deamino-arginine-vasopressin and Polycystic-Ovary-Syndrome

In women suffering from polycystic ovary syndrome (PCOS), correction of hyperinsulinemia results enhances spontaneous ovulation or alternatively, the responsiveness to ovulation induction agents such as clomiphene citrate (CC). We investigated the effect of rosiglitazone maleate on ovulation induction in overweight and obese, CC-resistant women with PCOS.. Double-blind, randomized, placebo-controlled trial.. Academic reproductive endocrinology clinic.. Overweight and obese women with clinical and laboratory manifestations of PCOS who desired pregnancy and were resistant to CC.. Twenty-five women were randomized into two treatment groups. Subjects in Group I (n = 12) were randomized to receive rosiglitazone 4 mg b.i.d. with a placebo on cycle days 5-9. Group II (n = 13) was randomized to receive rosiglitazone 4 mg b.i.d. with CC on cycle days 5-9. The duration of the study was 2 months.. The primary outcome was ovulation as defined by luteal serum progesterone greater than 5 ng/dL assessed on days 21, 24, and 28 of the cycle. Secondary outcomes were pregnancy and changes in insulin sensitivity, serum lipoproteins, and androgens.. Overall, 14 of 25 (56%) women, who were previously resistant to CC, successfully ovulated. In subjects taking rosiglitazone alone (Group I), 4 of 12 (33%) subjects ovulated compared with 10 of 13 (77%) women randomized to rosiglitazone with CC (Group II) (P=.04, Fisher's exact). One subject in Group I became pregnant, resulting in one uncomplicated live birth; two subjects in Group II conceived, with one successful live birth and one first trimester, spontaneous abortion. For all subjects, fasting insulin declined from 29.4 +/- 13.8 microU/mL to 17.3 +/- 7.8 microU/mL after rosiglitazone (P=.003, paired t-test). Although mean levels of total testosterone (T) and dehydroepiandrosterone sulfate (DHEAS) did not decline significantly, sex hormone-binding globulin (SHBG) did increase from 0.7 +/- 0.3 microg/dL to 1.0 +/- 0.3 microg/dL after rosiglitazone therapy (P=.001, paired t test). There was also a decrease in luteinizing hormone (LH) from 9.4 +/- 6.3 mU/mL to 7.2 +/- 3.7 mU/mL (P=.01). Lipoproteins including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides did not change.. Short-term rosiglitazone therapy enhances both spontaneous and clomiphene-induced ovulation in overweight and obese women with PCOS. Rosiglitazone therapy improves insulin sensitivity and decreases hyperandrogenemia primarily through increases in SHBG.

Topics: Adolescent; Adult; Blood Glucose; Clomiphene; Deamino Arginine Vasopressin; Dehydroepiandrosterone Sulfate; Double-Blind Method; Fasting; Female; Glycated Hemoglobin; Humans; Hypoglycemic Agents; Insulin; Insulin Resistance; Ovulation Induction; Placebos; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Outcome; Rosiglitazone; Sex Hormone-Binding Globulin; Testosterone; Thiazoles; Thiazolidinediones

Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age. It is characterized by hyperandrogenism, oligomenorrhea/amenorrhea and polycystic ovaries. It is associated with obesity, diabetes, dyslipidemia and cardiovascular disease. No studies have been conducted on the prevalence of PCOS in Brazilian or South American women. Few studies using the Rotterdam criteria have been published. The objective of the present study was to calculate the prevalence of PCOS at primary healthcare level in Salvador, Brazil based on these criteria.. This was a cross-sectional, two-phase study conducted in a probability sample of women of 18-45 years of age screened for cervical cancer in the primary healthcare network of the city of Salvador, Brazil. In the first phase, interviews were conducted, weight, height, waist circumference, blood pressure and random blood sugar levels were measured, and the presence of acne and hirsutism was investigated. Women with at least one diagnostic criterion were referred for the second phase, which consisted of specialist consultation, pelvic ultrasonography and hormone measurements for differential diagnosis and/or investigation of a second criterion.. Of the 859 women interviewed, 88.5% were black and 58.7% had 11 years of schooling or less. A diagnosis of PCOS was excluded in 84.4%, undetermined in 7.1% and confirmed in 8.5% (95% CI: 6.80-10.56). There were no statistically significant differences between these three groups with respect to weight, body mass index, waist circumference, blood sugar levels or arterial blood pressure. Women with PCOS were younger (p = 0.00), taller (p = 0.04), had fewer children (p = 0.00), were better educated (p = 0.01), and had higher total testosterone levels (p = 0.01) and a higher LH/FSH ratio (p = 0.01).. According to the Rotterdam criteria, the prevalence of PCOS in women seeking primary healthcare in Salvador, Brazil, was 8.5%.

Topics: Acne Vulgaris; Adolescent; Adult; Black People; Blood Glucose; Blood Pressure; Body Height; Body Weight; Brazil; Cross-Sectional Studies; Deamino Arginine Vasopressin; Educational Status; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Middle Aged; Polycystic Ovary Syndrome; Primary Health Care; Testosterone; Waist Circumference; White People