups according to a BMI threshold of 25 kg/m2.
Results: Hyperandrogenemia was present in 78.2% of the patients. Elevated levels of T were found in 58.4%, while elevated levels of FT and D4-A were found in 42.5% and 34.1% of patients. A greater proportion of smokers were found in women having hyperandrogenemia. The levels of TT, FT and Δ4 were higher as expected, in women with hyperandrogenemia. Also, 17-OHP and DHEAS had higher levels in PCOS women with hyperandrogenemia. Additionally, lower TSH levels were found in these women. In normal weight women (BMI ≤ 25 kg/m2) with hyperandrogenemia lower values of hip circumference and HOMA-IR and increased levels of T, FT, Δ4-A, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), white blood cells (WBC) and neutrophils were observed compared to women without hyperandrogenemia. Also, in overweight women higher levels of T, FT, Δ4-A, 17-OHP, DHEAS and cortisol were measured, while lower thyroid-stimulating hormone (TSH) levels were comparable to women without hyperandrogenemia. The FT was increased in overweight / obese women with hyperandrogenemia compared with underweight / normal women.
Conclusion: Hyperandrogenemia in our study was observed in 78.2% of PCOS patients. The most frequent elevated androgen was T (58.4%) and the most frequent clinical characteristic acne (57.3%). The most common combination was that of elevated T with normal FT and D4-A (25.6%), followed by the combination of elevated both T and FT (12.4%). The impact of hyperandrogenemia on the metabolic profile of PCOS patients is evident in normal weight women. The FT appears to be significantly increased and hence more representative androgen for determining hyperandrogenemia relative to T in overweight / obese women with PCOS.
Main subject category:
Polycystic ovary syndrome, Hyperandrogenemia, DHEAS, Testosterone, Androstendione
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