Ferriman Gallwey Research Articles

7789 PCOS and probiotics - a randomized controlled trial with a comparison to metformin

Abstract Disclosure: B.M. Obermayer-Pietsch: None. B. Valentin: None. B. Luegger: None. R. Regina: None. C.W. Haudum: None. V. Tandl: None. Polycystic ovary syndrome (PCOS) has a complex association not only with gonadal hormones, but also with insulin resistance and the gut – showing a decreased alpha diversity of the microbiome in PCOS women. Based on our previous investigations, we conducted a randomized controlled trial (RCT) using probiotics (OMNi-BiOTiC®, Institut Allergosan) and placebo daily, compared to a metformin group over 6 months. In this RCT, we included 112 women with PCOS, defined by Rotterdam criteria. Clinical and biochemical characterisation covered medical history with cycle abnormalities, Ferriman–Gallwey (FG) Score and anthropometric data. Hormonal profiles included gonadal hormones with a focus on androgens and AMH. Oral glucose tolerance tests (oGTT) with parallel insulin/c-peptide determinations and stool sampling for microbiome determination at every visit were done. Study participants were randomized 2:1 for probiotics/placebo or metformin (Glucophage®, Merck) and further 1:1 between probiotics and placebo for 6 months followed by a voluntary 6 months period on probiotics only. NGS for microbiome profiles was carried out. 93 PCOS women completed the study, 19 drop-outs for various reasons including 6 pregnancies were recorded (5 in the probiotic/placebo group, 1 in the metformin group). Participants were 27±5 years old, obesity with a BMI >30 was found in 35% of them. Initial cycle duration ranged from 22 to 200 days, 18% had amenorrhoea. Hirsutism was present with a mean FG score of 12,7±7,71. Mean levels (±standard deviation, reference range, no units depicted) for total testosterone were 0,38±0,15 (0,14-0,77), SHBG 54,1±29,0 (19–117), free testosterone 3,2±3,1 (0,45-2,19) and AMH 8,9±4,8 (0,17-7,37). Initial oGTTs showed insulin resistance prevalent in 43%, with an overall reduction to 36% at visit 2. Weight loss over 6 months was documented in 37%, cycle abnormalities decreased overall to 14%. Group comparisons and microbiome characterisation are ongoing. No serious adverse reactions related to the study medication were recorded. All intervention products were well tolerated in our PCOS study cohort. Based on the intended cycle normalisation, 6 pregnancies were recorded. Metabolic changes were seen both in the probiotic/placebo and in the metformin groups, with fewer changes in the placebo group despite nutritional counselling. Microbiome changes were recorded in both intervention groups. Presentation: 6/3/2024

7789 PCOS and probiotics - a randomized controlled trial with a comparison to metformin

Abstract Disclosure: B.M. Obermayer-Pietsch: None. B. Valentin: None. B. Luegger: None. R. Regina: None. C.W. Haudum: None. V. Tandl: None. Polycystic ovary syndrome (PCOS) has a complex association not only with gonadal hormones, but also with insulin resistance and the gut – showing a decreased alpha diversity of the microbiome in PCOS women. Based on our previous investigations, we conducted a randomized controlled trial (RCT) using probiotics (OMNi-BiOTiC®, Institut Allergosan) and placebo daily, compared to a metformin group over 6 months. In this RCT, we included 112 women with PCOS, defined by Rotterdam criteria. Clinical and biochemical characterisation covered medical history with cycle abnormalities, Ferriman–Gallwey (FG) Score and anthropometric data. Hormonal profiles included gonadal hormones with a focus on androgens and AMH. Oral glucose tolerance tests (oGTT) with parallel insulin/c-peptide determinations and stool sampling for microbiome determination at every visit were done. Study participants were randomized 2:1 for probiotics/placebo or metformin (Glucophage®, Merck) and further 1:1 between probiotics and placebo for 6 months followed by a voluntary 6 months period on probiotics only. NGS for microbiome profiles was carried out. 93 PCOS women completed the study, 19 drop-outs for various reasons including 6 pregnancies were recorded (5 in the probiotic/placebo group, 1 in the metformin group). Participants were 27±5 years old, obesity with a BMI >30 was found in 35% of them. Initial cycle duration ranged from 22 to 200 days, 18% had amenorrhoea. Hirsutism was present with a mean FG score of 12,7±7,71. Mean levels (±standard deviation, reference range, no units depicted) for total testosterone were 0,38±0,15 (0,14-0,77), SHBG 54,1±29,0 (19–117), free testosterone 3,2±3,1 (0,45-2,19) and AMH 8,9±4,8 (0,17-7,37). Initial oGTTs showed insulin resistance prevalent in 43%, with an overall reduction to 36% at visit 2. Weight loss over 6 months was documented in 37%, cycle abnormalities decreased overall to 14%. Group comparisons and microbiome characterisation are ongoing. No serious adverse reactions related to the study medication were recorded. All intervention products were well tolerated in our PCOS study cohort. Based on the intended cycle normalisation, 6 pregnancies were recorded. Metabolic changes were seen both in the probiotic/placebo and in the metformin groups, with fewer changes in the placebo group despite nutritional counselling. Microbiome changes were recorded in both intervention groups. Presentation: 6/3/2024

7874 Management Of “Hyperandrogenism” Confounded By Dermatology Biotin Prescriptions

Abstract Disclosure: S.S. Sundar: None. S. Shankar: None. M.S. Vaishnav: None. L. Lekkala: None. S. Sathyanarayana: None. C. Siddlingappa: None. K. M: None. T.-. Kamala: None. R.B. V: None. V. Nath: None. M.D. Chitra: None. P. Ravikumar: None. Introduction: Immunoassay interferences include: Cross-reactions, heterophile antibodies, biotin and anti-analyte antibodies, with positive or negative bias, leading to difficulties in clinical decision-making (confounding diagnosis, unnecessary investigations or inappropriate treatments). The interfering substance may be exogenous (e.g., drug or substance absorbed by patient) or endogenous (e.g., antibodies produced by patient). Clinical Case 2023 Dec 1 Dermatology management for hyperandrogenism 28-year-old female evaluated for acne 3 years (increased 4 months), hair fall 6 months and hirsutism 3 years (threading) Total Testosterone 443 ng/dL (10-55) CLIA Free Testosterone 8.9 pg/mL (0.1-6.4) ELISA DHEAS 209 µg/dL (35-430) CLIA S Cortisol 8 am 6.9 µg/dL (2.6-10.5) CLIA LH 4.2 mIU/mL (1.9-12.5); FSH 5.3 mIU/mL (3.0-8.0) T3 133 ng/dL (80-200); T4 8.5 ug/dL (4.8-12.7), TSH 3.78 µIU/mL (0.5-5.3) HbA1c 5.0%; Glucose fasting 81 mg/dL; Insulin fasting 39.4 mU/L (3-25); HOMA-IR 5.2; HOMA%B 380; HOMA%S 19.2; T3 133 ng/dL (80-200) 2023 Dec 14 Endocrinology for “scaringly” very high testosterone levels Menstrual history: Menarche 11 years; Cycles regular. Unmarried Family history: Diabetes++; Hirsutism+; Infertility- Physical exam: Height 159 cm; Weight 55 kg; BMI 21.8 kg/m2; Ferriman Gallwey score 11; Pulse 75; BP 79/62; Thyroid: Grade 0. In view of total testosterone levels in “neoplastic androgen excess” range, further endocrinology evaluations (multiple labs and assays) were carried out. However, discordance between the mild clinical versus severe biochemical hyperandrogenism was noted. Review of the dermatology prescription indicated that patient had consumed only one 10 mg tablet of biotin 36 hours before the earlier blood draw obtained by dermatologist. Total Testosterone 22.3 and 33.8 ng/dL (6-82) ECLIA; 19.7 (15-70) LCMS Free Testosterone 0.69 pg/mL (< 2.85) (ELISA) DHEAS 101 µg/dL (45-380) LCMS Androstenedione 104 ng/dL (75-205) LCMS 17OH Progesterone 0.89 ng/mL (0.16-2.05) EIA; 0.40 (0.35-2.9) LCMS S Cortisol 5.92 ug/dl (6-18) ECLIA; 5.45 (5-23) LCMS FSH 2.74; LH 6.07; Prolactin 20.1 ng/mL (4.7-23.3) T3 114 ng/dL; T4 7.2 µg/dL; TSH 1.29 Diagnosis Falsely elevated total testosterone (and free testosterone) levels due to biotin immunoassay interference. Clinical Lessons: Very limited studies exist confirming the exact clinical indications for biotin (eg: improvement of hair quality or quantity, or nail growth). FDA warning highlights biotin’s interference (false elevations or reductions) with immunoassays relying on biotin-streptavidin technology. Physicians must ask patients about supplement usage, and discontinue biotin for 8 hours for patients taking 10 mg/day, 3 days for 100-300 mg/day, 7 days for children taking 2 and 15 mg/kg/daily, and inform laboratory if diagnostic test was performed while taking biotin. Presentation: 6/2/2024

How Frequently Is Ultrasound Required to Diagnose Polycystic Ovary Syndrome in a Clinical Population?

Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition, affecting up to 20% of reproductive aged women worldwide. Polycystic ovarian morphology (PCOM) may be present, but is not required for diagnosis. Our study seeks to evaluate the utility of ultrasound in diagnosing or excluding PCOS by 2023 International Guidelines Criteria. Materials and Methods: Subjects were patients seen in a tertiary care referral clinic in whom other causes of hyperandrogenism (HA) were ruled out. All underwent complete history, physical, modified Ferriman Gallwey scoring, and serum androgen testing; followed by transvaginal ultrasound (TVUS) to assess ovarian morphology if indicated. PCOM was identified as antral follicle count ≥20 and/or ovarian volume >10 mL in at least one ovary. After clinical classification, PCOS was diagnosed by at least two of three: biochemical/clinical HA, ovulatory dysfunction (OD), and PCOM. Statistics were calculated using Fisher's exact test and chi-square. Results: In total, 454 subjects were included. 299 were classified as group A/B and did not require TVUS for diagnosis. Of 82 subjects with HA alone, 50 (61.0%) were classified as group C after demonstrating PCOM. Fifty-five subjects had OD alone, 37 (67.3%) of which were classified as group D based on PCOM. In total, 137/454, or 30.2% of subjects required TVUS for diagnosis or exclusion of PCOS. Conclusions: TVUS was necessary in less than one-third of subjects, primarily identifying PCOS groups C or D. Selective use of ovarian ultrasonography may reduce the costs and complexity of epidemiological and clinical studies for PCOS.

Metabolic characteristics of different phenotypes in reproductive-aged women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is an endocrine metabolic disorder in reproductive-aged women. The study was designed to investigate the metabolic characteristics of different phenotypes in women with PCOS of reproductive age. A total of 442 women with PCOS were recruited in this cross-sectional study. According to different phenotypes, all women were divided into three groups: the chronic ovulatory dysfunction and hyperandrogenism group (OD-HA group, n = 138), the chronic ovulatory dysfunction and polycystic ovarian morphology group (OD-PCOM group, n = 161), and the hyperandrogenism and polycystic ovarian morphology group (HA-PCOM group, n = 143). The metabolic risk factors and prevalence rates of metabolic disorders among the three groups were compared. The body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR) of women from the OD-HA group and HA-PCOM group were significantly higher than those of women from the OD-PCOM group (p < 0.05). The serum insulin concentration and homeostasis model assessment of insulin resistance (HOMA IR) at 2h and 3h after oral glucose powder in women from the OD-HA group and HA-PCOM group were significantly higher than those from the OD-PCOM group (p < 0.05). The serum total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in women from the OD-HA group and HA-PCOM group were significantly higher than those in women from the OD-PCOM group (p < 0.05). The prevalence rates of impaired glucose tolerance (IGT), type 2 diabetes mellitus (T2DM), insulin resistance (IR), metabolic syndrome (MS), nonalcoholic fatty liver disease (NAFLD), and dyslipidemia of women with PCOS were 17.9%, 3.6%, 58.4%, 29.4%, 46.6%, and 43.4%, respectively. The prevalence rates of IGT, IR, MS, NAFLD, and dyslipidemia of women in the OD-HA group and HA-PCOM group were significantly higher than those of women in the OD-PCOM group (p < 0.05). T concentration (>1.67 nmol/L) and Ferriman-Gallwey (F-G) score (>3) significantly increased the risk of metabolic disorders in women with PCOS (p < 0.05). The phenotypes of OD-HA and HA-PCOM in women with PCOS were vulnerable to metabolic disorders compared to OD-PCOM. Thus, the metabolic disorders in women with PCOS especially those with the HA phenotype should be paid more attention in order to reduce long-term complications.

The possible short-term of Nigella sativa – L in the management of adolescent polycystic ovarian syndrome: results of a randomized controlled trial

BackgroundPolycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age and the most common cause of infertility due to anovulation. PCOS in adolescents is concerning. Nigella sativa is effective in improving gonadotropins and sex hormones. The current study was designed to investigate the effect of Nigella sativa supplementation on PCOS symptoms and their severity in adolescents.MethodsThe current randomized clinical trial was conducted on 114 adolescents with PCOS who were referred to gynecologist offices and clinics in Gonabad, Iran from March 2022 to March 2023. Participants were randomly allocated to the intervention (Nigella sativa 1000 mg/day) and control (10 mg/day medroxyprogesterone from the 14th day of the cycle for 10 nights) groups. The study duration was 16 weeks. Ovarian volume (measured by ultrasound), anthropometric and blood pressure; serum testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), luteinizing hormone (LH), hirsutism severity (Ferriman–Gallwey score) levels were evaluated before and after the study.ResultsData from 103 participants (control group = 53, intervention group = 50) were analyzed. The mean age of participants was 17.0 (Interquartile range [IQR]:2.0). The mean difference in hirsutism score changes (p < 0.001), right (p = 0.002), and left (p = 0.010) ovarian volume, serum LH (p < 0.001) and testosterone (p = 0.001) were significantly higher in the intervention group compared to the control group. The frequency of oligomenorrhea, menometrorrhagia, and amenorrhea, were significantly reduced after the study in the intervention group compared to the control group (ps < 0.001).ConclusionsShort-term Nigella sativa supplementation may be effective in reducing ovarian volume and improving hormonal balance, and menstrual irregularities in adolescents with PCOS. Further research and long-term studies are warranted to validate the potential therapeutic effects of Nigella sativa in adolescents with PCOS.IRCT registration numberIRCT20221017056209N1 Registration date: 2022-11-22.

Impact of Laser Therapy on the Quality of Life in Women Living With Polycystic Ovary Syndrome-Associated Hirsutism: An Observational Study.

This study aimed to observe the impact of laser-assisted hair removal (LAHR) on the quality of life in women with polycystic ovary syndrome (PCOS)-associated hirsutism. An observational study was conducted on 172 women living with PCOSat a specialized clinic. The Dermatology Life Quality Index (DLQI) and Ferriman-Gallwey (FG) score were employed to assess the quality of life and severity of hirsutism, respectively. Laser therapy was administered using ruby diode or alexandrite lasers. Follow-up on the DLQIand FG score assessment was done at 12-, 18-, and 24-weekpost-treatment. The number of cases that reported stress, anxiety, and depression reduced over time. However, there was no correlation between the patient-reporteddecrease and DLQI scores. The FG score was significantly related to mental health. The severity of the hirsutism impacted mental health. The regrowth of hair at six months indicated limited long-term efficacy LAHR. LAHR significantly improves the quality of life in the short term for women living with PCOS. However, the short-term benefit of the therapy indicates a need for research to find new treatment strategies.

Clinical assessment of the efficacy of Ayurvedic management in PCOS: Study protocol for a randomized open-label standard control trial

Abstract INTRODUCTION: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, typically characterized by anovulation, hormonal imbalances, obesity, infertility, and associated features, with a significant impact on the physiological and psychological wellbeing of females belonging to the reproductive age group. Due to the multifactorial etiology, treatment is often personalized with specific targets, and monotherapy is rarely used. In the present study, the efficacy of an Ayurveda regimen, comprising the Ayush-SSM tablet (a coded Ayurvedic formulation) administered after Virechana therapy (purgation), is being explored against conventional standard care. MATERIALS AND METHODS: This study is an open-label, randomized, controlled clinical trial consisting of 180 participants diagnosed with PCOS. The participants in the trial group will receive Ayurvedic treatment consisting of Virechana therapy followed by administration of Ayush-SSM (500 mg), two tablets twice a day for 6 months. The participants in the control group will receive metformin tablet 500 mg once a day in the first week, 500 mg twice a day in the second week, 500 mg thrice a day in the third week, and 850 mg twice a day from the fourth week till 6 months. The primary outcome is the proportion of study participants who attain normal menstrual cycle length (21–35 days) or ovulation and change in hirsutism as per the modified Ferriman–Gallwey (FG) Score. The secondary outcomes are change in acne score and acanthosis nigricans; change in abdominal girth, waist circumference, and BMI; and clinical safety of the trial interventions. CONCLUSION: The findings of the study could potentially demonstrate that the Ayurveda regimen, including Virechana therapy followed by administration of the Ayush-SSM tablet, may be as effective as conventional standard care. Trial registration: Clinical Trial Registry of India (CTRI/2022/09/045478, dated August 4, 2022).

Physician and Adolescent Hirsutism Score Ratings and Their Concordance to Androgen Levels [ID 2683618

INTRODUCTION: Hirsutism affects 5–15% of reproductive-aged women. The gold standard for quantifying hirsutism is the modified Ferriman–Gallwey (mFG) score. This study explores whether adolescent and physician ratings of hirsutism using the mFG score, correlate with androgen levels in the setting of confounders like depilation. METHODS: Hispanic adolescent females with irregular menstruation and suspected polycystic ovary syndrome (PCOS) were recruited from obstetrics and gynecology clinics at TTUHSC El Paso between September 2021 and May 2023. Patients completed an intake questionnaire, completed PCOS laboratory testing, and rated their hair growth using the mFG visual scoring method. Providers used same the methods for rating hirsutism during the same visit. We estimated Lin’s concordance correlation and Bland–Altman agreement between patient and provider mFG ratings. Linear regression explored factors affecting score changes. Statistical analysis was done by STATA 17.0. RESULTS: Forty females participated in this study. The average age at enrollment was 16.19 with a mean (SD) mFG score of 10.55 (5.95) (physicians) and 18.29 (5.78) (adolescents). Adolescents reported higher mean mFG scores than physicians. There is a low level of agreement between the two groups (−7.95; 95% CI: −23.02, 7.12). Specifically, physicians underrated hirsutism scores for arm hair. Using unadjusted linear regression, DHEAS and 17-hydroxyprogesterone levels demonstrate the hormonal influence on hirsutism. CONCLUSION: Preliminary findings indicate discordance between physicians’ and patients’ mFG scores, possibly influenced by examination precision and patient perception. Physician-scored mFG, and evaluation of androgen levels, may serve as precise hirsutism markers for Hispanic adolescents.

Association of hirsutism and anthropometric profiles with sexual dysfunction and anxiety levels in infertile Indonesian women with polycystic ovarian syndrome

BackgroundHyperandrogenism is frequently found in polycystic ovary syndrome (PCOS) and contributes to physical manifestations like hirsutism and obesity, along with infertility. This condition can result in anxiety, depression, and body image disorders, potentially leading to sexual dysfunction. The objective of this investigation was to assess the correlation among hirsutism, anthropometric characteristics, sexual dysfunction, and anxiety levels among infertile Indonesian women diagnosed with PCOS.MethodsFrom December 2021 to December 2022, a cross-sectional study was undertaken involving 71 infertile women diagnosed with PCOS at Yasmin Clinic, Dr. Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. Hirsutism was assessed using the modified Ferriman-Gallwey (mFG) score; the anthropometric profile was assessed using BMI and waist-to-hip ratio. The assessment of sexual dysfunction was conducted using the Female Sexual Function Index (FSFI) questionnaire, while the evaluation of anxiety levels utilized the HAM-A questionnaires.ResultsIn this study, it was discovered that 53.3% of subjects experienced sexual dysfunction. However, there was no statistically significant relationship between hirsutism, anthropometric profile, and sexual dysfunction score in infertile women with PCOS (p > 0.05). Analysis of the overall FSFI domain score revealed that lubrication and satisfaction were lower in obese patients (p = 0.02 and p = 0.03), but this did not contribute to an overall sexual dysfunction score. Also, we found that subjects who experienced sexual dysfunction had a higher anxiety score (p < 0.005), with correlation analysis showing that Ferriman-Gallwey (FG) scores have a significant positive correlation with anxiety.ConclusionThere is no correlation between hirsutism, anthropometric profile, and sexual dysfunction in infertile Indonesian women diagnosed with PCOS. However, hirsutism could play a role in causing anxiety in Indonesian PCOS women. Additional investigation is required, as female sexual function is an intricate subject.

Triglyceride-Glucose Index as A Crucial Marker for Polycystic Ovary Syndrome Women with Insulin Resistance

BACKGROUND: Insulin resistance (IR) is considered as the main driver of polycystic ovary syndrome (PCOS) pathogenesis. In PCOS condition, IR is frequently related to glucose, anthropometric profile, lipid profile, and hormone profile parameters. However, not all PCOS phenotype show IR. Therefore, this study was conducted to determine the association the parameters mentioned above in PCOS subjects with and without IR.METHODS: Fifty PCOS women with IR and 26 PCOS women without IR were recruited. All subjects underwent physical examination for measurement of weight, waist circumference (WC), and body mass index (BMI). Ferriman Gallwey Score (FGS) was used to evaluate hirsutism. Blood sample was taken from each subject for measurement of fasting glucose, postprandial glucose, fasting insulin, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglyceride (TG), sex hormone binding globulin (SHBG), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), follicle stimulating hormone (FSH), and prolactin. Homeostatic model assessment for IR (HOMA-IR), TG-glucose index (TyGI), and free testosterone index (FTI) were then calculated.RESULTS: From all the parameters examined, only fasting insulin (p&lt;0.001), HOMA-IR (p&lt;0.001), SHBG (p=0.012), TG (p&lt;0.001), and TyGI (p=0.008) that show significant differences between PCOS subjects with and without IR. After multivariate analysis, TyGI was found to have strong association with IR occurrence in PCOS subjects (p=0.005) with an odd ratio of 5.26 (1.65–16.74).CONCLUSION: TyGI appears to have a significant association with the IR occurrence in PCOS subjects. Hence, it can be suggested that TyGI could be an important marker for PCOS women with IR.KEYWORDS: insulin resistance, lipid metabolism, polycystic ovary syndrome, triglyceride-glucose index

ASSOCIATION OF POLYCYSTIC OVARY SYNDROME AND THYROID DYSFUNCTION AMONG REPRODUCTIVE WOMEN: A CROSS-SECTIONAL STUDY

Objective: Polycystic ovarian syndrome (PCOS) is became most common problem in the reproductive age group women who seem to be adversely affected by associated thyroid dysfunction. Ovarian failure and pregnancy-related complications leaded by both factors. The study helps to explore the incidence and etiology of diverse thyroid conditions among PCOS individuals. Methods: This prospective single‑center study with 40 female patients with hyperandrogenism, hirsutism, oligo‐anovulation, and polycystic ovaries patients were defined as having PCOS according to the revised 2003 Rotterdam criteria and Ferriman–Gallwey score with comprised the study population. Normal female subjects were studied as the control population who had normal thyroid function and without PCOS. By measuring of serum thyroid-stimulating hormone (TSH), free thyroxine levels (free T3 and free T4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone, and testosterone can evaluate thyroid function. Along with ultrasound was performed to confirm the PCOS. By SPSS version 19 Chi-square test and t-test were determined. Results: This case–control study revealed that a statistically significant higher prevalence of PCOS patients was found to have higher mean TSH values that were 5.33±2.51 μIU/mL, the mean for T3 and T4 was 154±138 μg/dL and 11.27±8.47 μg/dL, respectively. The mean FSH values were 07.27±4.49 μIU/mL, the mean LH was 84.27±38.49 μIU/mL, the mean estrogen 342±202 pg/mL, the mean progesterone values were 14.2±8.9 ng/mL and the mean testosterone levels were 69.73±9.28 ng/mL. Conclusion: Thyroid dysfunction shows a high prevalence in PCOS patients. Dysfunction can be treated which helps to manage infertility associated with PCOS.

Body Composition Parameters, Adiponectin, Leptin and Adiponectin/Leptin Ratio are Correlated with LH/FSH Ratio in Women with PCOS but not in Women without PCOS

Objective: To investigate the correlation between body composition parameters, adiponectin, leptin and the adiponectin/leptin ratio and the LH/FSH ratio in women with polycystic ovary syndrome (PCOS).&#x0D; Methods: A cross-sectional study was conducted at Reproductive Cluster Yasmin, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, with sixty women with PCOS and sixty healthy women as controls (matched for age and BMI). Body composition parameters, including body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), percent body fat (PBF), visceral fat area (VFA), percent subcutaneous fat (PSF) and skeletal muscle mass (SMM), were measured; levels of fasting glucose, fasting insulin, testosterone, and sex hormone binding globulin (SHBG) were measured; and homeostatic model assessment for insulin resistance (HOMA-IR) values, anti-Mullerian hormone (AMH), free androgen index (FAI), Ferriman-Gallwey (FG) score, adiponectin levels, leptin levels, adiponectin/leptin ratio, LH, FSH and LH/FSH ratio were measured.&#x0D; Results: Body composition parameters (body weight, BMI, WC, WHR, PBF, VFA, PSF, SMM) were not significantly different between women with PCOS and controls. Fasting insulin (P&lt;0.05), HOMA-IR (P&lt;0.05), AMH (P&lt;0.01), FAI (P&lt;0.01), FG score (P&lt;0.01) and LH/FSH ratio (P&lt;0.05) were higher in PCOS women. Adiponectin (P&lt;0.01) was lower in PCOS women, while leptin and the adiponectin/leptin ratio were not significantly different between groups. Most of body composition parameters, adiponectin, leptin and adiponectin/leptin ratio were correlated with HOMA-IR in both groups.&#x0D; SMM was positively correlated with the LH/FSH ratio, while body weight, BMI, WC, PBF, VFA, and PSF were inversely correlated with the LH/FSH ratio in PCOS patients but not in controls. WHR was not correlated in either group. Leptin (r=-0.278; P&lt;0.05) was negatively correlated with the LH/FSH ratio only in the PCOS group. Adiponectin (r=0.394; P&lt;0.01) and the adiponectin/leptin ratio (r=0.413; P&lt;0.01) were also positively correlated with the LH/FSH ratio only in the PCOS group. AMH was correlated with the LH/FSH ratio, whereas testosterone level, FAI, FG score, fasting insulin level and HOMA-IR value were not correlated with the LH/FSH ratio in PCOS women.&#x0D; Conclusion: Most of the body composition parameters, leptin, adiponectin and the adiponectin/leptin ratio were significantly correlated with HOMA-IR in both groups. However, correlations of those parameters with LH/FSH ratio were found only in PCOS but not in women without PCOS. Adiponectin and leptin may play a significant role in the mechanism of neuroendocrine disorders in PCOS, which is characterized by an increased LH/FSH ratio.&#x0D; Keywords: adiponectin, adiponectin/leptin ratio, body composition, HOMA-IR, leptin, LH/FSH ratio, PCOS

O-03 Adrenalectomy for Cushing's syndrome during pregnancy

Abstract Introduction Cushing's syndrome (CS) is rare in pregnancy because CS itself is a cause of anovulatory infertility due to excess cortisol secretion. Moreover it is also difficult to diagnose CS in pregnancy because placental production of corticotropin releasing and adrenocorticotropic hormone (ACTH), increased maternal production of estrogen induced corticosteroid binding globulin leads to physiological hypercortisolism during pregnancy. So physicians face a clinical overlap in many features of CS such as weight gain, fatigue, edema, hypertension, hyperglycemia, stretch marks, mood changes that can also be attributed to pregnancy. Thus their coexistence represents a diagnostic challenge. Herein we report a case of CS that was diagnosed and successfully treated during pregnancy. Clinical Case A 43-year-old gravida 3 female was consulted at the 21st week of gestation with persistent high blood pressure and hyperglycemia for a month. She had an obstetric history of 2 spontaneous first term abortion, 2 healthy labor 18 years ago and she was healthy after. She was in such a depressive mood that she was consulted with psychiatry many times. On physical examination edema, proximal weakness of lower extremities and hirsutism (modified Ferriman–Gallwey score of 9) was detected. Initial laboratory tests were all within normal range except potassium level (2.7 mmol/L), the results were not consistent with preeclampsia and there was a suspicious adrenal mass detected on ultrasound. She was currently receiving high dose antihypertensive treatment with methyldopa, calcium channel blockers, rapid acting and detemir insulin for diabetes and i.v. potassium replacement. We ruled out conns syndrome with normal plasma aldosterone renin ratio and found catecholamine levels normal. Hormonal analyses revealed with high plasma cortisol levels, increased nocturnal cortisolemia, a suppressed plasma ACTH and dehydroepiandrosterone sulfate level and distinctly elevated 24-hour urinary cortisol greater than 3-fold the upper normal reference range. Non contrast magnetic resonance imaging demonstrated a 47×32 mm left adrenal mass. Laparoscopic adrenalectomy was performed in the 26th week of gestation and the following histopathology revealed an adrenocortical adenoma. Antihypertensive medication was progressively reduced, glycemic control and hypokalemia reversal were achieved. She was followed up with appropriate glucocorticoid replacement. At 34 weeks of gestation, after sudden labor pain and regular uterine contractions a 2586 g male infant with Apgar scores of 8 was born by cesarean section. They were discharged in good health. Conclusion CS should be kept in mind especially in the case of hypertension and diabetes that started before the 20th gestational age. Analysis of the urinary free cortisol level and circadian rhythm of cortisol is necessary to diagnose. Despite the diagnostic challenge we can achieve better maternal and fetal outcomes with proper management.Figure 1.Non-contrast magnetic resonance imaging of the patient Table 1.Patient's laboratuary test results Table 2.Patient's laboratory test results

Clinical and Biochemical Evaluation of Hirsutism in Young, Lean Girls from Kirkuk City, Iraq: A Cross-Sectional Study

Background: An increase in terminal hair in androgen-dependent regions is known as hirsutism. It is not solely caused by hyperandrogenemia; idiopathic forms are also frequently seen. Objective: To examine the modified Ferriman Gallwey (mFG) cut-off score in female Iraqis as well as the etiological, biochemical, and clinical characteristics of hirsutism. Methods: This prospective cross-sectional study included one thousand young girls with a normal BMI. The features associated with clinical hirsutism were identified using the mFG scoring system. We eliminated eighty-eight young girls who were diagnosed with PCOS. Samples of blood were drawn for biochemical analyses. Results: 53.1%, 19.6%, and 1.2% of females had mild, moderate, or severe hirsutism, respectively. For the young females who participated in the study, their mean mFG scores were 7.07, 11.26, 16.26, and 29, respectively. Only 5% of girls with mild hirsutism had high serum free testosterone levels, despite a considerable difference in free testosterone levels between them and the normal girls. The chin, upper lip, and lower abdomen were the sites that contributed the most to mFGs. Of the girls who were moderately hirsute, 55% had a positive family history of hirsutism. Conclusion: Iraqi women do not need to consider the mFG score system's cut-off number of 8. The endocrine society's guidelines for hirsutism estimation should be adhered to by the examiner.

SAT358 Race And Ethnicity Of Women With 21-hydroxylase Deficient Non-classic Adrenal Hyperplasia (NCAH) Compared With PCOS

Abstract Disclosure: L.A. Pace: None. K.L. VanHise: None. J.L. Chan: None. M.D. Pisarska: None. R. Azziz: Advisory Board Member; Self; Arora Forge. Consulting Fee; Self; Rani Therapeutics, Fortress Biotech, Spruce Biosciences, Core Access Surgical Technologies. Grant Recipient; Self; Foundation for Research and Education Excellence, Ferring Pharmaceuticals. Stock Owner; Self; Martin Imaging. Background: 21-hydroxylase (21-OH) deficient non-classic adrenal hyperplasia (NCAH) is found in 1-10% of androgen excess patients and is one of the most common autosomal recessive disorders in humans. In turn, PCOS has complex inheritance and is one of the most common endocrine disorders of women. Objective: To compare the racial and ethnic distribution of NCAH vs. PCOS in a referral population. Methods: We analyzed data from a database collected prospectively of consecutive female patients presenting with androgen excess at a tertiary care referral clinic. Results: Among 645 consecutive female patients with androgen excess who completed their evaluation, 15 (2.3%) had NCAH and 619 (96.0%) had PCOS defined by the Rotterdam 2003 criteria. Of 15 women with NCAH, 13 (86.7%) were White (10 White Non-Hispanic [WNH] and 3 White Hispanic [WH]), one (6.7%) was Asian, and one (6.7%) was of mixed race. Of PCOS subjects, 479 (77.4%) were White (347 WNH, 121 WH, and 11 of undocumented ethnicity), 65 (10.5%) were Black (55 Black Non-Hispanic [BNH], 5 Black Hispanic [BH], and 5 were Black of undocumented ethnicity), 47 (7.6%) were Asian Non-Hispanic (ANH), 6 (1.0%) were Native Hawaiian/Pacific Islander Non-Hispanic, 14 (2.3%) were of mixed race (4 Hispanic and 10 Non-Hispanic), and 7 (1.1%) were other or undocumented race. Comparing key phenotypic features, the mean (±SD) age at first visit for NCAH patients was 33.1 (±14.1) years vs. 28.9 (±6.9) for PCOS (p=0.03); mean BMI of NCAH patients was 27.7 (±8.2) kg/M2 vs. 30.2 (±8.2) in PCOS (p=0.26); mean Ferriman-Gallwey (FG) score for NCAH patients was 8.6 (± 6.2) vs. 6.7 (±5.1) PCOS (p=0.19); and mean menstrual cycles per year were 7.8 (±5.2) in NCAH vs. 6.0 (±3.9) in PCOS (p=0.12). Conclusions: Phenotypically, patients with NCAH were slightly older, but did not differ in BMI, degree of hirsutism, or menstrual dysfunction vs. PCOS patients, emphasizing the need to screen for NCAH using basal follicular-phase measurements of 17-hydroxyprogesterone. However, there were notable racial differences between the NCAH and PCOS cohorts. While 10% of PCOS patients were Black in this referral clinic database, no patient with NCAH was Black. The paucity of NCAH among Black individuals evaluated for androgen excess mirrors the ethnic/racial distribution in the classic form of 21-OH deficient adrenal hyperplasia. These data question whether Black women suspected of androgen excess or PCOS should be routinely screened for NCAH. Presentation Date: Saturday, June 17, 2023

SAT368 Severe Hyperandrogenism in a Young Woman with Elevated BMI: A Case Study of The Role of Weight Loss in The Management of PCOS

Abstract Disclosure: S. Rodriguez Ortega: None. I.R. Bass: None. Background: Increased adiposity enhances the phenotypic expression and severity of hyperandrogenism in women with Polycystic Ovarian Syndrome (PCOS). Weight loss has been associated with improved endocrine features in women with PCOS and elevated Body Mass Index (BMI). Bariatric surgery can be an effective means of significant weight loss and restoration of the hypothalamic pituitary axis. Case Presentation: A 21-year-old Hispanic nulligravid woman presented with history of oligomenorrhea, weight gain and hirsutism. Her symptoms started after menarche at 15 years old with irregular periods, hair growth on her face and neck, and rapid weight gain. She was evaluated by an endocrinologist and was found to have an elevated total testosterone level by LC/MS on several different occasions: 309ng/dl, 259ng/dl and 229 ng/dl, as well as elevated androstenedione 346 ng/dl (41-262ng/dl). She was treated with metformin and oral contraceptive pill for two years and then referred for second opinion. On our physical exam, she had a BMI of 44.60 kg/ m2, a deep voice, Ferriman Gallwey score of 12 and acanthosis nigricans. OCPs were held for three months for accurate testing and work up revealed total testosterone 164.7 ng/dl (10.0-55.0 ng/dl), sex hormone binding globulin 25.4 nmol/L (24.6-112.0 nmol/L), bioavailable testosterone 84.3ng/dL (51.4%), DHEAs 375 µg/dl (110-431.7 µg/dl), and androstenedione 264 ng/dl (41-262 ng/dl). Other causes of hyperandrogenism such as hyperprolactinemia, hypothyroidism and congenital adrenal hyperplasia were ruled out. MRI pituitary from outside facility was reviewed and was normal. MRI abdomen and pelvis with/without contrast was performed, which demonstrated normal adrenal glands and an 8.1 cm midline pelvic cyst, containing a 0.7 cm enhancing solid nodule. She was referred for surgery for concern for possible virilizing tumor. The cyst was surgically removed and intra-operative ovarian exploration and cytopathology from pelvic washing were negative. She was referred for bariatric surgery and underwent a sleeve gastrectomy. After 6 weeks, she lost 30lbs, BMI improved to 37.1 kg/ m2 and her menses resumed. Repeat labs showed improvement in her androgens: total testosterone 64.8ng/dl, SHBG 104nmol/L, androstenedione 127ng/dl. After 8 months, she lost 110lbs and has dramatic improvement in her hirsutism and clearance of her acanthosis nigricans. Conclusion: Sustained lifestyle changes and weight loss are a mainstay in the treatment of patients with PCOS and obesity. Bariatric surgery results in durable weight loss and restores the normal physiological balance of sex hormones and improves signs and symptoms of hyperandrogenism. Presentation Date: Saturday, June 17, 2023

Superb Microvascular Imaging Doppler Technique In The Evaluation Of Ovarian Stromal Vascularity In Women With Polycystic Ovary Syndrome.

To compare the assessment of intra-ovarian stromal vascularity through transabdominal ultrasonography with colour Doppler imaging, power Doppler imaging, colour superb microvascular imaging and monochrome superb microvascular imaging in polycystic ovary syndrome cases. The retrospective cross-sectional study was conducted at the Obstetrics and Gynaecology outpatient department of the Usak Training and Research Hospital, Turkey, from April 11 to June 18, 2018, and comprised grayscale colour Doppler imaging, power Doppler imaging, colour superb microvascular imaging and monochrome superb microvascular imaging of women with polycystic ovary syndrome. The recorded video images were evaluated by three radiologists and rated through consensus decision. Mean values for age, body mass index, follicle stimulating hormone and luteinizing hormone levels, luteinizing hormone-follicle stimulating hormone ratio, Ferriman Gallwey score, and mean ovarian volume of the subjects were evaluated. Data was analysed using Number Cruncher Statistical System. Of the 54 women evaluated, data of 42(77.8%) was included. There were a total of 83 ovaries, as the left ovary of 1(1.2%) patient was not visible. The mean age and body mass index were 24.02±5.8 years and 25.08±4.5kg/m2. Mean follicle stimulating hormone and luteinizing hormone levels were 5.51±1.91 and 7.91±6.13m IU/mL. Luteinizing hormone/follicle stimulating hormone ratio and Ferriman Gallwey score were 1.4±0.8 and 8.67 ±6.94, respectively. The mean ovarian volume was 12.2±3.43 cm3. The detection of vascularity was colour Doppler imaging 0.72±0.97, power Doppler imaging 0.96±1.08, colour superb microvascular imaging 2.47±1.25, and monochrome superb microvascular imaging 2.75±1.31. The techniques were significant for superb microvascular imaging Doppler than conventional Doppler (p<0.001). Hyper- ovarian stromal vascularity, like a 'stellate' sign, was detected in 17(20.5%) of the total 83 ovaries analysed. Transabdominal ultrasonography-colour superb microvascular imaging was found to be more effective in detecting ovarian vascularity than conventional Doppler technique in women with polycystic ovary syndrome.

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set.

Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes. Prospective observational study. In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup. The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.

A randomized controlled trial comparing myoinositol with metformin versus metformin monotherapy in polycystic ovary syndrome.

Insulin resistance and hyperinsulinemia plays an important role in pathogenesis of polycystic ovary syndrome (PCOS). Metformin, Myoinositol and d-chiro-inositol acts as insulin sensitizers and exerts a beneficial effects in PCOS. The objective is to compare the effect of metformin monotherapy versus a combination of metformin with Myoinositol and d-chiro-inositol in PCOS. This study is a randomized controlled trial conducted over a period of 6 months. All overweight and obese women with PCOS with the age group between 18 and 35 were included and randomized into two groups, 27 in the metformin monotherapy arm and 26 in the myoinositol combination arm. The variables assessed were duration of menstrual cycle, anthropometric parameters, modified Ferriman Gallwey score, global acne score, Fasting insulin, HOMA-IR, fasting lipid profile, serum testosterone, sex hormone binding globulin, luteinizing hormone, follicle stimulating hormone, anti-Mullerian hormone, and pelvic ultrasound to assess ovarian volume, PCOS Questionnaire score. Changes in the parameters from baseline at the end of 6 months of treatment were assessed and compared between the groups. Menstrual cycle regularity improved in both groups with significantly greater improvement in the group receiving myoinositol-based therapy (p < .001). Pregnancy rate was equal in both the arms. There was a significant improvement in PCOSQ score in myoinositol-based therapy group (p < .001). However, there was no statistically significant difference in other hormonal, metabolic parameters between two groups in spite of symptomatic benefits. The addition of myoinositol to metformin exerts additional benefits in improving menstrual cycle regularity, and quality of life in women with PCOS.