Abstract
BackgroundTo verify the feasibility of ovarian stromal evaluation and correlate ovarian parameteres (echogenicity and volume) with hyperandrogenism, and both cardiovascular and metabolic risk factors in PCOS.MethodsTwenty four young PCOS patients and twelve age-matched control women were enrolled. Diagnosis of PCOS was based on the Rotterdam criteria. Ultrasound ovarian study included ovarian volume, stromal volume, stromal area and stromal area/total ovarian area ratio (S/A). Concerning hormones, insulin, LH, FSH, estradiol, androstenedione, testosterone, DHEAS, 17-hydroxy-progesterone, and SHBG were measured during the early follicular phase (days 2-5). Cardiovascular risk factors were represented by fasting plasma levels of glucose, lipids (total and HDL-cholesterol), plasminogen activator inhibitor 1 (PAI-1), von-Willebrand factor (vWF), and adiponectin. Carotid intima-media thickness (C-IMT) was measured as a parameter of cardiovascular risk.ResultsA positive correlation between the S/A ratio and plasma levels of testosterone (p < 0.05) and androstenedione (p < 0.05) was found. The stromal volume, stromal area and S/A ratio were also significantly and positively correlated with PAI-1, and vWF levels, and with IMT in PCOS women (P < 0.05).ConclusionsThis study shows that the ultrasound measurement of ovarian stroma is a predicting factor of hyperandrogenism degree, prothrombotic factors and cardiovascular risk in patients with PCOS.
Highlights
To verify the feasibility of ovarian stromal evaluation and correlate ovarian parameteres with hyperandrogenism, and both cardiovascular and metabolic risk factors in Polycystic ovary syndrome (PCOS)
The LH, Androstenedione, Testosterone, DHEA-S and sex hormone-binding globulin (SHBG) concentration was significantly higher in PCOS (P < 0.05) (Table 3)
Ovarian volume is more reliable in routinary clinical practice, only ovarian stroma measurement may correspond to histological findings of prominent theca and fibrotic thickening of prominent lutheal cell albuginea, alterations that explain many of clinical features of the syndrome [18]
Summary
To verify the feasibility of ovarian stromal evaluation and correlate ovarian parameteres (echogenicity and volume) with hyperandrogenism, and both cardiovascular and metabolic risk factors in PCOS. The strict criteria for diagnosis of PCOS have been long debated, but a recent joint ASRM/ESHRE consensus has proposed a new definition of the syndrome, that In this definition, at least two of the following three criteria are necessary for diagnosis: 1) oligo- and/or anovulation, 2) hyperandrogenism (clinical and/or biochemical), and 3) the ultrasonic appearance of polycystic ovaries. Even though ovarian stromal hypertrophy is largely involved in the pathophysiology of PCOS [6] and it could be properly identified by vaginal endosonography [9], the acceptance of ultrasound ovarian stromal hypertrophy as a additional criterion for diagnosis of PCOS is still controversial This is due to the fact that results are strictly dependent on both the experience of the operator and the quality of ultrasound machine equipment, with a risk of low reproducibility of ultrasound measurements. Many parameters to judge the ovarian morphological alterations has been adopted: doubling of the cross-sectional area, doubling of the number of ripening and atresic follicles, a 50% increase in tunica thickness, a 33% increase of cortical and a five-fold increase of medullar stroma [13]
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