UOG Journal Club: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome?
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UOG Journal Club: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome?

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This Journal Club presentation provides a summary and discussion of the following free access article published in UOG: ...

This Journal Club presentation provides a summary and discussion of the following free access article published in UOG:
Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome?
S. Catteau-Jonard, J. Bancquart, E. Poncelet, C. Lefebvre-Maunoury, G. Robin, D. Dewailly
Volume 40 Issue 2, Date: August 2012, pages 223–229

It can be accessed here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.11202/abstract

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UOG Journal Club: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? UOG Journal Club: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Presentation Transcript

  • UOG Journal Club: August 2012Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? S. Catteau-Jonard, J. Bancquart, E. Poncelet, C. Lefebvre-Maunoury, G. Robin, D. Dewailly Volume 40 Issue 2, Date: August 2012, pages 223–229 Journal Club slides prepared by Ligita Jokubkiene (UOG Editor for Trainees)
  • Polycystic ovary syndrome (PCOS)is the most common cause of: Infertility Hyperandrogenism Norman RJ M et al., Lancet 2007
  • Rotterdam criteria for PCOS*• 12 or more follicles 2–9 mm in size in at least one ovary, or ovarian volume >10 mL at ultrasound examination on cycle day 2–5• Oligo- and/or anovulation• Clinical and/or biochemical signs of hyperandrogenism*At least two of the three criteria are necessary for PCOS diagnosis Revised 2003 consensus. Hum Reprod 2004
  • Polycystic ovaries (PCO)Only ultrasound criteria are met: 12 or more follicles 2–9 mm in size in at least one ovary or ovarian volume >10 mL Observed in 21–63 % of apparently normal women Is PCO a normal ovarian appearance or does it reflect ovarian follicle abnormality in a similar way to PCOS?The inclusion of PCO ultrasound criteria into the PCOS definition is controversial because of lack of specificity. Polson DW et al., Lancet 1988 Farquhar CM et al., Aust N Z J Obstet Gynaecol 1994 Duijkers IJ et al., Gynecol Endocrinol 2010 Johnstone EB et al., J Clin Endocrinol Metab 2010
  • Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? S. Catteau-Jonard et al., UOG 2012 ObjectiveTo determine whether PCO is a normal ovarian state orwhether it reflects an abnormality in ovarianfolliculogenesis similar to PCOS
  • Comparative study (2004–2008)Three age-matched groups of 95 women in each group:Control group – no symptoms and normal ovaries at ultrasoundPCO group – no symptoms but PCO at ultrasound*PCOS group – PCOS according to Rotterdam criteria*Comparison of: Exclusion criteria:• Hormonal parameters • Women with at least one follicle >9 mm• Metabolic parameters • Serum estradiol level > 300 pmol/L• Ultrasound parameters*Ovarian volume was not considered for PCO and PCOS definition
  • MethodologyClinical Serum sampling: Ultrasoundexamination: •Estradiol,17-OH- examination:•Assessment of progesterone •Menstrual cyclehirsutism •Testosterone (elevated if ≥ day 2–5•Measurement of 0.6ng/mL) •2D transvaginalwaist circumference •Androstenedione (elevated ultrasound•Body mass index if ≥ 2.2 ng/mL) •Follicles 2–9 mm(BMI) •DHEAS, LH, FSH, SHBG, counted•Blood pressure insulin •Anti-Mullerian hormone (AMH) •Free-androgen index, HDL cholesterol, triglyceridesDHEAS, dehydroepiandrosterone sulfate; HDL, high-density lipoprotein; LH, luteinizinghormone: FSH, follicle-stimulating hormone; SHBG, sex-hormone-binding globulin
  • Statistical analysis Follicle number = Right ovary + Left ovary Ovarian area = Right ovary + Left ovaryANOVA and covariance analysis with Bonferroni correction on log values
  • Number of follicles 2–9 mm and AMH serum level * p<0.05Number of follicles and AMH level is intermediate in women with PCO: significantly higher than in controls and significantly lower than in PCOS group. Difference in AMH remains significant after adjustment for follicle 2–9 mm number
  • Comparison of AMH serum levels Subgroups of PCOS women: •Amenorrhea (Am) – no menstrual periods > 3 months (n = 13) •Oligomenorrhea (Oligo) – < 8 menstrual periods in preceding year (n = 70) •Eumenorrhea (Eum) – regular menstrual cycle 25 – 35 days (n = 12)AMH level was similar between women with PCO and eumenorrheic women withPCOS. Both groups had significantly lower AMH levels than PCOS patients with oligomenorrhea and amenorrhea.
  • Hormonal parameters Controls PCO PCOS P-value 0.79 0.90 1.39 Testosterone < 0.05* (0.17–1.84) (0.14–1.80) (0.17–3.57) Andro- 4.37 5.25 6.09 < 0.05* stenedione (0.63–7.66) (1.57–7.70) (2.1–17.36) Androgen serum levels except for DHEAS were similar between control and PCO groups and significantly higher in PCOS group than in PCO group. LH was significantly higher in PCOS group than PCO group. No difference in FSH and estradiol levels between PCOS and PCO groups was observed.*Difference between PCO and PCOS groups; results presented as median (range)
  • Metabolic parameters No difference in any metabolic markers (BMI, blood pressure, waist circumference, insulin, triglycerides, SHBG, HDL cholesterol) between control and PCO groupsBMI, waist circumference and triglycerides significantly higher in women with PCOS than control or PCO groupSHBG, HDL cholesterol levels significantly lower in PCOS than control or PCO group
  • Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? S. Catteau-Jonard et al., UOG 2012 Conclusions•PCO is an abnormal condition that differs from controls by higher AMHserum levels but not by hyperandrogenism. This suggests a granulosa cellabnormality in PCO similar to that observed in PCOS•The absence of hyperandrogenism in PCO does not seem to be linked tothe metabolic status
  • Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? S. Catteau-Jonard et al., UOG 2012 Discussion points• What are the criteria for polycystic ovary syndrome according to the Rotterdam consensus in 2003?• What is the difference between polycystic ovary syndrome (PCOS) and polycystic ovaries (PCO)?• Does number of follicles differ between patients with PCOS and PCO?• Do hormonal markers differ between patients with PCOS and PCO?• Do androgen levels differ between patients with PCOS and PCO and women without PCO?• Are metabolic parameters affected in women with PCO?• Is PCO a normal ovarian appearance or does it reflect ovarian follicle abnormality in a similar way to PCOS?