Η κλινική προσέγγιση και τα βιοχημικά χαρακτηριστικά του συνδρόμου πολυκυστικών ωοθηκών σε νεαρές γυναίκες αναπαραγωγικής ηλικίας στην Ελλάδα με βάση τα διαφορετικά κριτήρια διάγνωσης

Abstract

OBJECTIVE: It is a matter of ongoing debate whether the newer phenotypes, derivedfrom Rotterdam criteria, share the same metabolic risk with the classic ones (NIH1990). In this context, our survey makes an effort to distinguish PCOS according tophenotypic expression and to estimate the their prevalence in a Greek population. Wealso sought to compare the prevalence of metabolic syndrome (MS) and glucosehomeostasis parameters in Greek women with classic and newer PCOS phenotypes.MATERIALS AND METHODS: Greek women aged 18 to 35 years old, who visitedthe outpatients department, complaining of irregular menstruation (oligo- oranovulation OA) or clinical manifestations of hyperandrogenaemia (HA) wererecruited. They gave full medical history and underwent clinical examination(including transvaginal ultrasound scan to identify polycystic ovarian morphology -PCO). Blood samples were collected to perform hormonal and metabolic analysis.Acute or chronic disorders were excluded. Finally,266 PCOS women constituted the study population, who were divided into groupsaccording to which two of three Rotterdam criteria were fulfilled. Four groups wereformed: a) the group with hyperandrogenemia(HA),,oligo-anovulation(OA) andpolycystic ovaries by ultrasound(PCO) (classic phenotype), b) the group withhyperandrogenemia and oligo-anovulation(classic phenotype) , c) the group withhyperandrogenemia and polycystic ovaries by ultrasound(newer phenotype) and D)the group with oligo-anovulation and polycystic ovaries by ultrasound (newerphenotype). Subsequently the study population was divided into two groups; the firstrepresented the classic phenotypes, while the second one reflected the newerphenotypes. The clinical, biochemical, hormonal and ultrasound characteristics of thetwo groups were explored. All subjects were evaluated for the presence of MS and180also underwent a 2-hour glucose tolerance test to assess the insulin resistance indicesHOMA-IR, QUICKY and MATSUDA.RESULTS: According to our results, 44.4% of Greek PCOS women belong tophenotype A, 18% to phenotype B, 26.3% to phenotype C and 11.3% to phenotype D.62.4% of PCOS women belong to the classic NIH phenotypes. 32 women with classicPCOS phenotypes had MS (prevalence 19.6%). Only 4 patients from the newerphenotypes had MS (prevalence 4.1). 11.7 % of the subjects with classic phenotypesexhibited impaired glucose tolerance (threefold higher compared to patients withnewer phenotypes). Regarding insulin resistance indices, HOMA-IR was significantlyhigher and QUICKY significantly lower. MATSUDA showed a tendency to be lowerin classic phenotypes.CONCLUSIONS: The full blown phenotype (HA+OA+PCO) is the predominantphenotype in our Greek population. Greek PCOS women with classic phenotypes areat increased risk for MS and impaired glucose homeostasis compared to women withnewer phenotypes. The subclassification of PCOS phenotypes permits the earlierrecognition and closer surveillance of women with a metabolic profile thatpredisposes to adverse health outcomes.