Age Associated Differences in Prevalence of Individual Rotterdam Criteria and Metabolic Risk Factors During Reproductive Age in 446 Caucasian Women with Polycystic Ovary Syndrome

Abstract

Clinical manifestations and metabolic risk factors may differ according to age in patients with polycystic ovary syndrome (PCOS). Therefore, a retrospective trans-sectional study in academic tertiary-care medical center was designed. A cohort of 446 premenopausal, Caucasian women (age range 15–49 years) with PCOS were divided into 4 subgroups according to age: group 1 (15–19 years, n=42), group 2 (20–29 years, n=180), group 3 (30–39 years, n=187), group 4 (40–49 years, n=37) and underwent clinical evaluation (Ferriman-Gallwey score, BMI, waist, blood pressure), hormone analyses (sex hormones, fasting lipids, insulin, glucose), transvaginal ultrasound, oral glucose tolerance tests (OGTT) (n=234), and ACTH tests (n=201). BMI, waist, Ferriman-Gallwey score, blood pressure, and lipid profile were higher in older vs. younger age groups whereas androgen levels were lower. Measures of insulin resistance were unchanged between age groups, but glucose levels were significantly higher in older age groups. Rotterdam criteria: The prevalence of PCO and biochemical hyperandrogenism decreased in the oldest age group whereas clinical hyperandrogenism increased. Young patients are characterized by PCO and biochemical hyperandrogenism, whereas older patients are more obese with more severe hirsutism and more cardiovascular and metabolic risk factors.

Key words

age - oral glucose tolerance test - insulin resistance - diabetes - ACTH test

• References

• 1 Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 1: 19-25
• 2 Glintborg D, Andersen M. An update on the pathogenesis, inflammation, and metabolism in hirsutism and polycystic ovary syndrome. Gynecol Endocrinol 2010; 4: 281-296
• 3 Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 5: 2038-2049
• 4 Kristensen SL, Ramlau-Hansen CH, Ernst E, Olsen SF, Bonde JP, Vested A, Toft G. A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed?. Hum Reprod 2010; 12: 3117-3122
• 5 Bryhni B, Arnesen E, Jenssen TG. Associations of age with serum insulin, proinsulin and the proinsulin-to-insulin ratio: a cross-sectional study. BMC Endocr Disord 2010; 21
• 6 Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR. Androgen excess in women: experience with over 1 000 consecutive patients. J Clin Endocrinol Metab 2004; 2: 453-462
• 7 Glintborg D, Hermann AP, Brusgaard K, Hangaard J, Hagen C, Andersen M. Significantly higher adrenocorticotropin-stimulated cortisol and 17-hydroxyprogesterone levels in 337 consecutive, premenopausal, caucasian, hirsute patients compared with healthy controls. J Clin Endocrinol Metab 2005; 3: 1347-1353
• 8 Moran C, Azziz R. The role of the adrenal cortex in polycystic ovary syndrome. Obstet Gynecol Clin North Am 2001; 1: 63-75
• 9 Puurunen J, Piltonen T, Jaakkola P, Ruokonen A, Morin-Papunen L, Tapanainen JS. Adrenal androgen production capacity remains high up to menopause in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2009; 6: 1973-1978
• 10 Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod 2001; 9: 1995-1998
• 11 Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999; 1: 141-146
• 12 Glintborg D, Henriksen JE, Andersen M, Hagen C, Hangaard J, Rasmussen PE, Schousboe K, Hermann AP. Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 Caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 2004; 6: 1570-1579
• 13 Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol 1961; 1440-1447
• 14 Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. POSITION STATEMENT: Glucose Intolerance in Polycystic Ovary Syndrome A Position Statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007; 12: 4546-4556
• 15 Lykkesfeldt G, Bennett P, Lykkesfeldt AE, Micic S, Moller S, Svenstrup B. Abnormal androgen and oestrogen metabolism in men with steroid sulphatase deficiency and recessive X-linked ichthyosis. Clin Endocrinol (Oxf) 1985; 4: 385-393
• 16 Radziuk J. Insulin sensitivity and its measurement: structural commonalities among the methods. J Clin Endocrinol Metab 2000; 12: 4426-4433
• 17 Duijkers IJ, Klipping C. Polycystic ovaries, as defined by the 2003 Rotterdam consensus criteria, are found to be very common in young healthy women. Gynecol Endocrinol 2010; 3: 152-160
• 18 Jones GL, Hall JM, Balen AH, Ledger WL. Health-related quality of life measurement in women with polycystic ovary syndrome: a systematic review. Hum Reprod Update 2008; 1: 15-25
• 19 Janssen OE, Hahn S, Tan S, Benson S, Elsenbruch S. Mood and sexual function in polycystic ovary syndrome. Semin Reprod Med 2008; 1: 45-52
• 20 Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol 2010; 3: 201-205
• 21 Elting MW, Korsen TJ, Rekers-Mombarg LT, Schoemaker J. Women with polycystic ovary syndrome gain regular menstrual cycles when ageing. Hum Reprod 2000; 1: 24-28
• 22 Hudecova M, Holte J, Olovsson M, Larsson A, Berne C, Sundstrom-Poromaa I. Prevalence of the metabolic syndrome in women with a previous diagnosis of polycystic ovary syndrome: long-term follow-up. Fertil Steril 2011; 96: 1271-1274
• 23 Kumar A, Woods KS, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf) 2005; 6: 644-649
• 24 Park SJ, Goldsmith LT, Weiss G. Age-related changes in the regulation of luteinizing hormone secretion by estrogen in women. Exp Biol Med (Maywood) 2002; 7: 455-464
• 25 Brann DW, Mahesh VB. The aging reproductive neuroendocrine axis. Steroids 2005; 4: 273-283
• 26 Chen H, Guo JH, Lu YC, Ding GL, Yu MK, Tsang LL, Fok KL, Liu XM, Zhang XH, Chung YW, Huang P, Huang H, Chan HC. Impaired CFTR-Dependent Amplification of FSH-Stimulated Estrogen Production in Cystic Fibrosis and PCOS. J Clin Endocrinol Metab 2011; Dec 14 [Epub ahead of print]
• 27 Skalba P, Dabkowska-Huc A, Kazimierczak W, Samojedny A, Samojedny MP, Chelmicki Z. Content of 5-alpha-reductase (type 1 and type 2) mRNA in dermal papillae from the lower abdominal region in women with hirsutism. Clin Exp Dermatol 2006; 4: 564-570
• 28 Horton R, Pasupuletti V, Antonipillai I. Androgen induction of steroid 5 alpha-reductase may be mediated via insulin-like growth factor-I. Endocrinology 1993; 2: 447-451
• 29 Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Position Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95: 2038-2049