History Of Oligomenorrhea Research Articles

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

Frequency of hirsutism in patients with PCOS (polycystic ovary syndrome)

Objective: To estimate the prevalence of PCOS, a clinically noticeable disorder in women that causes excessive development of coarse or dark hair on the face, chest, and back in a male-like pattern, between first-degree female relatives in families with a proband who has the condition. Methods: A history of oligomenorrhea, hirsutism or biochemical proof of hyperandrogenism (raised entire or free T) and other illnesses were used to diagnose PCOS. Moreover, for better results, Study participants through PCOS (age 24.3G5.8 years, Body Mass Index 26.8G6.9 kg/m2) were used for better results. An R8-modified Ferriman-Gallwey score was used to characterize hirsutism. Results: 24% of the mothers and 32% of the sisters among the moms and sisters assessed had PCOS, respectively. Only premenopausal women who were not receiving treatment i.e., moms (35%) and sisters (40%) for PCOS were found to have the condition, which is consistent with symptoms becoming better due to hormone therapy or age. These PCOS prevalence percentages are much greater than the illness's frequency in the normal community (about 4%), which points to a considerable hereditary component. Furthermore, in comparison to female without hirsutism, hirsute female were pretty young, had greater BMIs, and also had greater amounts of circulatory androgens.

CASE REPORT: SPONTANEOUS HEMOTHORAX- A RARE PRESENTATION OF ECTOPIC PREGNANCY

Common presenting symptoms of an ectopic pregnancy are pain abdomen, amenorrhea, vaginal bleeding and syncope some times. Although it is typically confined to pelvis, rare manifestations involving the thorax, abdomen or pericardium have been documented(3-6). We are reporting a case of ruptured ectopic pregnancy presenting mainly as hemothorax. A 27 Years old female patient P2L2A2, Previous 2 LSCS not tubal ligated with history of oligomenorrhea, initially complained of pain abdomen, vomiting and syncopal attack for which she received some pain killer and IV fluids at some local hospital. Over next 3 to 4 days, she complained of increasing breathlessness and cough. Her chest X- RAY (figure- 1) and chest CECT was done that showed right side massive pleural effusion with collapse of right lung and left side shift of trachea and mediastinum. In view of these findings ICT was inserted that drained 2 liters of dark hemorrhagic fluid. CECT abdomen showed an irregular mildly enhancing, solid, cystic lesion of size 7.5X 4.8X 5.6 cm in right adnexal region with mild to moderate fluid collection in peritoneal cavity. UPT was positive, Serum beta HCG was 1286 m IU/ml. Laparotomy was done in view of ruptured ectopic pregnancy with hemoperitoneum with associated hemothorax. Intraoperatively approx. 1500cc hemoperitoneum (Figure-4) found. In postop period ICT Drain fluid changed to serous and drained only 150cc in next 24 hrs (Figure-5). This is a rare case of spontaneous hemothorax precipitated by hemoperitoneum secondary to ruptured tubal ectopic pregnancy. There have been few case reports of hemothorax associated with ectopic pregnancy in literature.

Effect of Hypothyroidism on Menstrual Cycle Pattern and Fertility at a Tertiary Care Centre in South India

Introduction: Thyroid disorders are very common in females and are known to prevent ovulation. Thyroid disorders can impact menstrual cycles and causes menstrual irregularities and infertility in females. Aim: To determine effects of hypothyroidism on menstrual cycle pattern and prevalence of subfertility among women having thyroid dysfunction. Materials and Methods: This cross-sectional study was conducted in Department of Obstetrics and Gynaecology in collaboration with Department of Endocrinology in Government Medical College, Datia Madhya Pradesh, India from July 2019 to June 2021. A total of 205 patients aged 18-45 years were taken. Among them, 116 and 89 patients were of hypothyroid and euthyroid respectively. After properly selecting patients, detailed history of their menstrual cycles was taken and effect of thyroid dysfunction on menstrual irregularities was assessed. The collected data were evaluated and analyzed using Statistical Package of the Social Sciences (SPSS). Results: A total of 205 patients participated in present study. Mean age was 35+/-5 years. Among 205 subjects, 116 were hypothyroid and 89 were euthyroid. Among the hypothyroid subjects, 72 (62.1%) had normal menstrual cycles, 23 (19.8%) had history of oligomenorrhea, 12 (10.3%) had polymenorrhea, and 9 (7.7%) had amenorrhea, while among the thyroid subjects, 76 (85.4%) had normal menstrual cycle, 6 (6.7%) had oligomenorrhea, 5 (5.6%) had polymenorrhea, and 2 (2.2%) had amenorrhea, with statistically significant differences (p<0.001). The proportions of primary 13 (11.2%) and secondary 9 (7.7%) subfertility were significantly higher among hypothyroid subjects compared with thyroid subjects (p<0.05). The prevalence of subfertility was 7 (7.8%), 10 (14.28%), and 12 (26.08%) among the thyroid, overtly hypothyroid, and subclinical hypothyroid subjects, respectively. Conclusion: In this study, effects of thyroid dysfunction were presumably significant on menstrual cycle pattern and fertility; therefore, thyroid status should be assessed in all patients with menstrual disorders and appropriate treatment should be initiated early.

INFERTILITY SCREENING

Infertility is a common condition caused by the female factor, male factor, or both. Infertility problems can have a significant impact on married couples who experience them. In addition to causing medical problems, infertility can also cause economic and psychological problems. Couples who experience infertility will undergo a long process of evaluation and treatment, where this process can be both physical and psychological for the infertile couple. The aim of this article is presenting a literature study on infertility screening. Infertility affects millions of people of reproductive age worldwide and impacts family and community life. Estimates suggest that between 48 million couples and 186 million people are living with infertility. Infertility occurs in 15% of couples. Female factors cause infertility in 50-70%, and malefactors are the cause of infertility in 40-50% of couples. Given the high prevalence of malefactors in infertility heterosexual couples, medical history and early evaluation of male partners are needed. Ovulation dysfunction was defined as a history of oligomenorrhea or amenorrhea, recurrent luteal progesterone levels of less than 3 ng/mL, or both. For many women, a menstrual history is sufficient to assess ovulatory function. The clinical history can be used to assess the ovulatory cycle as most women will have regular menstrual cycles every 25–35 days. Anovulation may be associated with obesity, hypothalamic and pituitary dysfunction, PCOS, and other etiologies. Polycystic ovary syndrome is the most common cause of ovulatory infertility.
 Women with PCOS who have been diagnosed are at increased risk of the metabolic syndrome associated with cardiovascular events and negatively impacting pregnancy.
 Infertility is the failure of a couple to get pregnant for at least 12 months having regular sex without contraception, or also known as primary infertility. Secondary infertility is the inability of a person to have children or maintain a pregnancy. Idiopathic infertility refers to infertile couples who have undergone standard examinations, including ovulation tests, tubal patency, and semen analysis with normal results.

CLINICAL, METABOLIC, ENDOCRINE AND SONOGRAPHIC CHARACTERISTICS OF OBESE ADOLESCENT WITH PCOS

Introduction- PCOS is a complex metabolic, endocrinopathy and reproductive disorder that results in the production of androgens and is associated with insulin resistance. Adolescents with PCOS are more obese than normal adolescents and have an increased risk of metabolic syndrome. In obese adolescent increasing abdominal adiposity, worsening insulin sensitivity and Dyslipoproteinemiadyslipoproteinemia give rise to NAFLD in adulthood. This study aimed to investigate the association between PCOS, obesity, NAFLD and Metabolic syndrome in adolescents with PCOS. MATERIALAND METHOD- Retrospective study of 24 obese adolescent PCOS patients. with mean BMI 32.89 kg/m2. Data were taken from 1st January 2015 to 31st December 2020. PCOS patients were diagnosed according to Rotterdam 2003 criteria. Data were collected from the medical records of the patients including clinical history, height, weight, blood pressure, waist circumference and Modied Ferriman-Gallway score for hirsutism. Laboratory values were obtained ultrasound nding of polycystic ovarian disease and fatty liver were obtained from the records. RESULTS:- 2 In our study, the mean age was 15.2 yr The mean body mass index was 32.89 kg/m and the mean age of menarche was 12.3 yr. Hirsutism was present in 75% by modied FG Score system, Family history of PCOS was present in 29.16%, Family history of Cardiovascular disease was present in 12.5%. Afamily history of diabetes mellitus was present in 20.83%. The majority 87.5% of the obese adolescent girl's were presented with menstrual problems. mostly 70.83% with a history of Oligomenorrhea. Waist circumference, >0.80 was present in 87.5%, 50% of patients were hypertensive. 20.83% were prediabetes, 54.16% of patients were found to have dyslipidaemia and 45.83% of patients had Metabolic syndrome. In our mean LH was 10.6 IU/L, mean FSH was 5.8 IU/L, mean Serum testosterone 18.5 ng/ml, mean Serum prolactin was 21.2 ng/mL and mean Serum TSH was 3.3 µIU/mL.75 % of patients had Polycystic appearing ovarian morphology in USG.45.83 % of obese PCOS patient had NAFLD in USG and 33.33% of obese patients had abnormal liver enzymes with NAFLD in USG nding. CONCLUSION:-In our study, we found both metabolic syndrome and NAFLD were frequent in patients with obese adolescent PCOS conrming a relevant clinical association between these three conditions. This study highlights the importance of preventing obesity during the management of adolescent PCOS. The importance of obesity counselling in obese adolescent women is a must to reduce the risks associated with metabolic syndrome. The therapeutic intervention combined with lifestyle modication may provide better treatment for adolescent PCOS.

Ovarian Thecoma Fibroma Causing Menstrual Disorder & Infertility: Dramatic Resolution with Surgery

Purpose: To report the case of successfully managed oligo-amenorrhoea with infertility as a result of thecoma fibroma in a young Nigerian Igbo woman. Case Presentation: She was a 24-year-old, married, nulliparous woman who presented with 5 years history of oligomenorrhoea and 18 months history of infertility. Following her menarche at 14 years of age, she had a regular 30-day menstrual cycle with 4 - 6 days moderate flow. Symptoms of oligomenorrhoea worsened to amenorrhoea over time with menstrual flow occurring only when a progesterone agent was used. Clinical evaluation revealed no abnormalities in the systems apart from the presence of left adnexal mass on pelvic examination. Radiological test suggested benign left adnexal mass. Results: She had surgical removal of the mass after work up. Her normal menstrual flow resumed 48 hours following surgery and became regular thereafter. The histopathology report confirmed thecoma-fibroma. She commenced sexual intercourse 12 weeks after surgery. At 18 weeks post operative period, she presented with amenorrhoea and pregnancy symptoms. Intra-uterine pregnancy was confirmed with a pelvic ultrasound scan. She was managed in antenatal clinic till 38 weeks gestational age when she had spontaneous vaginal delivery of a live female neonate that weighed 3 kg with good APGAR scores. She is currently being followed up. Conclusion: Ovarian thecoma-fibroma is a rare cause of menstrual irregularities and infertility in young women. Surgical removal could result in a dramatic and favourable clinical response, as in the case presented.

Role Of Insulin Like Growth Factor in Polycystic Ovary Syndrome

Objectives: The polycystic ovary syndrome (PCOS) is conventionally defined as a combination of hyperandrogenism and anovulation with polycystic ovaries. Insulin-like growth factor I (IGF-I) is a 70 aa polypeptide hormone with endocrine, paracrine, and autocrine effects. it is now established that the ovary is a site of IGF-I gene expression and reception. However, this huge amount of data could be somehow distractive since different species may produce distinct IGFs (or their relative binding proteins and receptors) at different stages of follicular development. Objective: The aim of this work was to determine the serum level of IGF-I to evaluate its role in PCOS. Subjects and Methods: Twenty-five infertile women with PCOS diagnosed by ultrasound examination and a history of oligomenorrhea, hirsutism and obesity were studied. Serum levels of insulin-like growth factor-1 (IGF-1) and hormonal profile were measured. Fifteen healthy and fertile women with regular menstrual cycles served as a comparison group. Results: The serum levels of IGF-I were significantly elevated in women with PCOS compared with control and there was positive correlation between IGF-I from one side and each of BMI, W/H ratio, LH, LH/FSH ratio, TSN, T/SHBG ratio, right and left ovarian volumes. On the other side, IGF-I was inversely correlated with SHBG, right and left uterine artery PI and RI. Conclusion: The significant finding of this study is that PCOS patients have increased circulating IGF-I levels than healthy controls and it can be used as a biochemical marker for PCOS.

The Association between Oligomenorrhea, Onset of Menopause and Metabolic Syndrome in Thai Postmenopausal Women.

ObjectivesThis study explored the association between a history of oligomenorrhea and onset of menopause and metabolic parameters.MethodsThe study population was 605 postmenopausal women who were patients at the Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between February 2015 and December 2015. A questionnaire was used to ask all women about their history of oligomenorrhea. The study also collected medical data, including weight, height, waist circumference, blood pressure, and blood glucose and lipid profile.ResultsOf the 231 postmenopausal women with a complete data record, 31 had a history of oligomenorrhea and 200 did not. The age of onset of menopause was around 48 years in both groups. Prevalence of metabolic syndrome was 12.1%. More women with a waist circumference larger than 80 cm had a history of oligomenorrhea at the interview than women who had not, but a history of oligomenorrhea did not relate to other metabolic parameters. The adjusted odds ratio of a history of oligomenorrhea to waist circumference was 3.69 (95% confidence interval, 1.17–11.64).ConclusionsA history of oligomenorrhea did not affect the age at menopause, but was associated with waist circumference during menopause.

Severe Hypercortisolism with Hypokalemic Alkalosis Mimicking Ectopic Cushing Syndrome in a Patient with Cushing Disease Due to Pituitary Microadenoma.

Severe Hypercortisolism with Hypokalemic Alkalosis Mimicking Ectopic Cushing Syndrome in a Patient with Cushing Disease Due to Pituitary Microadenoma.

PAPSS2 deficiency causes androgen excess via impaired DHEA sulfation--in vitro and in vivo studies in a family harboring two novel PAPSS2 mutations.

Context:PAPSS2 (PAPS synthase 2) provides the universal sulfate donor PAPS (3′-phospho-adenosine-5′-phosphosulfate) to all human sulfotransferases, including SULT2A1, responsible for sulfation of the crucial androgen precursor dehydroepiandrosterone (DHEA). Impaired DHEA sulfation is thought to increase the conversion of DHEA toward active androgens, a proposition supported by the previous report of a girl with inactivating PAPSS2 mutations who presented with low serum DHEA sulfate and androgen excess, clinically manifesting with premature pubarche and early-onset polycystic ovary syndrome.Patients and Methods:We investigated a family harboring two novel PAPSS2 mutations, including two compound heterozygous brothers presenting with disproportionate short stature, low serum DHEA sulfate, but normal serum androgens. Patients and parents underwent a DHEA challenge test comprising frequent blood sampling and urine collection before and after 100 mg DHEA orally, with subsequent analysis of DHEA sulfation and androgen metabolism by mass spectrometry. The functional impact of the mutations was investigated in silico and in vitro.Results:We identified a novel PAPSS2 frameshift mutation, c.1371del, p.W462Cfs*3, resulting in complete disruption, and a novel missense mutation, c.809G>A, p.G270D, causing partial disruption of DHEA sulfation. Both patients and their mother, who was heterozygous for p.W462Cfs*3, showed increased 5α-reductase activity at baseline and significantly increased production of active androgens after DHEA intake. The mother had a history of oligomenorrhea and chronic anovulation that required clomiphene for ovulation induction.Conclusions:We provide direct in vivo evidence for the significant functional impact of mutant PAPSS2 on DHEA sulfation and androgen activation. Heterozygosity for PAPSS2 mutations can be associated with a phenotype resembling polycystic ovary syndrome.

A Case of Subacute Thyroiditis Presenting with Oligomenorrhea

Subacute thyroiditis is usually associated with a prodromal flu-like illness and neck pain, with variable enlargement of the thyroid gland. In this case, a 43-year-old woman presented to her GP with a two year history of oligomenorrhoea and an initial suspicion of the perimenopause. Further investigation, however, revealed deranged thyroid function tests and, subsequently, a history of neck pain. The patient's condition resolved of its own accord, and her menstrual cycle began to regulate once again. Thyroid function tests are standard baseline investigations in oligomenorrhoea in primary care and, yet, in this case they had not been undertaken.

A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India.

Introduction:Polycystic ovary disease is a common endocrine condition which is rapidly gaining epidemic proportions. No community based prevalence data is available for this syndrome in India.Materials and Methods:A cross-sectional community-based study was undertaken in a sampled census block of Mumbai to assess the prevalence of polycystic ovarian syndrome (PCOS) among 778 adolescents and young girls aged 15-24 years. Among them, 600 completed all clinical, ultrasonography (USG), and biochemical investigations.Results:The prevalence of PCOS among them was 22.5% by Rotterdam and 10.7% by Androgen Excess Society criteria. Nonobese comprised 71.8% of PCOS diagnosed by Rotterdam criteria. Mild PCOS (oligomenorrhea and polycystic ovaries on USG) was the most common phenotype (52.6%). History of oligomenorrhea had a positive predictive value of 93.3% and negative predictive value of 86.7% to detect a possible case of PCOS. Hyperinsulinemia (serum insulin >15 μlU/mL) was present among 19.2% of diagnosed PCOS cases. Obese girls with PCOS were more hirsute, hypertensive, and had significantly higher mean insulin and 2 h post 75 g glucose levels compared with nonobese PCOS.Conclusion:To our knowledge, this is the first urban community-based study diagnosing PCOS and phenotypes among adolescent and young girls in India. This study demonstrates that PCOS is an emerging disorder during adolescence and screening could provide opportunity to target the group for promoting healthy lifestyles and early interventions to prevent future morbidities.

Twin Pregnancy of a Complete Hydatidform Mole and a Co-existent Fetus: A Very Rare Case Report

Dear Editor; Molar pregnancy is a disorder of chorionic villi including trophoblastic proliferation and villous stromal swelling. One case of molar pregnancy is reported per 1500-2000 pregnancies in USA. Studies showed that the incidence of hydatiform mole in Asia, Africa and Central America is more than USA, Europe and Australia (1). Hydatiform mole is classified to partial (PM) and complete (CM) mole regards to the histopathology examination (2). Suspicion arises when an ultrasound reports a fetal pole associated with an abnormal placenta. (3) Twin pregnancy of a complete hydatiform mole and a natural fetus is a rare condition and accounts for one in 22000 to one in 100000 of pregnancies. Its importance is regards to the significant increased risk of pregnancy complications like preterm labor; making decision about the true management is much harder due to the probable viable fetus(3, 4). In this paper we present a case of molar pregnancy with a co-existence abnormal fetus. A 23-years-old nulliparous woman was referred to our academic hospital with acute vaginal bleeding at 29th week of gestation, no pain and leaking was mentioned. She had a history of severe hirsotism and oligomenorrhea and previous hospitalization because of high blood pressure about two weeks ago (pre-eclampsia was ruled out at that time).Her husband had a family relation with her. In general appearance she had a marked edema in face and extremities. Fetal Heart rate (FHR) was134 beat/min and mother blood pressure (BP) was measured as 140/100 mmHg. She was diagnosed as having severe pre-eclampsia. Laboratory tests were as followings: Urea = 16 mg/dl, Creatinine = 0.8 mg/dl, Uric acid = 5.1 mg/dl, AST = 25 U/L, ALT = 29 U/L, Alk.P = 600 U/L, Hb = 12.2 gr/dl, HCT = 37%, platelet = 230000/microL, INR = 1, PT = 12 s, PTT = 33 s, Mother blood group = O+ Her ultrasound reported (at the 3rd month) molar changes and the second Ultrasound examination at this admission showed a hypervolumic placenta. Polycystic Ovary Syndrome (PCOs) was diagnosed regards to the clinical manifestations and laboratory testing. Pregnancy termination was suggested but she wanted to save the baby. Induction of labor with oxytocin was started, and she was transferred for cesarean section due to the arrested labor. Placenta showed molar changes in histopathologic examination and the female baby had a distended abdomen, severe bilateral hydronephrosis was reported in ultrasound due to the bilateral congenital polycystic kidney disease (PKD). Neonate was admitted to the pediatric referral hospital and a unilateral nephrostomy was done but she died after 3 days. Twin pregnancy of a complete hydatidform mole and a co-existent fetus is one of the rare occurrences in the literature. Most symptoms are similar to a singleton hydatiform mole, including vaginal bleeding, failure of appropriate uterine growth and hypertension or pre-eclampsia in the first or second trimester (3). Some probable risk factors are mentioned in hydatidform mole but long term studies are needed to be confirmed (1). However, our patient had a history of oligomenorrhea and hirsotism and PCOs was diagnosed. None of the other studies we reviewed mentioned these symptoms neither the familial relationship between the parents. These could be hypothesized as probable risk factors. Makrydimas et al reported a case of singleton pregnancy with a phenotypically normal fetus in which diffuse changes of complete mole were present in the placenta. The fetus was normal at birth and developed normally at 15 months (2). In our case, the fetus had abnormality in prenatal ultrasound and abdominal distension at birth and died after 3 days. Hamanoue et al also reported a twin pregnancy with complete hydatiform mole and preterm labor of a normal neonate (4). Other studies that reported twin pregnancy with hydatiform mole, mentioned a normal fetus such as Papoutsis et al, that reported a partial mole pregnancy with a chromosomically and phenotypically normal embryo, and Copeland et al who had reported dizygotic twin pregnancy with a normal fetus and partial hydatiform mole (5, 6). One of the noticeable facts in studies reviewed was the gender of the fetus which was female. Studies revealed a connection of partial moles with male fetus (1). It could be concluded that such cases of molar pregnancy as a twin to normal or abnormal fetus could be an area of interest in gynecology field and its etiology could be further studied.

Increasing hirsutism due to a granulosa-cell tumor in a woman with polycystic ovary syndrome: case report and review of the literature

Background: Granulosa-cell tumors (GCT), rare malignancies that arise from sex-cord stromal cells, account for less than 5% of ovarian tumors. These tumors present with an endocrine syndrome and mass signs. Surgery is the primary treatment approach. The risk of recurrence is more frequent in the juvenile-onset form.Case report: We report the case of an obese 18-year-old Caucasian women with hirsutism and oligomenorrhea. Abdominal palpation revealed a voluminous firm mass. Hormonal evaluation documented severe hyperandrogenism. The ovary-specific tumor marker CA125 was elevated, whereas human-chorionic-gonadotropin was in the normal range. Abdominal imaging examination revealed a 19 cm mass in the left ovary. Twenty-four hours after removal of the mass, menstrual flow reappeared and androgens progressively normalized. Microscopically, the predominant pattern was one of uniform, bland, epithelioid to spindle-shaped cells. After three months, a significant weight loss was recorded, hirsutism had decreased slightly and oligomenorrhea reappeared. Δ4-Androstenedione levels remained elevated (4200 ng/L), whereas CA125 had normalized. In light of the pre-existing polycystic-ovary-syndrome (PCOS), the patient started estrogen-progestin treatment.Conclusion: We report an interesting case of a woman with severe hirsutism due to GCT, and a history of oligomenorrhea caused by PCOS. After surgery, a dramatic clinical improvement was observed, whereas PCOS signs persisted.

Relative Contributions of Oligomenorrhea and Hyperandrogenemia to the Risk of Metabolic Syndrome in Midlife Women

Young reproductive-age women with irregular menses and androgen excess are at high risk for unfavorable metabolic profile; however, recent data suggest that menstrual regularity and hyperandrogenism improve with aging in affected women approaching menopause. The objective of the study was to determine whether women with hyperandrogenemia (HA) and a history of oligomenorrhea (Oligo) are at an elevated risk for metabolic syndrome (MetS) at the early stages of menopausal transition. Baseline data from 2543 participants (mean age of 45.8 yr) in the Study of Women's Health Across the Nation were analyzed. Women with a lifetime history of more than one 3-month interval of nongestational and nonlactational amenorrhea were classified as having a history of Oligo. The highest tertile of serum testosterone was used to define HA. Women with normal serum androgens and eumenorrhea were used as the reference group. Logistic regression models generated adjusted odds ratios (AOR), controlling for age, ethnicity, body mass index, smoking, and study site. Oligo was associated with MetS only when coincident with HA [AOR of 1.93 for Oligo and HA [95% confidence interval (CI) 1.17-3.17], AOR of 1.25 for Oligo and normal androgens (95% CI 0.81-1.93)]. In contrast, HA conferred a consistently significant risk for MetS, regardless of the menstrual frequency status [AOR of 1.48 for HA and eumenorrhea (95% CI 1.15-1.90)]. Our results suggest that HA but not history of Oligo is independently associated with the risk of prevalent MetS in pre- and perimenopausal women in their 40s.

Evaluation of the relationship between gestational diabetes and a history of polycystic ovarian syndrome

Introduction Gestational diabetes mellitus (GDM) is the most common metabolic disorder that occurs during pregnancy. Knowing the risk factors for GDM is thus particularly important. Objective To evaluate the relationship between GDM and a history of polycystic ovarian syndrome (PCOS). Methods A case-control study was conducted involving 188 pregnant women. Ninety-four cases had GDM based on an impaired glucose tolerance test (GTT) and the other 94 cases (control group) were pregnant women without GDM. The subjects in each group were questioned regarding a history of PCOS (i.e., a history of oligomenorrhea and hyperandrogenism) and then their health documentation's were reviewed and those women whose documentation's were complete (sonologic and hormonal evidences for PCOS) entered the study. The relationship between GDM and a history of PCOS was then evaluated. Results The women with GDM had a history of PCOS more often than the control group of women (15 cases of PCOS in GDM group vs. 6 cases of PCOS in the control group, P = 0.03), but regarding body mass index, a history of PCOS were not shown to have a significant relationship with GDM. Regarding the number of pregnancies, a history of PCOS had a significant relationship with GDM ( P = 0.05). Conclusions GDM has a relationship with a history of PCOS, therefore in women with a history of PCOS, the risk of GDM should be considered.

The Biological Variation of C-Reactive Protein in Polycystic Ovarian Syndrome

An inverse relationship between increased C-reactive protein (CRP) concentrations and insulin sensitivity has occurred in individuals with polycystic ovarian syndrome (PCOS) (1) and is thought to contribute to an increased risk of coronary heart disease (2). However, no data currently exist on the biological variability of CRP and insulin resistance within the same individuals with PCOS, information that is essential to assess the full relationship between the two measures. We describe a study to establish whether a PCOS patient’s CRP concentration remains within narrow biological limits or varies more widely over a given time period, as well as to correlate its variability to that of insulin resistance. Twelve overweight [mean (SD) body mass index (BMI), e.g., 33.2 (6.3) kg/m2] Caucasian women, diagnosed with PCOS [median (range) age, 28 (18–31) years], and 11 weight-matched Caucasian women [controls; mean (SD) BMI, 29.9 (3.3) kg/m2], with regular menses (every 28–30 days) and without PCOS [median (range) age, 30 (19–33) years], participated in the study. The BMI in the PCOS group was not significantly greater ( P = 0.151) than that of the control group. Diagnosis of PCOS was based on evidence of hyperandrogenemia [defined as free androgen index >8; mean (SD) index: PCOS group, 21.85 (7.95); controls, 4.68 (2.05)], with a history of oligomenorrhea and hirsutism or acne. Mean (SD) concentrations of testosterone and sex hormone–binding globulin (SHBG) in the PCOS group compared with the control group …

Insulin resistance, acanthosis nigricans, and hypertriglyceridemia

A 23-year-old white female was seen in consultation in the Dermatology Clinic at the National Institutes of Health, in Bethesda, Maryland for plaques involving the neck, axillae, and inguinal areas. At 4 months of age, she was noted to have hepatomegaly and hypertriglyceridemia with values as high as 6000 mg/dL. The patient described a ravenous appetite from a young age. Type 2 diabetes mellitus was diagnosed at age 12 and, despite attempts at dietary modification, her blood glucose levels remained poorly controlled. Treatment with metformin was initiated at age 14, followed shortly thereafter by insulin because of continued poor control. Menarche occurred at age 15, and the patient described a history of oligomenorrhea. A liver biopsy at age 18 prompted by elevated transaminases yielded a diagnosis of nonalcoholic steatohepatitis (NASH) with early cirrhosis. The patient's medications at the time of presentation included metformin 850 mg three times a day and U-500 insulin totaling 800 units daily.

Vascular endothelial growth factor and insulin-like growth factor-1 in polycystic ovary syndrome and their relation to ovarian blood flow

Objectives: (1) To determine the serum levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) in women with polycystic ovary syndrome (PCOS). (2) To study Doppler blood flow changes within the ovarian stroma of women with PCOS. (3) To evaluate the relationship between VEGF and IGF-1 and Doppler indices as well as hormonal profile. Setting: Department of Obstetrics and Gynecology, and Department of Biochemistry, Faculty of Medicine, Assiut University, Egypt. Design: Cross-sectional study. Patients and methods: Fifty infertile women with PCOS diagnosed by ultrasound examination and a history of oligomenorrhea, hirsutism and obesity were studied. Serum levels of vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1) and hormonal profile were measured. Doppler blood flow velocity waveforms analysis in both right and left intraovarian arteries was done. Twenty healthy and fertile women with regular menstrual cycles served as a comparison group were similarly studied at the third day of the cycle. Results: The serum levels of VEGF, IGF-1 (4.79 ± 0.91, 253.15 ± 70.07 versus 2.39 ± 0.42, 186.65 ± 42.7) were significantly elevated ( P < 0.001 and P < 0.01, respectively) in women with PCOS compared with control. Doppler indices, PI (2.01 ± 0.77, 2.66 ± 1.00 versus 2.98 ± 0.77, 3.75 ± 0.98) and RI (0.77 ± 0.12, 0.82 ± 0.09 versus 0.87 ± 0.09, 0.89 ± 0.09) in both right and left intraovarian vessels were significantly lower in the patients than controls. The VEGF and IGF-1 levels were negatively correlated with RI and PI in the uterine and intraovarian arteries. VEGF level was positively correlated with IGF-1 ( r = 0.41, P < 0.05) in women with PCOS. Conclusions: Higher serum levels of VEGF and IGF-1 in PCOS women may be related to the increased vascularity that underlies the increased blood flow demonstrated by Doppler blood flow measurements in these women.