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      Should All Women with Polycystic Ovary Syndrome Be Screened for Metabolic Parameters?: A Hospital-Based Observational Study

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          Abstract

          This hospital-based observational study aims to estimate differences in metabolic abnormalities between different polycystic ovary syndrome (PCOS) phenotypes and their distribution characteristics. The prevalence of metabolic abnormalities among different PCOS phenotypes, including diabetes mellitus (DM), metabolic syndrome (MS), pre-diabetes mellitus (pre-DM), insulin resistance (IR) and dyslipidemia were compared. A total of 2436 women who were ≥18 years old and who were hospitalized in Sun Yat-Sen University affiliated hospital from 1998 to 2015 in GuangZhou, China, were included in this study. PCOS phenotypes were recorded according to the 2003 Rotterdam criteria, including the polycystic ovary morphology (PCO), hyperandrogenism (HA) and ovulation dysfunction (OD) phenotype (PCO+HA+OD); the ovulation phenotype (PCO+HA); the non-PCO phenotype (HA+OD); and the non-HA phenotype (PCO+OD). Notably, 56% of the patients had the classic phenotype (PCO+HA+OD). Importantly, there was no significant difference in the prevalence of metabolic abnormalities or the distribution characteristics of the metabolic abnormalities among these four PCOS phenotypes. Our study supports the notion that metabolic abnormalities and the distribution characteristics of metabolic abnormalities should not be used to distinguish among the various clinical PCOS phenotypes.

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          Most cited references13

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          Metabolic risk in PCOS: phenotype and adiposity impact.

          Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women, with reproductive, cardiometabolic, and psychological features. The heterogeneity in insulin resistance, obesity, and cardiometabolic features has led to controversy on the independent contributions of PCOS status, diagnostic criteria, phenotype, and adiposity. It now appears that women with PCOS have an increased risk of insulin resistance and cardiometabolic features, which is independent of, but worsened by, adiposity and central adiposity, and is unrelated to reproductive phenotype. Obesity may be more prevalent in the more severe phenotypes, which suggests either an exacerbation of the reproductive features or a more likely diagnosis in overweight women with PCOS. Therefore, all women with PCOS should be targeted for prevention, screening, and management of cardiometabolic features.
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            Hyperandrogenemia in Polycystic Ovary Syndrome: Exploration of the Role of Free Testosterone and Androstenedione in Metabolic Phenotype

            Objective To evaluate the association between androstenedione, testosterone, and free testosterone and metabolic disturbances in polycystic ovary syndrome. Methods We analyzed the association between androstenedione, testosterone, and free testosterone and metabolic parameters in a cross-sectional study including 706 polycystic ovary syndrome and 140 BMI-matched healthy women. Polycystic ovary syndrome women were categorized into 4 groups: normal androstenedione and normal free testosterone (NA/NFT), elevated androstenedione and normal free testosterone (HA/NFT), normal androstenedione and elevated free testosterone (NA/HFT), elevated androstenedione and free testosterone (HA/HFT). Results Polycystic ovary syndrome women with elevated free testosterone levels (HA/HFT and NA/HFT) have an adverse metabolic profile including 2 h glucose, HbA1c, fasting and 2 h insulin, area under the insulin response curve, insulin resistance, insulin sensitivity index (Matsuda), triglycerides, total and high density lipoprotein cholesterol levels compared to NA/NFT (p<0.05 for all age- and BMI-adjusted analyses). In binary logistic regression analysis adjusted for age and BMI, odds ratio for insulin resistance was 2.78 (1.34–5.75, p = 0.006) for polycystic ovary syndrome women with HA/HFT compared to NA/NFT. We found no significantly increased risk of metabolic disorders in polycystic ovary syndrome women with HA/NFT. In multiple linear regression analyses (age- and BMI-adjusted), we found a significant negative association between androstenedione/free testosterone-ratio and area under the insulin response curve, insulin resistance, and total cholesterol/high density lipoprotein cholesterol-ratio and a positive association with Matsuda-index, and high density lipoprotein cholesterol (p<0.05 for all). Conclusions Polycystic ovary syndrome women with elevated free testosterone levels but not with isolated androstenedione elevation have an adverse metabolic phenotype. Further, a higher androstenedione/free testosterone-ratio was independently associated with a beneficial metabolic profile.
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              Racial and ethnic disparities in reproductive endocrinology and infertility.

              This review examines racial and ethnic disparities in reproductive health focusing on 3 key topical areas: (1) infertility, (2) polycystic ovarian syndrome, and (3) reproductive aging. We report that an increasing body of knowledge points toward reduced infertility access and in vitro fertilization outcomes in Asian, black, and Hispanic women compared with white women. There are differences in the reproductive and metabolic phenotypes of Asian, black, and Hispanic women presenting with the polycystic ovarian syndrome compared with white women. Reproductive aging differences appear to exist in all racial and ethnic groups. Awareness of racial and ethnic disparities is critical to a complete understanding of the health issues facing women of reproductive age. Copyright (c) 2010 Mosby, Inc. All rights reserved.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                30 November 2016
                2016
                : 11
                : 11
                : e0167036
                Affiliations
                [1 ]Department of Reproductive Medicine Center, Sun Yat-Sen Memorial Hospital, GuangZhou, China
                [2 ]Department of Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, GuangZhou, China
                Zhejiang University College of Life Sciences, CHINA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: DY XC HL.

                • Data curation: HL JG.

                • Formal analysis: HL LL JG YL.

                • Funding acquisition: DY XC.

                • Investigation: HL DY.

                • Methodology: DY XC HL.

                • Project administration: HL DY XC.

                • Resources: HL XC.

                • Software: HL LL.

                • Supervision: HL DY.

                • Validation: HL LL JG.

                • Visualization: HL LL.

                • Writing – original draft: HL LL JG XC.

                • Writing – review & editing: HL LL JG XC.

                Article
                PONE-D-16-28302
                10.1371/journal.pone.0167036
                5130242
                27902723
                d1898dcb-ccaa-4473-a139-fb2194eff1bb
                © 2016 Li et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 July 2016
                : 8 November 2016
                Page count
                Figures: 2, Tables: 2, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81402168
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100002402, Sun Yat-sen University;
                Award ID: 2014005
                Award Recipient :
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Gynecological Tumors
                Polycystic Ovary Syndrome
                Biology and Life Sciences
                Genetics
                Phenotypes
                Medicine and Health Sciences
                Endocrinology
                Endocrine Physiology
                Menstrual Cycle
                Ovulation
                Biology and Life Sciences
                Physiology
                Endocrine Physiology
                Menstrual Cycle
                Ovulation
                Medicine and Health Sciences
                Physiology
                Endocrine Physiology
                Menstrual Cycle
                Ovulation
                Biology and Life Sciences
                Physiology
                Reproductive Physiology
                Menstrual Cycle
                Ovulation
                Medicine and Health Sciences
                Physiology
                Reproductive Physiology
                Menstrual Cycle
                Ovulation
                Biology and Life Sciences
                Anatomy
                Reproductive System
                Ovaries
                Medicine and Health Sciences
                Anatomy
                Reproductive System
                Ovaries
                Biology and Life Sciences
                Biochemistry
                Hormones
                Androgens
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Biology and Life Sciences
                Biochemistry
                Metabolism
                Carbohydrate Metabolism
                Glucose Metabolism
                Custom metadata
                To protect patient confidentiality, the data could not be made publicly available. Some data can be made available upon request. Please submit data related inquires to the authors at the following email address: lihui77@ 123456mail2.sysu.edu.cn .

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