Clinical implications of polycystic ovary syndrome

Česká verzia

Authors: Ingrid Dravecká
Authors place of work: I. interná klinika LF UPJŠ a UN L. Pasteura Košice, Slovenská republika
Published in the journal: Vnitř Lék 2016; 62(5): 392-397
Category: Reviews

Summary

Polycystic ovary syndrome (PCOS) is a heterogeneous and complex endocrine disease which among the female population belongs to the most widespread endocrinopathies and it is the most frequent cause of hyperthyroidism, anticoagulation and infertility. Insulin resistance is one of the important diabetology factors impacting hyperglycaemia in a majority of women with PCOS (60–80 %). Clinical expressions of PCOS include reproduction disorders, metabolic characteristics and psychological implications. Reproduction disorders include hyperthyroidism, menstruation cycle disorders, infertility and pregnancy complications as well as early abortions, gestational diabetes and pregnancy induced hypertension. Long-term metabolic risks of PCOS include type 2 diabetes mellitus, dyslipidemia, arterial hypertension and endothelial dysfunction. The available data confirms higher incidence of cardiovascular diseases in women with PCOS. In particular among obese women PCOS is more frequently associated with non-alcoholic hepatic steatosis, sleep apnoea syndrome and endometrial cancer. The literature includes some controversial data about the relationship between PCOS and autoimmunity. Women with PCOS are more prone to suffer from insufficient confidence with higher incidence of anxiety, depression, bipolar disorder and eating disorders.

Key words:
autoimmunity – diabetes mellitus – pregnancy – insulin resistance – metabolic syndrome – menstrual disorders – polycystic ovary syndrome

Zdroje

1. de Melo AS, Dias SV, Cavalli Rde C et al. Pathogenesis of polycystic ovary syndrome: multifactorial assessment from the foetal stage to menopause. Reproduction 2015; 150(1): R11-R24.

2. Ben-Shlomo I, Younis JS. Basic research in PCOS: are we reaching new frontiers? Reprod Biomed Online 2014; 28(6): 669–683.

3. Jayasena CN, Franks S. The management of patients with polycystic ovary syndrome. Nat Rev Endocrinol 2014; 10(10): 624–638.

4. Moran LJ, Norman RJ, Teede HJ et al. Metabolic risk in PCOS: phenotype and adiposity impact. Trends Endocrinol Metab 2015; 26(3): 136–143.

5. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013; 6: 1–13.

6. Svačina Š. Metabolické aspekty syndromu polycystických ovárií. Vnitř Lék 2002; 48(12): 1142–1146.

7. Stárka L, Cermáková I, Dusková M et al. Hormonal Profile of Men with Premature Balding. Exp Clin Endocrinol Diabetes 2004; 112(1): 24–28.

8. Livadas S, Diamanti-Kandarakis E. Polycystic Ovary Syndrome: Definitions, Phenotypes and Diagnosis Approach. Front Horm Res 2013; 40: 1–21.

9. Pasquali R, Gamberini A. Targeting insulin sensitivity in the treatment of polycystic ovary syndrome. Expert Opin Ther Targets 2009; 13(10): 1205–1226.

10. [The Rotterdam ESHRE/ASRM-sponsored PCOS consensus Workshop Group]. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reprod 2004; 19(1): 41–47.

11. Moran L, Teede H. Metabolic features of the reproductive phenotypes of polycystic ovary syndrome. Human Reprod Update 2009; 15(4): 477–488.

12. Evidence-based Methology Workshop on Polycystic Ovary Syndrome. National Institutes of Health (NIH). 3–5.12. 2012. Dostupné z WWW: <https://prevention.nih.gov/programs-events/pathways-to-prevention/past-workshops/pcos>.

13. Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health 2011; 3: 25–35.

14. Nandi A, Chen Z, Patel R et al. Polycystic Ovary Syndrome. Endocrinol Metab Clin N Am 2014; 43(1): 123–147.

15. Diamanti-Kandarakis E, Dunaif A. Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications. Endocrine Reviews 2012; 33(6): 981–1030.

16. Vrbíkova J. Sexageny a lipidy u žen. Interní Med Prax 2005; 7(10): 430–432.

17. Wild RA, Carmina E, Diamanti-Kandarakis E et al. Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95(5): 2038–2049.

18. Schröder AK, Tauchert S, Ortmann O et al. Insulin resistance in patients with polycystic ovary syndrome. Ann Med 2004; 36(6): 426–439.

19. Goodarzi MO, Korenman SG. The importance of insulin resistance in polycystic ovary syndrome. Fertil Steril 2003; 80(2): 255–258.

20. Glintborg D, Andersen M. An update on the pathogenesis, inflammation, and metabolism in hirsutism and polycystic ovary syndrome. Gynecol Endocrinol 2010; 26(4): 281–296.

21. Čermáková I, Vrbíková J, Dušková M et al. Sexuální steroidy a inzulinová rezistence. DMEV 2003; 6(3): 143–148.

22. Bajuk Studen K, Jensterie Sever M, Pfeifer M. Cardiovascular risk and subclinical cardiovascular disease in polycystic ovary syndrome. Front Horm Res 2013; 40: 64–82.

23. Rocha MP, Marcondes JA, Barcellos CR et al. Dyslipidemia in women with polycystic ovary syndrome: incidence, pattern and predictors. Gynecol Endocrinol 2010; 27(10): 814–819.

24. Macut D, Bjekiuć-Macut J, Savić-Radjević A. Dyslipidemia and oxidative stress in PCOS. Front Horm Res 2013; 40: 51–63.

25. Kim JJ, Choi YM. Dyslipidemia in women with polycystic ovary syndrome. Obstet Gynecol Sci 2013; 56(3): 137–142.

26. Vrbíková J. Syndrom polycystických ovarií. Vnitř Lék 2015; 61(10): 886–895.

27. Vassilatou E. Nonalcoholic fatty liver disease and polycystic ovary syndrome. World J Gastroenterol 2014; 20(26): 8351–8363.

28. Wang ET, Cirillo PM, Vittinghoff E et al. Menstrual Irregularity and Cardiovascular Mortality. J Clin Endocrinol Metab 2011; 96(1): E114-E118.

29. de Groot PC, Dekkers OM, Romijn JA et al. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Human Reprod Update 2011; 17(4): 495–500.

30. Schmidt J, Landin-Wilhelmsen K, Brännström M et al. Cardiovascular Disease and Risk Factors in PCOS Women of Postmenopausal Age: A 21-Year Controlled Follow-Up Study. J Clin Endocrinol Metab 2011; 96(12): 3794–3803.

31. Shaw LJ, Bairey Merz CN, Azziz R et al. Postmenopasual women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health – National Heart, Lung, and Blood Institute sponsored Women´s Ischemia Syndrome Evaluation. J Clin Endocrinol Metab 2008; 93(4): 1276–1284.

32. Setji TL, Brown AJ. Polycystic Ovary Syndrome: Update on Diagnosis and Treatment. AMJMED 2014; 127(10): 912–919.

33. Tasali E, Chapotot F, Leproult R et al. Treatment of Obstructive Sleep Apnea Improves Cardiometabolic Function in Young Obese Women with Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2011; 96(2): 365–374.

34. Qin JZ et al. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol 2013; 11: 56.

35. Diamanti-Kandarakis E, Christakou CD, Kandaraki E et al. Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome. Eur J Endocrinol 2010; 162(2): 193–212.

36. Petríková J, Lazúrová I, Yehuda S. Polycystic ovary syndrome and autoimmunity. EJIM 2010; 21(5): 369–371.

37. Janssen OE1, Mehlmauer N, Hahn S et al. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol 2004; 150(3): 363–369.

38. Glintborg D, Andersen M, Hagen C et al. Association of Pioglitazone Treatment with Decreased Bone Mineral Density in Obese Premenopausal Patients with Polycystic Ovary Syndrome: A Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab 2008; 93(5): 1696–1701.

39. Diamanti-Kandarakis E, Baillargeon JP, Iuorno MJ et al. A Modern Medical Quandary: Polycystic Ovary Syndrome, Insulin Resistance, and Oral Contraceptive Pills. J Clin Endocrinol Metab 2003; 88(5): 1927–1932.

40. Haoula Z, Salman M, Atiomo W. Evaluating the Association Between Endometrial Cancer and Polycystic Ovary Syndrome. Hum Reprod 2012; 27(5): 1327–1331.

41. Kaas R, Lukanova A, Kurzer MS. Obesity, Endogenous Hormones and Endometrial Cancer Risk: A Synthetic Review. Cancer Epidemiol Biomarkers Prev 2002; 11(12): 1531–1543.

42. Galazis N, Afxentiou T, Xenophontos M et al. Proteomic biomarkers of type 2 diabetes mellitus risk in women with polycystic ovary syndrome. Eur J Endocrinol 2013; 168(2): R33-R43.

43. Saha L, Kaur S, Saha PK. Pharmacotherapy of polycystic ovary syndrome – an update. Fundam Clin Pharmacol 2012; 26(1): 54–62.

44. Diamanti-Kandarakis E, Papavassiliou AG. Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol Med 2006; 12(7): 324–332.