Clinical and Biochemical Characterization of Women with Polycystic Ovary Syndrome in North Rhine-Westphalia

 

 Buy Article Permissions and Reprints

Abstract

Polycystic ovary syndrome (PCOS), defined as the combination of oligoanovulation and hyperandrogenism, affects more than 5 % of women of reproductive age. Insulin resistance and hyperinsulinemia appear to play an important role in its pathogenesis. Here, we will present a characterization of a PCOS cohort from North Rhine-Westphalia in Germany. Clinical features, family history as well as endocrine and metabolic parameters were prospectively recorded from 200 successive patients. All patients were evaluated for insulin resistance and β-cell-function by oral glucose tolerance test. Patient data were compared with those of 98 age-matched control women. PCOS patients showed significantly higher BMI, body fat mass and androgen levels as well as impaired glucose and insulin metabolism. A positive family history of PCOS and diabetes was more frequent in PCOS patients. Insulin resistance (71 %) was the most common metabolic abnormality in PCOS patients followed by obesity (52 %) and dyslipidemia (46.3 %), with an incidence of 31.5 % for the metabolic syndrome. C-reactive protein and other cardiovascular risk factors were frequently elevated even in young PCOS patients. While the clinical characteristics and endocrine parameters of this German PCOS cohort were heterogeneous, they were comparable to those from other Caucasian populations.

References

• 1 Franks S. Polycystic ovary syndrome.  N Engl J Med. 1995;  333 853-861
  CrossrefPubMedGoogle Scholar
• 2 Asuncion M, Calvo R M, San Millan J L, Sancho J, Avila S, Escobar-Morreale H F. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain.  J Clin Endocrinol Metab. 2000;  85 2434-2438
  CrossrefPubMedGoogle Scholar
• 3 Azziz R, Sanchez L A, Knochenhauer E S, Moran C, Lazenby J, Stephens K C, Taylor K, Boots L R. Androgen excess in women: experience with over 1000 consecutive patients.  J Clin Endocrinol Metab. 2004;  89 453-462
  Google Scholar
• 4 Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis.  Endocr Rev. 1997;  18 774-800
  CrossrefPubMedGoogle Scholar
• 5 ESHRE/ASRM . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.  Fertil Steril. 2004;  81 19-25
  PubMedGoogle Scholar
• 6 Stein I, Leventhal M. Amenorrhoea associated with bilateral polycystic ovaries.  Am J Obstet Gynecol. 1935;  29 181-185
  PubMedGoogle Scholar
• 7 Fox R, Hull M. Ultrasound diagnosis of polycystic ovaries.  Ann N Y Acad Sci. 1993;  687 217-223
  PubMedGoogle Scholar
• 8 Balen A H, Laven J S, Tan S L, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions.  Hum Reprod Update. 2003;  9 505-514
  CrossrefPubMedGoogle Scholar
• 9 Amer S A, Li T C, Bygrave C, Sprigg A, Saravelos H, Cooke I D. An evaluation of the inter-observer and intra-observer variability of the ultrasound diagnosis of polycystic ovaries.  Hum Reprod. 2002;  17 1616-1622
  CrossrefPubMedGoogle Scholar
• 10 Dunaif A, Segal K R, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome.  Diabetes. 1989;  38 1165-1174
  CrossrefPubMedGoogle Scholar
• 11 Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study.  Clin Endocrinol (Oxf). 2000;  52 595-600
  Google Scholar
• 12 Loverro G, Lorusso F, Mei L, Depalo R, Cormio G, Selvaggi L. The plasma homocysteine levels are increased in polycystic ovary syndrome.  Gynecol Obstet Invest. 2002;  53 157-162
  CrossrefPubMedGoogle Scholar
• 13 Wild R A. Long-term health consequences of PCOS.  Hum Reprod Update. 2002;  8 231-241
  PubMedGoogle Scholar
• 14 Legro R S. Polycystic ovary syndrome and cardiovascular disease: a premature association?.  Endocr Rev. 2003;  24 302-312
  PubMedGoogle Scholar
• 15 Solomon C G. The epidemiology of polycystic ovary syndrome. Prevalence and associated disease risks.  Endocrinol Metab Clin North Am. 1999;  28 247-263
  CrossrefPubMedGoogle Scholar
• 16 Wijeyaratne C N, Balen A H, Barth J H, Belchetz P E. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference?.  Clin Endocrinol (Oxf). 2002;  57 343-350
  CrossrefPubMedGoogle Scholar
• 17 Norman R J, Mahabeer S, Masters S. Ethnic differences in insulin and glucose response to glucose between white and Indian women with polycystic ovary syndrome.  Fertil Steril. 1995;  63 58-62
  PubMedGoogle Scholar
• 18 Dunaif A, Sorbara L, Delson R, Green G. Ethnicity and polycystic ovary syndrome are associated with independent and additive decreases in insulin action in Caribbean-Hispanic women.  Diabetes. 1993;  42 1462-1468
  PubMedGoogle Scholar
• 19 Kauffman R P, Baker V M, Dimarino P, Gimpel T, Castracane V D. Polycystic ovarian syndrome and insulin resistance in white and Mexican American women: a comparison of two distinct populations.  Am J Obstet Gynecol. 2002;  187 1362-1369
  CrossrefPubMedGoogle Scholar
• 20 Williamson K, Gunn A J, Johnson N, Milsom S R. The impact of ethnicity on the presentation of polycystic ovarian syndrome.  Aust N Z J Obstet Gynaecol. 2001;  41 202-206
  PubMedGoogle Scholar
• 21 Ferriman D, Gallwey J D. Clinical assessment of body hair growth in women.  J Clin Endocrinol Metab. 1961;  21 1440-1447
  CrossrefPubMedGoogle Scholar
• 22 Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412 - 419
  Google Scholar
• 23 Phillips D I, Clark P M, Hales C N, Osmond C. Understanding oral glucose tolerance: comparison of glucose or insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and insulin secretion.  Diabet Med. 1994;  11 286-292
  CrossrefPubMedGoogle Scholar
• 24 Matsuda M, DeFronzo R. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.  Diabetes Care. 1999;  22 1462-1470
  CrossrefPubMedGoogle Scholar
• 25 NIH . Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).  Jama. 2001;  285 2486-2497
  CrossrefPubMedGoogle Scholar
• 26 Alberti K G, Zimmet P Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.  Diabet Med. 1998;  15 539-553
  CrossrefPubMedGoogle Scholar
• 27 Bender R, Lange S, Ziegler A G. Wichtige Signifikanztests.  Dtsch Med Wochenschr. 2002;  127 T1-T3
  PubMedGoogle Scholar
• 28 Sadrzadeh S, Klip W A, Broekmans F J, Schats R, Willemsen W N, Burger C W, Van Leeuwen F E, Lambalk C B. Birth weight and age at menarche in patients with polycystic ovary syndrome or diminished ovarian reserve, in a retrospective cohort.  Hum Reprod. 2003;  18 2225-2230
  CrossrefPubMedGoogle Scholar
• 29 Glueck C J, Wang P, Goldenberg N, Sieve-Smith L. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin.  Hum Reprod. 2002;  17 2858-2864
  CrossrefPubMedGoogle Scholar
• 30 Kovacs G T. Polycystic Ovary Syndrome. Cambridge, UK; Cambridge University Press 2000
  Google Scholar
• 31 Morin-Papunen L, Vauhkonen I, Koivunen R, Ruokonen A, Martikainen H, Tapanainen J S. Metformin versus ethinyl estradiol-cyproterone acetate in the treatment of nonobese women with polycystic ovary syndrome: a randomized study.  J Clin Endocrinol Metab. 2003;  88 148-156
  PubMedGoogle Scholar
• 32 Elter K, Imir G, Durmusoglu F. Clinical, endocrine and metabolic effects of metformin added to ethinyl estradiol-cyproterone acetate in non-obese women with polycystic ovarian syndrome: a randomized controlled study.  Hum Reprod. 2002;  17 1729-1737
  PubMedGoogle Scholar
• 33 Kelly C J, Gordon D. The effect of metformin on hirsutism in polycystic ovary syndrome.  Eur J Endocrinol. 2002;  147 217-221
  PubMedGoogle Scholar
• 34 Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex.  Br J Dermatol. 1977;  97
  PubMedGoogle Scholar
• 35 Azziz R. Androgen excess is the key element in polycystic ovary syndrome.  Fertil Steril. 2003;  80 252-254
  PubMedGoogle Scholar
• 36 Buffington C K, Givens J R, Kitabchi A E. Enhanced adrenocortical activity as a contributing factor to diabetes in hyperandrogenic women.  Metabolism. 1994;  43 584-590
  CrossrefPubMedGoogle Scholar
• 37 Legro R S, Driscoll D, Strauss J F 3rd, Fox J, Dunaif A. Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome.  Proc Natl Acad Sci U S A. 1998;  95 14 956-14 960
  PubMedGoogle Scholar
• 38 Kahsar-Miller M D, Nixon C, Boots L R, Go R C, Azziz R. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS.  Fertil Steril. 2001;  75 53-58
  CrossrefPubMedGoogle Scholar
• 39 Govind A, Obhrai M S, Clayton R N. Polycystic ovaries are inherited as an autosomal dominant trait: analysis of 29 polycystic ovary syndrome and 10 control families.  J Clin Endocrinol Metab. 1999;  84 38-43
  CrossrefPubMedGoogle Scholar
• 40 Diamanti-Kandarakis E, Kouli C R, Bergiele A T, Filandra F A, Tsianateli T C, Spina G G, Zapanti E D, Bartzis M I. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile.  J Clin Endocrinol Metab. 1999;  84 4006-4011
  CrossrefPubMedGoogle Scholar
• 41 Velazquez E M, Mendoza S, Hamer T, Sosa F, Glueck C J. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy.  Metabolism. 1994;  43 647-654
  CrossrefPubMedGoogle Scholar
• 42 Ehrmann D A, Cavaghan M K, Imperial J, Sturis J, Rosenfield R L, Polonsky K S. Effects of metformin on insulin secretion, insulin action, and ovarian steroidogenesis in women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 1997;  82 524-530
  PubMedGoogle Scholar
• 43 Diamanti-Kandarakis E, Kouli C, Tsianateli T, Bergiele A. Therapeutic effects of metformin on insulin resistance and hyperandrogenism in polycystic ovary syndrome.  Eur J Endocrinol. 1998;  138 269-274
  CrossrefPubMedGoogle Scholar
• 44 La Marca A, Morgante G, Paglia T, Ciotta L, Cianci A, De Leo V. Effects of metformin on adrenal steroidogenesis in women with polycystic ovary syndrome.  Fertil Steril. 1999;  72 985-989
  CrossrefPubMedGoogle Scholar
• 45 Moghetti P, Castello R, Negri C, Tosi F, Perrone F, Caputo M, Zanolin E, Muggeo M. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation.  J Clin Endocrinol Metab. 2000;  85 139-146
  CrossrefPubMedGoogle Scholar
• 46 George S S, George K, Irwin C, Job V, Selvakumar R, Jeyaseelan V, Seshadri M S. Sequential treatment of metformin and clomiphene citrate in clomiphene-resistant women with polycystic ovary syndrome: a randomized, controlled trial.  Hum Reprod. 2003;  18 299-304
  PubMedGoogle Scholar
• 47 Achad C, Thiers J. Le virilisme pilaire et son association a l'insuffisance glycolytique (diabete des femmes a barbe).  Bull Acad Natl Med. 1921;  86 51-64
  PubMedGoogle Scholar
• 48 Burghen G A, Givens J R, Kitabchi A E. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease.  J Clin Endocrinol Metab. 1980;  50 113-116
  CrossrefPubMedGoogle Scholar
• 49 Ehrmann D A, Barnes R B, Rosenfield R L, Cavaghan M K, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome.  Diabetes Care. 1999;  22 141-146
  CrossrefPubMedGoogle Scholar
• 50 Legro R S, Kunselman A R, Dodson W C, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women.  J Clin Endocrinol Metab. 1999;  84 165-169
  CrossrefPubMedGoogle Scholar
• 51 Conway G S, Agrawal R, Betteridge D J, Jacobs H S. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome.  Clin Endocrinol (Oxf). 1992;  37 119-125
  PubMedGoogle Scholar
• 52 Wild R A. Obesity, lipids, cardiovascular risk, and androgen excess.  Am J Med. 1995;  98 27S-32S
  CrossrefPubMedGoogle Scholar
• 53 Christian R C, Dumesic D A, Behrenbeck T, Oberg A L, Sheedy P F 2nd , Fitzpatrick L A. Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2003;  88 2562-2568
  CrossrefPubMedGoogle Scholar
• 54 Faloia E, Canibus P, Gatti C, Frezza F, Santangelo M, Garrapa G G, Boscaro M. Body composition, fat distribution and metabolic characteristics in lean and obese women with polycystic ovary syndrome.  J Endocrinol Invest. 2004;  27 424-429
  PubMedGoogle Scholar
• 55 Blake G J, Rifai N, Buring J E, Ridker P M. Blood pressure, C-reactive protein, and risk of future cardiovascular events.  Circulation. 2003;  108 2993-2999
  CrossrefPubMedGoogle Scholar
• 56 Kelly C C, Lyall H, Petrie J R, Gould G W, Connell J M, Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome.  J Clin Endocrinol Metab. 2001;  86 2453-2455
  CrossrefPubMedGoogle Scholar

O. E. Janssen, M. D.

Div. of Endocrinology, Dept. of Medicine, University of Duisburg-Essen ·

Hufelandstraße 55 · 45122 Essen · Germany

Phone: +49(201)7232854

Fax: +49(201)7235976 ·

Email: onno.janssen@uni-essen.de