Patient Care Endocrinology & Cardiology - December 2007 - (Page 23)

Polycystic ovary syndrome I Case resolution Laboratory tests showed negative pregnancy test and normal levels of follicle-stimulating hormone, luteinizing hormone, free testosterone, dehydroepiandrosterone sulfate, thyroid-stimulating hormone, and prolactin. The patient’s LDL cholesterol (LDL-C) level was 145 mg/dL, and HDL cholesterol (HDL-C), 38 mg/dL. Oral glucose tolerance testing showed fasting serum glucose was 98 mg/dL and 123 mg/dL after 2 hours with a 75-g glucose load. Pelvic ultrasonography revealed no enlarged ovaries with multiple follicles less than 20 mm and an otherwise normal uterus. The patient was counseled about polycystic ovary syndrome and her cardiovascular risk factors including obesity, family history of cardiovascular disease, mildly elevated LDL-C and low HDL-C levels. She was referred to a dietitian for weight reduction recommendations. She was advised to follow a low-calorie diet along with a moderate exercise regimen 5 to 6 times a week, with a goal of reaching a body mass index lower than 25; an LDL-C level of less than 130 mg/dL, and an HDL-C level of more than 40 mg/d. A 24-day monophasic pill with drospirenone, 3.0 mg/ethinyl estradiol, 20 mcg (YAZ) was initiated for contraception. Drospirenone (progestin) has antimineralocorticoid and antiandrogen features and is pharmacologically related to spironolactone, which may help treat hirsutism. Dr Gibson discloses that she has no financial relationship with any manufacturer in this area of medicine. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. REFERENCES 1. Azziz R, Woods KS, Reyna R, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-2749. 2. Committee on Practice Bulletins-Gynecology, Practice Bulletin 41: Polycystic Ovary Syndrome. Obstetrics & Gynecology. 2002;100(6):13891402. 3. Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 113(6):e85-e151. [published corrections appear in Circulation. 2006; 113(14):e696 and Circulation. 2006;114(23):e630]. 4. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Fertil Steril. 2004;81:19-25. 5. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev.1997;18(6):774-800. 6. Conway GS, Jacobs HS, Holly JM, et al. Effects of luteinizing hormone, insulin, insulin-like growth factor-1 and insulin-like growth factor small bind- 25. 26. 27. 28. 29. 30. ing protein-1 in the polycystic ovary syndrome. Clinical Endocrinol. 1990;33(5):593-603. Dunaif A, Segal K, Futterweit W, et al. Profound peripheral insulin resistance, independent of obesity in polycystic ovary syndrome. Diabetes. 1989;38(9):1165-1174. Ehrmann DA, Barnes RB, Rosenfield RL, et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22(1):141-146. Paradisi G, Steinberg HO, Hempfling A, et al. Polycystic ovary syndrome is associated with endothelial dysfunction. Circulation. 2001;103(10): 1410-1415. Kelly CJ, Speirs A, Gould GW, et al. Altered vascular function in young women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002; 87(2):742-746. Orio F, Palomba S, Spinelli L, et al. The cardiovascular risk of young women with polycystic ovary syndrome: an observational, analytical, prospective case-control study. J Clin Endocrinol Metab. 2004;89(2):3696-3701. Dagre A, Lekakis J, Mihas C, et al. Association of dehydroepiandrosteronesulfate with endothelial function in young women with polycystic ovary syndrome. Eur J Endocrinol. 2006;154(6):883-890. Meyer C, McGrath B, Cameron J, et al. Vascular dysfunction and metabolic parameters in polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(8):4630-4635. Jesse RL, Loesser K, Eich DM, et al. Dehydroepiandrosterone inhibits human platelet aggregation in vitro and in vivo. Ann NY Acad Sci. 1995;774:281-290. Arad Y, Badimon JJ, Badimon L, et al. Dehydroepiandrosterone feeding prevents aortic fatty streak formation and cholesterol accumulation in cholesterol-fed rabbit. Arteriosclerosis. 1989;9(2):159-166. Birdsall MA, Farquhar CM, White HD. Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catheterization. Ann Intern Med. 1997;126(1):32-35. 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. Wild RA. Long-term health consequences of PCOS. Human Reprod Update. 2002;8(3):231-241. Wild S, Pierpoint T, Mckeigue PM, et al. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol (Oxf). 2000;52:595-600. Schachter M, Raziel A, Friedler S, et al. Insulin resistance in patients with polycystic ovary syndrome is associated with elevated plasma homocysteine. Hum Reprod. 2003;18(4):721-727. Kelly CC, Lyall H, Petrie JR, et al. Low-grade chronic inflammation in women with polycystic ovarian syndrome. J Clin Endocrinol Metab. 2001;86(6):2453-2455. Hardiman P, Pillay OC, Atiomo W. Polycystic ovary syndrome and endometrial carcinoma. Lancet. 2003;361(9371):1810-1812. Boomsma CM, Eijkemans MJ, Hughes EG, et al. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12(6):673-683. Mosca L, Mochari H, Christian A, at al. National study of women’s awareness, preventive action, and barriers to cardiovascular health. Circulation. 2006;113(4):525-534. Mosca L, Banka CL, Benjamin EJ, at al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007;115(11):1481-1501. Standards of medical care in diabetes—2007. American Diabetes Association. Diabetes Care. 2007;30(suppl):S4-41. Stamets K, Taylor DS, Kunselman A, et al. A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome. Fertil Steril. 2004;81(3):630-637. Tang T, Glanville J, Hayden CJ, et al. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome: a randomized, placebo-controlled, double-blind multicentre study. Hum Reprod. 2006;21(1):80-89. Lord JM, Flight IH, Norman RJ. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ. 2003;32(7421):951-953. Harborne L, Fleming R, Lyall H, et al. Descriptive review of the evidence References continued on page 24 DECEMBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 23

Table of Contents Feed for the Digital Edition of Patient Care Endocrinology & Cardiology - December 2007

Patient Care Endocrinology & Cardiology - December 2007 Research Digest Contents Medicine in the News Options for Managing Diabetes: Three Types of Basal Insulin Therapy Using the New AHA Guidelines for Preventing Coronary Heart Disease in Women Cardiovascular and Metabolic Implications of Polycystic Ovary Syndrome Case & Comment Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - December 2007

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