Polycystic ovary syndrome
Authors:
Jana Vrbíková
Authors‘ workplace:
Endokrinologický ústav Praha, ředitelka doc. RNDr. Běla Bendlová, CSc.
Published in:
Vnitř Lék 2015; 61(10): 886-895
Category:
Reviews
Overview
For diagnosing of polycystic ovary syndrome (PCOS) it is currently recommended to follow the ESHRE criteria. For diagnosis according to them two of the following three symptoms are sufficient: 1. morphology of polycystic ovaria, 2. clinical manifestations of hyperandrogenism or laboratory proof of hyperandrogenemia, and 3. oligo-anovulation. PCOS is a complex disorder in whose pathogenesis genetic and environmental effects interact. It is not a gynecological disorder alone, the syndrome is accompanied by insulin resistance which leads to increased incidence of type 2 diabetes mellitus and impaired glucose tolerance (4 times and twice, independently of BMI). Also gestational DM occurs more frequently. Dyslipidemia, arterial hypertension, elevated CRP and homocysteine levels, endothelial dysfunction and greater intima-media thickness are also more frequent. It is not quite clear, however, whether women with PCOS suffer cardiovascular events more frequently as well. More often than is accidental PCOS is associated with depression, anxiety and eating disorders, further with nonalcoholic steatohepatitis and with the sleep apnoea syndrome – especially in obese women. Therapeutic measures include non-pharmacological methods – lifestyle adjustments focused on weight reduction in obese individuals, cosmetic measures for dermatologic manifestation of hyperandrogenism, in particular laser and pharmacotherapy (combined hormonal contraceptives and antiandrogens). Menstrual irregularities can be treated with contraceptives or cyclical administration of gestagens, also metformin can be used.
Key words:
antiandrogens – diabetes mellitus – hormonal contraception – insulin resistance – ischemic heart disease – metformin
Sources
1. Carmina E, Lobo RA. Does metformin induce ovulation in normoandrogenic anovulatory women? Am J Obstet Gynecol 2004; 191(5): 1580–1584.
2. Chen X, Yang D, Mo Y et al. Prevalence of polycystic ovary syndrome in unselected women from southern China. Eur J Obstet Gynecol Reprod Biol 2008; 139(1): 59–64.
3. Yildiz BO, Bozdag G, Yapici Z et al. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod 2012; 27(10): 3067–3073.
4. Azziz R, Marin C, Hoq L et al. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab 2005; 90(8): 4650–4658.
5. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Hum Reprod 2004; 19(1): 41–47.
6. Vink JM, Sadrzadeh S, Lambalk CB et al. Heritability of polycystic ovary syndrome in a Dutch twin-family study. J Clin Endocrinol Metab 2006; 91(6): 2100–2104.
7. Kahsar-Miller MD, Nixon C, Boots LR et al. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil Steril 2001; 75(1): 53–58.
8. McAllister J M, Legro RS, Modi BP et al. Functional genomics of PCOS: from GWAS to molecular mechanisms. Trends Endocrinol Metab 2015; 26(3): 118–124.
9. Carmina E, Legro RS, Stamets K et al. Difference in body weight between American and Italian women with polycystic ovary syndrome: influence of the diet. Hum Reprod 2003; 18(11): 2289–2293.
10. Goodarzi MO, Dumesic DA, Chazenbalk G et al. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol 2011; 7(4): 219–231.
11. Kandaraki E, Chatzigeorgiou A, Livadas S et al. Endocrine disruptors and polycystic ovary syndrome (PCOS): elevated serum levels of bisphenol A in women with PCOS. J Clin Endocrinol Metab 2011; 96(3): E480-E484.
12. Tarantino G, Valentino R, Somma CD et al. Bisphenol A in Polycystic Ovary Syndrome and its Association with Liver-Spleen Axis. Clin Endocrinol (Oxf) 2013; 78(3): 447–453.
13. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352(12): 1223–1236.
14. Blank SK, McCartney CR, Marshall JC. The origins and sequelae of abnormal neuroendocrine function in polycystic ovary syndrome. Hum Reprod Update 2006; 12(4): 351–361.
15. Taylor AE, McCourt B, Martin KA et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab 1997; 82(7): 2248–2256.
16. Vrbikova J, Hainer V. Obesity and polycystic ovary syndrome. Obes Facts 2009; 2(1): 26–35.
17. Hoeger KM. Obesity and lifestyle management in polycystic ovary syndrome. Clin Obstet Gynecol 2007; 50(1): 277–294.
18. Martinez-Bermejo E, Luque-Ramirez M, Escobar-Morreale HF. Obesity and the polycystic ovary syndrome. Minerva Endocrinol 2007; 32(3): 129–140.
19. Starka L, Duskova M, Cermakova I et al. Premature androgenic alopecia and insulin resistance. Male equivalent of polycystic ovary syndrome? Endocr Regul 2005; 39(4): 127–131.
20. Fauser BC, Tarlatzis BC, Rebar RW et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97(1): 28–38.
21. Balen AH, Lumholtz IB. Consensus statement on the bio-safety of urinary-derived gonadotrophins with respect to Creutzfeldt-Jakob disease. Hum Reprod 2005; 20(11): 2994–2999.
22. Yildiz BO. Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab 2006; 20(2): 167–176.
23. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010; 8: 41. Dostupné z DOI: <http://doi: 10.1186/1741–7015–8-41>.
24. Huang A, Brennan K, Azziz R. Prevalence of hyperandrogenemia in the polycystic ovary syndrome diagnosed by the National Institutes of Health 1990 criteria. Fertil Steril 2010; 93(6): 1938–1941.
25. Stanczyk FZ. Diagnosis of hyperandrogenism: biochemical criteria. Best Pract Res Clin Endocrinol Metab 2006; 20(2): 177–191.
26. Rosner W, Auchus RJ, Azziz R et al. Utility, limitations and pitfalls in measuring testosterone: An Endocrine Society Position Statement. J Clin Endocrinol Metab 2007; 92(2): 405–413.
27. Jayagopal V. Kilpatrick ES, Jennings PE et al. The biological variation of testosterone and sex hormone-binding globulin (SHBG) in polycystic ovarian syndrome: implications for SHBG as a surrogate marker of insulin resistance. J Clin Endocrinol Metab 2003; 88(4): 1528–1533.
28. Iliodromiti S, Kelsey TW, Anderson RA et al. Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab 2013; 98(8): 3332–3340.
29. Dewailly D, Gronier H, Poncelet E et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod 2011; 26(11): 3123–3129.
30. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18(6): 774–800.
31. Dunaif A. Insulin resistance in women with polycystic ovary syndrome. Fertil Steril 2006; 86(Suppl 1): S13-S14.
32. Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv 2004; 59(2): 141–154.
33. Vrbikova J, Hill M, Starka L et al. An analysis of the relationship between insulin resistance and the activity of steroid C17,20-lyase and 3beta-hydroxysteroid dehydrogenase in ovaries and adrenals in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2000; 108(7): 455–462.
34. Dunaif A, Segal KR, Futterweit W et al. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989; 38(9): 1165–1174.
35. Toprak S, Yonem A, Cakir B et al. Insulin resistance in nonobese patients with polycystic ovary syndrome. Horm Res 2001; 55(2): 65–70.
36. Svendsen PF, Nilas L, Norgaard K et al. Obesity, body composition and metabolic disturbances in polycystic ovary syndrome. Hum Reprod 2008; 23(9): 2113–2121.
37. Sir-Petermann T, Angel B, Maliqueo M et al. Prevalence of Type II diabetes mellitus and insulin resistance in parents of women with polycystic ovary syndrome. Diabetologia 2002; 45(7): 959–964.
38. Sam S, Sung YA, Legro RS et al. Evidence for pancreatic beta-cell dysfunction in brothers of women with polycystic ovary syndrome. Metabolism 2008; 57(1): 84–89.
39. Toulis KA, Goulis DG, Kolibianakis EM et al. Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Fertil Steril 2009; 92(2): 667–677.
40. Moran LJ, Pasquali R, Teede HJ et al. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril 2009; 92(6): 1966–1982.
41. Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. Bjog 2006; 113(10): 1148–1159.
42. Salley KE, Wickham EP, Cheang KI et al. Position statement: Glucose Intolerance in Polycystic Ovary Syndrome. A Position Statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007; 92(12): 4546–4556.
43. Moran LJ, Misso ML, Wild RA et al. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010; 16(4): 347–363.
44. Joham AE, Ranasinha S, Zoungas S et al. Gestational diabetes and type 2 diabetes in reproductive-aged women with polycystic ovary syndrome. J Clin Endocrinol Metab 2014; 99(3): E447-E452.
45. Legro RS, Blanche P, Krauss RM et al. Alterations in low-density lipoprotein and high-density lipoprotein subclasses among Hispanic women with polycystic ovary syndrome: influence of insulin and genetic factors. Fertil Steril 1999; 72(6): 990–995.
46. Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 2001; 111(8): 607–613.
47. Pirwany IR, Fleming R, Greer IA et al. Lipids and lipoprotein subfractions in women with PCOS: relationship to metabolic and endocrine parameters. Clin Endocrinol (Oxf) 2001; 54(4): 447–453.
48. Wild RA, Bartholomew MJ. The influence of body weight on lipoprotein lipids in patients with polycystic ovary syndrome. Am J Obstet Gynecol 1988; 159(2): 423–427.
49. Wild RA, Painter PC, Coulson PB et al. Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1985; 61(5): 946–951.
50. Talbott E, Clerici A, Berga SL et al. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J Clin Epidemiol 1998; 51(5): 415–422.
51. Wild RA, Rizzo M, Clifton S et al. Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril 95(3): 1073–1079.
52. Dahlgren E, Johansson S, Lindstedt G et al. Women with polycystic ovary syndrome wedge resected in 1956 to 1965: a long-term follow-up focusing on natural history and circulating hormones. Fertil Steril 1992; 57(3): 505–513.
53. Cibula D, Cifkova R, Fanta M et al. Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome. Hum Reprod 2000; 15(4): 785–789.
54. Conway GS, Agrawal R, Betteridge DJ et al. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992; 37(2): 119–125.
55. Luque-Ramirez M, Alvarez-Blasco F, Mendieta-Azcona C et al. Obesity is the major determinant of the abnormalities in blood pressure found in young women with the polycystic ovary syndrome. J Clin Endocrinol Metab 2007; 92(6): 2141–2148.
56. Holte J, Gennarelli G, Berne C et al. Elevated ambulatory day-time blood pressure in women with polycystic ovary syndrome: a sign of a pre-hypertensive state? Hum Reprod 1996; 11(1): 23–28.
57. Sampson M, Kong C, Patel A et al. Ambulatory blood pressure profiles and plasminogen activator inhibitor (PAI-1) activity in lean women with and without the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1996; 45(5): 623–629.
58. Toulis KA, Goulis DG, Mintziori G et al. Meta-analysis of cardiovascular disease risk markers in women with polycystic ovary syndrome. Hum Reprod Update 2011; 17(6): 741–760.
59. Trakakis E, Balanika A, Baltas C et al. Hemodynamic alterations and wall properties in large arteries of young, normotensive, and non-obese women with polycystic ovary syndrome. J Endocrinol Invest 2008; 31(11): 1001–1007.
60. Rajendran S, Willoughby SR, Chan WP et al. Polycystic ovary syndrome is associated with severe platelet and endothelial dysfunction in both obese and lean subjects. Atherosclerosis 2009; 204(2): 509–514.
61. Ketel IJ, Stehouwer CD, Serne EH et al. Obese but not normal-weight women with polycystic ovary syndrome are characterized by metabolic and microvascular insulin resistance. J Clin Endocrinol Metab 2008; 93(9): 3365–3372.
62. Guzick DS, Talbott EO, Sutton-Tyrrell K et al. Carotid atherosclerosis in women with polycystic ovary syndrome: initial results from a case-control study. Am J Obstet Gynecol 1996; 174(4): 1224–1229; discussion 1229–1232.
63. Vryonidou A, Papatheodorou A, Tavridou A et al. Association of hyperandrogenemic and metabolic phenotype with carotid intima-media thickness in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(5): 2740–2746.
64. Kravariti M, Naka KK, Kalantaridou SN et al. Predictors of endothelial dysfunction in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(9): 5088–5095.
65. Meyer ML, Malek AM, Wild RA et al. Carotid artery intima-media thickness in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2012; 18(2): 112–126.
66. Christian RC, Dumesic DA, Behrenbeck T et al. Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88(6): 2562–2568.
67. Talbott EO, Zborowski JV, Rager JR et al. Evidence for an association between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004; 89(11): 5454–5461.
68. Wild S, Pierpoint T, McKeigue P et al. Cardiovascular disease in women with polycystic ovary syndrome at long- term follow-up: a retrospective cohort study. Clin Endocrinol (Oxf) 2000; 52(5): 595–600.
69. Legro RS. Polycystic ovary syndrome and cardiovascular disease: a premature association? Endocr Rev 2003; 24(3): 302–312.
70. Franks S. Are women with polycystic ovary syndrome at increased risk of cardiovascular disease? Too early to be sure, but not too early to act! Am J Med 2001; 111(8): 665–666.
71. Hjortrup A, Kehlet H, Lockwood K et al. Long-term clinical effects of ovarian wedge resection in polycystic ovarian syndrome. Acta Obstet Gynecol Scand 1983; 62(1): 55–57.
72. Solomon CG, Hu FB, Dunaif A et al. Menstrual cycle irregularity and risk for future cardiovascular disease. J Clin Endocrinol Metab 2002; 87(5): 2013–2017.
73. Mani H, Levy MJ, Davies MJ et al. Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20-year retrospective cohort study. Clin Endocrinol (Oxf) 2013; 78(6): 926–934.
74. Morgan CL, Jenkins-Jones S, Currie CJ et al. Evaluation of adverse outcome in young women with polycystic ovary syndrome versus matched, reference controls: a retrospective, observational study. J Clin Endocrinol Metab 2012; 97(9): 3251–3260.
75. de Groot PC, Dekkers OM, Romijn JA et al. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Hum Reprod Update 2011; 17(4): 495–500.
76. Shaw LJ, Bairey Merz CN, Azziz R et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health – National Heart, Lung, and Blood Institute sponsored Women’s Ischemia Syndrome Evaluation. J Clin Endocrinol Metab 2008; 93(4): 1276–1284.
77. Schmidt J, Landin-Wilhelmsen K, Brannstrom M et al. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metab 2011; 96(12): 3794–803.
78. Fauser BC, Bouchard P. Uncertainty remains in women with PCOS regarding the increased incidence of cardiovascular disease later in life, despite the indisputable presence of multiple cardiovascular risk factors at a young age. J Clin Endocrinol Metab 2011; 96(12): 3675–3677.
79. Rasgon NL, Rao RC, Hwang S et al. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord 2003; 74(3): 299–304.
80. Veltman-Verhulst SM, Boivin J, Eijkemans MJ et al. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update 2012; 18(6): 638–651.
81. Weber B, Lewicka S, Deuschle M et al. Testosterone, androstenedione and dihydrotestosterone concentrations are elevated in female patients with major depression. Psychoneuroendocrinology 2000; 25(8): 765–771.
82. Jedel E, Gustafson D, Waern M et al. Sex steroids, insulin sensitivity and sympathetic nerve activity in relation to affective symptoms in women with polycystic ovary syndrome. Psychoneuroendocrinology 2011; 36(10): 1470–1479.
83. Elsenbruch S, Hahn S, Kowalsky D et al. Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88(12): 5801–5807.
84. Barnard L, Ferriday D, Guenther N et al. Quality of life and psychological well being in polycystic ovary syndrome. Hum Reprod 2007; 22(8): 2279–2286.
85. Dokras A. Mood and anxiety disorders in women with PCOS. Steroids 2012; 77(4): 338–341.
86. Gambarin-Gelwan M, Kinkhabwala SV, Schiano TD et al. Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Clin Gastroenterol Hepatol 2007; 5(4): 496–501.
87. Brzozowska MM, Ostapowicz G, Weltman MD. An association between non-alcoholic fatty liver disease and polycystic ovarian syndrome. J Gastroenterol Hepatol 2009; 24(2): 243–247.
88. Vassilatou E, Lafoyianni S, Vryonidou A et al. Increased androgen bioavailability is associated with non-alcoholic fatty liver disease in women with polycystic ovary syndrome. Hum Reprod 2010; 25(1): 212–220.
89. Conway G, Dewailly D, Diamanti-Kandarakis E et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2014; 171(4): P1-P29.
90. Baillargeon JP, McClish DK, Essah PA et al. Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab 2005; 90(7): 3863–3870.
91. Cibula D, Hill M, Fanta M et al. Does obesity diminish the positive effect of oral contraceptive treatment on hyperandrogenism in women with polycystic ovarian syndrome? Hum Reprod 2001; 16(5): 940–944.
92. Luque-Ramirez M, Alvarez-Blasco F, Botella-Carretero JI et al. Comparison of ethinyl-estradiol plus cyproterone acetate versus metformin effects on classic metabolic cardiovascular risk factors in women with the polycystic ovary syndrome. J Clin Endocrinol Metab 2007; 92(7): 2453–2461.
93. Nader S, Diamanti-Kandarakis E. Polycystic ovary syndrome, oral contraceptives and metabolic issues: new perspectives and a unifying hypothesis. Hum Reprod 2007; 22(2): 317–322.
94. Meyer C, McGrath BP, Teede HJ. Effects of medical therapy on insulin resistance and the cardiovascular system in polycystic ovary syndrome. Diabetes Care 2007; 30(3): 471–478.
95. Teede HJ, Meyer C, Hutchison SK et al. Endothelial function and insulin resistance in polycystic ovary syndrome: the effects of medical therapy. Fertil Steril 2010; 93(1): 184–191.
96. Korytkowski MT, Mokan M, Horwitz MJ et al. Metabolic effects of oral contraceptives in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1995; 80(11): 3327–3334.
97. Morin-Papunen LC, Vauhkonen I, Koivunen RM et al. Endocrine and metabolic effects of metformin versus ethinyl estradiol-cyproterone acetate in obese women with polycystic ovary syndrome: a randomized study. J Clin Endocrinol Metab 2000; 85(9): 3161–3168.
98. Palep-Singh M, Mook K, Barth J et al. An observational study of Yasmin in the management of women with polycystic ovary syndrome. J Fam Plann Reprod Health Care 2004; 30(3): 163–165.
99. Armstrong VL, Wiggam MI, Ennis CN et al. Insulin action and insulin secretion in polycystic ovary syndrome treated with ethinyl oestradiol/cyproterone acetate. QJM 2001; 94(1): 31–37.
100. Cibula D, Fanta M, Vrbikova J et al. The effect of combination therapy with metformin and combined oral contraceptives (COC) versus COC alone on insulin sensitivity, hyperandrogenaemia, SHBG and lipids in PCOS patients. Hum Reprod 2005; 20(1): 180–184.
101. Cibula D, Sindelka G, Hill M et al. Insulin sensitivity in non-obese women with polycystic ovary syndrome during treatment with oral contraceptives containing low-androgenic progestin. Hum Reprod 2002; 17(1): 76–82.
102. Guido M, Romualdi D, Giuliani M et al. Drospirenone for the treatment of hirsute women with polycystic ovary syndrome: a clinical, endocrinological, metabolic pilot study. J Clin Endocrinol Metab 2004; 89(6): 2817–2823.
103. Vrbikova J, Cibula D. Combined oral contraceptives in the treatment of polycystic ovary syndrome. Hum Reprod Update 2005; 11(3): 277–291.
104. Chasan-Taber L, Willett WC, Stampfer MJ et al. A prospective study of oral contraceptives and NIDDM among U.S. women. Diabetes Care 1997; 20(3): 330–335.
105. Rimm EB, Manson JE, Stampfer MJ et al. Oral contraceptive use and the risk of type 2 (non-insulin-dependent) diabetes mellitus in a large prospective study of women. Diabetologia 1992; 35(10): 967–972.
106. Pasquali R, Gambineri A, Anconetani B et al. The natural history of the metabolic syndrome in young women with the polycystic ovary syndrome and the effect of long-term oestrogen-progestagen treatment. Clin Endocrinol (Oxf) 1999; 50(4): 517–527.
107. Jing Z, Liang-Zhi X, Tai-Xiang W et al. The effects of Diane-35 and metformin in treatment of polycystic ovary syndrome: an updated systematic review. Gynecol Endocrinol 2008; 24(10): 590–600.
108. Vrbikova J, Cibula D. Combined oral contraceptives in the treatment of polycystic ovary syndrome. Hum Reprod Update 2005; 11(3): 277–291.
109. Velazquez EM, Mendoza S, Hamer T et al. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism 1994; 43(5): 647–654.
110. Nestler JE. Sex hormone-binding globulin: a marker for hyperinsulinemia and/or insulin resistance? J Clin Endocrinol Metab 1993; 76(2): 273–274.
111. Nestler JE, Powers LP, Matt DW et al. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab 1991; 72(1): 83–89.
112. Attia GR, Rainey WE, Carr BR. Metformin directly inhibits androgen production in human thecal cells. Fertil Steril 2001; 76(3): 517–524.
113. Mansfield R, Galea R, Brincat M et al. Metformin has direct effects on human ovarian steroidogenesis. Fertil Steril 2003; 79(4): 956–962.
114. Romualdi D, Giuliani M, Cristello F et al. Metformin effects on ovarian ultrasound appearance and steroidogenic function in normal-weight normoinsulinemic women with polycystic ovary syndrome: a randomized double-blind placebo-controlled clinical trial. Fertil Steril 2010; 93(7): 2303–2310.
115. Dewailly D, Robert Y, Helin I et al. Ovarian stromal hypertrophy in hyperandrogenic women. Clin Endocrinol (Oxf) 1994; 41(5): 557–562.
116. Palomba S, Falbo A, Zullo F et al. Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review. Endocr Rev 2009; 30(1): 1–50.
117. Legro RS, Arslanian SA, Ehrmann DA et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013; 98(12): 4565–4592.
118. Azziz R, Ehrmann D, Legro RS et al. Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial. J Clin Endocrinol Metab 2001; 86(4): 1626–1632.
119. Ortega-Gonzalez C, Luna S, Hernandez L et al. Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(3): 1360–1365.
120. Baillargeon JP, Jakubowicz DJ, Iuorno MJ et al. Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril 2004; 82(4): 893–902.
121. McFarlane SI, Muniyappa R, Francisco R et al. Clinical review 145: Pleiotropic effects of statins: lipid reduction and beyond. J Clin Endocrinol Metab 2002; 87(4): 1451–1458.
122. Duleba AJ, Banaszewska B, Spaczynski RZ et al. Simvastatin improves biochemical parameters in women with polycystic ovary syndrome: results of a prospective, randomized trial. Fertil Steril 2006; 85(4): 996–1001.
123. Izquierdo D, Foyouzi N, Kwintkiewicz J et al. Mevastatin inhibits ovarian theca-interstitial cell proliferation and steroidogenesis. Fertil Steril 2004; 82(Suppl 3): S1193-S1197.
124. Raval AD, Hunter T, Stuckey B et al. Statins for women with polycystic ovary syndrome not actively trying to conceive. Cochrane Database Syst Rev 2011; (10): CD008565. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD008565.pub2>.
125. Swiglo BA, Cosma M, Flynn DN et al. Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol Metab 2008; 93(4): 1153–1160.
126. Huber-Buchholz MM, Carey DG, Norman RJ. Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J Clin Endocrinol Metab 1999; 84(4): 1470–1474.
127. Kiddy DS, Hamilton-Fairley D, Bush A et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992; 36(1): 105–111.
128. Gambineri A, Pelusi C, Genghini S et al. Effect of flutamide and metformin administered alone or in combination in dieting obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2004; 60(2): 241–249.
129. Holte J, Bergh T, Berne C et al. Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 1995; 80(9): 2586–2593.
130. Moran LJ, Noakes M, Clifton PM et al. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88(2): 812–819.
131. Moran LJ, Noakes M, Clifton PM et al. Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. J Clin Endocrinol Metab 2004; 89(7): 3337–3344.
132. Pasquali R, Gambineri A, Biscotti D et al. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J Clin Endocrinol Metab 2000; 85(8): 2767–2774.
133. Wahrenberg H, Ek I, Reynisdottir S et al. Divergent effects of weight reduction and oral anticonception treatment on adrenergic lipolysis regulation in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab 1999; 84(6): 2182–2187.
134. Moran LJ, Hutchison SK, Norman RJ et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011; (7):CD007506. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD007506.pub3>.
135. Consensus on infertility treatment related to polycystic ovary syndrome. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Fertil Steril 2008; 89(3): 505–522.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2015 Issue 10
Most read in this issue
- Functional hypothalamic amenorrhea
- Systemic glucocorticoids treatment: practical view
- Adrenal incidentaloma
- Adrenal insufficiency