Ovarian Stromal Hyperthecosis

Objective. Ovarian stromal hyperthecosis (SH) has variable clinical importance but can cause hyperandrogenism, particularly in premenopausal women. Sonography is often used to evaluate the ovaries of women with hyperandrogenism, but there is little published regarding the sonographic appearance of SH. The primary purpose of this study was to describe the sonographic features of SH. Methods. A computerized search of our institution's pathology and imaging databases from 1996 through 2007 was performed to identify patients with histologically proven SH who had pelvic sonography before surgery. Sonograms and histologic findings were reviewed in each case. Results. Twenty ovaries with SH were identified, occurring in 14 patients with a mean age of 59.8 years (range, 36–83 years). The SH was bilateral in 6 patients, unilateral in 6, and of uncertain laterality in 2 with a unilateral oophorectomy. Sonographic findings were as follows: 5 normal, 1 with a hemorrhagic cyst (later resolved) and otherwise normal, 3 enlarged but otherwise normal, 1 with a solid mass due to the nodular form of SH, 1 with a solid mass due to a fibroma, 2 with polycystic ovaries, and 7 not seen. Six of the 14 patients (43%) also had an ovarian fibrothecoma. Conclusions. Ovarian SH has variable sonographic features. Most commonly, the affected ovaries are either normal or slightly enlarged. A solid mass may infrequently be visible, and polycystic ovary syndrome changes may coexist with SH. A possible association of SH with fibrothecoma was also noted, which to our knowledge has not been previously reported.     

Technical difficulties of selective venous blood sampling in the differential diagnosis of female hyperandrogenism

To determine glandular steroid release of adrenals and ovaries in female hyperandrogenism, a standardized method for percutaneous transfemoral venous blood sampling was developed. In eight volunteers and 67 patients, catheterization was performed during the early follicular phase (days 3–7; between 8 and 10 a.m.) to reduce interference from cyclic and circadian variations of secretion. Serial samplings reduced the episodic effluent changes. Anatomical variations and collateral flow as well as stress effects and the dosage of contrast media were studied. During catheterization, peripheral cortisol levels did not differ significantly from control groups. Collaterals had no effect on hormone levels. Contrast media increased cortisol effluent levels only when they were sampled following venography. Four-vessel venous sampling was found to be indicated if peripheral testosterone was more than 1.5 ng/ml and/or dehydroepiandrosterone sulfate more than 6.700 ng/ml. If an ovarian (adrenal)/peripheral gradient of testosterone exceeded 2.7 mg/ml, surgical intervention for tumor removal at the site of hormone excess was felt to be necessary.     

Are Dietary Indices Associated with Polycystic Ovary Syndrome and Its Phenotypes? A Preliminary Study

Polycystic ovary syndrome (PCOS) is a complex hormonal disorder which impairs ovarian function. The adherence to healthy dietary patterns and physical exercise are the first line of recommended treatment for PCOS patients, but it is yet unclear what type of diet is more adequate. In this case-control study, we explored associations between adherence to five dietary quality indices and the presence of PCOS. We enrolled 126 cases of PCOS and 159 controls living in Murcia (Spain). Diagnostic of PCOS and its phenotypes were established following the Rotterdam criteria (hyperandrogenism (H), oligoanovulation (O), polycystic ovaries morphology (POM)). We used a validated food frequency questionnaires to calculate the scores of five dietary indices: alternate Healthy Eating index (AHEI), AHEI-2010, relative Mediterranean Dietary Score (rMED), alternate Mediterranean Dietary Score (aMED) and Dietary Approaches to Stop Hypertension (DASH). We used multivariable logistic regression to estimate adjusted odds ratios and confidence intervals. In the multivariable analysis, AHEI-2010 index was inversely associated with Hyperandrogenism + Oligoanovulation PCOS phenotype (OR_Q3 vs. _Q1 = 0.1; 95% CI: (0.0; 0.9); P_{for trend} = 0.02). We did not find any statistical significant association between dietary indices and total anovulatory or ovulatory PCOS. However, further studies with higher sample sizes exploring these associations among the diverse phenotypes of PCOS are highly warranted.     

丹栀逍遥散对多囊卵巢大鼠高雄激素血症雄激素、瘦素及其受体表达的影响

目的 观察丹栀逍遥散对多囊卵巢综合征伴高雄激素血症大鼠雄激素、瘦素及其受体的影响.方法 利用脱氢表雄酮诱导建立多囊卵巢大鼠高雄激素血症模型,随机设立丹栀逍遥组、达英组、模型组、空白对照组,予以相应药物干预.实验结束后观察卵巢形态学变化;酶联免疫法测定血清雄激素水平;ELISA法检测血清瘦素;免疫组化测定卵巢瘦素受体的表达.结果 与模型组相比,丹栀逍遥散可显著降低大鼠血清瘦素、睾酮、游离睾酮水平值,减少卵巢瘦素受体阳性表达,差异均有统计学意义(P<0.01).结论 丹栀逍遥散可降低多囊卵巢高雄激素血症大鼠血清瘦素、雄激素水平值,减少卵巢瘦素受体阳性表达,进而降低瘦素生物利用度及雄激素活性,从而改善多囊卵巢综合征高雄激素血症和排卵障碍.     

High Sucrose and Cholic Acid Diet Triggers PCOS-like Phenotype and Reduces Enterobacteriaceae Colonies in Female Wistar Rats

Polycystic ovary syndrome (PCOS), a common hormonal disorder in women of reproductive age, is associated with a poor and unhealthy diet. This study aimed to investigate the effect of a high sucrose and cholic acid (HSCA) diet in the presence of PCOS-like phenotypes. Female Wistar rats were divided into HSCA and normal diet groups for four weeks, each with twenty rats. Body weight was assessed before and after the study. Blood and fecal samples were obtained to measure HOMA-IR and testosterone level (ELISA) and Enterobacteriaceae isolates grown on MacConkey Agar. Obtained ovarian tissues were H&E-stained. HSCA rats demonstrated a reduction in Enterobacteriaceae colonies (median 4.75 × 10⁵ vs. 2.47 × 10⁴/CFU, p < 0.001) and an elevated HOMA-IR (mean 2.94 ± 1.30 vs. 4.92 ± 0.51, p < 0.001), as well as an increase in testosterone level (median 0.65 vs. 3.00 ng/mL, p < 0.001), despite no statistical differences in the change in body weight (mean −2.31 ± 14.42 vs. −3.45 ± 9.32, p = 0.769). In H&E staining, HSCA rats had a reduction in preovulatory follicle count (median 0.50 vs. 0.00, p = 0.005). The HSCA diet caused insulin resistance and high testosterone levels, which contribute to the development of PCOS, and affected folliculogenesis by altering follicular maturation, but had no effect on ovulation.     

Maternal hyperandrogenism beginning from early pregnancy and progressing until delivery does not produce virilization of a female newborn

A 33-year-old primagravida with a history of polycystic ovary syndrome was referred because of symptoms of moderate hyperandrogenism. Serum hormone levels, measured regularly from the 7th week of pregnancy until delivery, showed very high increases of testosterone, androstenedione and estradiol. Ultrasound showed no evidence of adrenal or ovarian masses. She delivered a female newborn with normal female external genitalia. Umbilical cord hormone levels were normal, except for a modest increase of serum testosterone. After delivery the androgen levels of the mother returned to normal and the symptoms of hyperandrogenism were also slightly improved.     

地黄丸合芎归二陈汤加减治疗肾虚血瘀型多囊卵巢综合征高雄激素血症

目的:观察地黄丸合芎归二陈汤加减对多囊卵巢综合征高雄激素血症(PCOS-HA)性激素水平和细胞因子的影响。方法:将120例患者以就诊先后,随机按数字表法分为对照组和观察组各60例。对照组口服炔雌醇环丙孕酮片,从月经第5天开始服用,1次/d,连续服用21 d,停药,待月经来潮。观察组采用地黄丸合芎归二陈汤加减治疗。两组疗程均为治疗3个月经周期。检测治疗前后血清睾酮(T),双氢睾酮(DHT),硫酸脱氢表雄酮(DHEAS),促黄体生成素(LH),卵泡刺激素(FSH),性激素结合球蛋白(SHBG),催乳素(PRL)水平,并计算游离睾酮指数(FAI);进行治疗前后痤疮严重情况(Rosenfield),多毛和肾虚血瘀证评分;进行妇科B超检查记录卵巢大小、每侧卵巢的窦卵泡个数、恢复排卵情况等;记录月经周期、月经量、基础体温(BBT),计算BBT双相率和月经恢复正常率;检测治疗前后瘦素(LP),胰岛素样生长因子-1(IGF-1)和脂联素(APN)水平;评价治疗前后胰岛素抵抗指数(HOMA-IR),体质量指数(BMI)和腰臀比(WHR)。结果:经有序资料的χ2检验,观察组的临床疗效优于对照组(χ2=7.213,P0.05);治疗后观察组患者T,DHT,DHEAS,FAI,LH,PRL水平均低于对照组,LH/FSH比值低于对照组,SHBG,FSH水平均高于对照组(P0.01);观察组患者Rosenfield,多毛、肾虚血瘀证评分均低于对照组,卵巢体积小于对照组(P0.01);观察组月经恢复率为86.67%,高于对照组的68.33%(χ2=5.784,P0.05);观察组患者排卵恢复率为78.33%,高于对照组的56.67%(χ2=6.419,P0.05);观察组BBT双相率为80%,高于对照组的60%(χ2=5.714,P0.05);观察组IGF-1和LP水平均低于对照组,APN水平高于对照组(P0.01);治疗后观察组患者HOMA-IR,BMI和WHR均低于对照组(P0.01)。结论:地黄丸合芎归二陈汤加减治疗肾虚血瘀型PCOS-HA,可改善高雄激素血症的临床症状和血清生化指标,调节内分泌指标,促进了PCOS月经恢复和自发排卵恢复,临床疗效优于西医治疗。