Enrico Carmina

University of Palermo

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Rogerio A. Løbo

Columbia University

A Jannî

Azienda Ospedaliero-Universitaria Careggi

Manfredi Rizzo

University of Palermo

Rosa Alba Longo

University Hospital of Oran

Giovam Battista Rini

University of Palermo

Ettore Guastella

University of Palermo

Ricardo Azziz

University of Alabama at Birmingham

Frank Z. Stanczyk

University of Southern California

Gaetana Di Fede

Agostino Gemelli University Polyclinic

Roger A. Lobo

Columbia University

Cooperative Institutions

University of Palermo

Harvard University

Columbia University

University of Southern California

University of Pennsylvania

University of California, San Francisco

Weatherford College

University of Naples Federico II

Mexican Social Security Institute

Brigham and Women's Hospital

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Milder forms of atherogenic dyslipidemia in ovulatory versus anovulatory polycystic ovary syndrome phenotype

Human Reproduction (2009)

Manfredi Rizzo Kaspar Berneis Martin Hersberger Ilenia Pepe Gaetana Di Fede

Dyslipidemia is common in women with polycystic ovary syndrome (PCOS) but its prevalence in different PCOS phenotypes is still largely unknown.We measured plasma lipids and lipoproteins in 35 anovulatory PCOS (age: 25 +/- 6 years, BMI: 28 +/- 6 kg/m(2)), 15 ovulatory PCOS (age: 30 +/- 6 years, BMI: 25 +/- 3 kg/m(2)) and 27 healthy women (controls) age- and BMI-matched with ovulatory PCOS. PCOS was diagnosed by the presence of clinical or biologic hyperandrogenism associated with chronic anovulation and/or polycystic ovaries at ultrasound. In women with normal menses chronic anovulation was indicated by low serum progesterone levels (<9.54 nmol/l) during midluteal phase (days 21-24) in two consecutive menstrual cycles.Total cholesterol, triglycerides and low-density lipoprotein (LDL)-cholesterol levels increased and high-density lipoprotein (HDL)-cholesterol decreased from controls to ovulatory and then to anovulatory PCOS (all P < 0.05). Levels of lipoprotein(a) (Lp(a)) and small, dense LDL increased (P < 0.0001 for both) and LDL size reduced (P < 0.005) between groups. Insulin resistance (by HOMA) showed a positive correlation with triglycerides and small, dense LDL and an inverse correlation with HDL-cholesterol and LDL size (P < 0.05 for all) in both PCOS phenotypes. No significant correlations were found with testosterone levels. At multivariate analysis, insulin resistance was independently associated with HDL-cholesterol and small, dense LDL in both PCOS phenotypes and with triglyceride concentrations in ovulatory PCOS only.Women with ovulatory PCOS showed milder forms of atherogenic dyslipidemia than anovulatory PCOS and this seemed to be related to the extent of insulin resistance. Future prospective studies are needed to assess the relative contribution of such alterations on cardiovascular risk.

Anovulation

Hyperandrogenism

Dyslipidemia

10.1093/humrep/dep121

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Citations (94)

Müllerian-inhibiting substance reflects ovarian findings in women with polycystic ovary syndrome better than does inhibin B

Fertility and Sterility (2005)

Micheline C. Chu Enrico Carmina Jeff Wang Rogerio A. Løbo

Hyperandrogenism

Anovulation

Anti-Müllerian hormone

10.1016/j.fertnstert.2005.06.026

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Citations (33)

21-Hydroxylase–deficient nonclassic adrenal hyperplasia is a progressive disorder: A multicenter study

American Journal of Obstetrics and Gynecology (2000)

Carlos Morán Ricardo Azziz Enrico Carmina Didier Dewailly Franca Fruzzetti

hirsutism

Hyperandrogenism

21-Hydroxylase

10.1067/mob.2000.108020

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Citations (15)

Differences in early dynamics of serum bone markers in women with postmenopausal osteoporosis treated by alendronate or risedronate

C. Sferrazza Enrico Carmina Cannone Daniel G. Fernández‐Ávila Loredana Sutera

Alendronic acid

Postmenopausal osteoporosis

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Citations (0)

Ovine corticotropin-releasing factor and dexamethasone responses in hyperandrogenic women

Fertility and Sterility (1990)

Enrico Carmina Jay H. Levin Graziella Malizia Rogerio A. Løbo

Factor (programming language)

Corticotropin-releasing hormone

10.1016/s0015-0282(16)53697-8

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Citations (19)

A Risk-Benefit Assessment of Pharmacological Therapies for Hirsutism

Drug Safety (2001)

Enrico Carmina

hirsutism

Antiandrogens

Flutamide

Hyperandrogenism

Cyproterone

10.2165/00002018-200124040-00004

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Citations (17)

Correlates of increased lean muscle mass in women with polycystic ovary syndrome

European Journal of Endocrinology (2009)

Enrico Carmina Ettore Guastella Rosa Alba Longo Giovam Battista Rini Rogerio A. Løbo

Muscle mass plays an important role in determining cardiovascular and metabolic risks in polycystic ovary syndrome (PCOS). In addition, whether lean mass influences carotid intima-media thickness (IMT) in PCOS has not been assessed.Prospective investigation.Ninety-five women with PCOS were age- and weight-matched to 90 ovulatory controls. All women had dual X-ray absorptiometry for lean, fat and bone mass, and bone mass density (BMD). Serum testosterone, sex hormone-binding globulin, insulin, and glucose and carotid IMT were determined. Free androgen index (FAI) and insulin resistance (by QUICKI) were calculated.In PCOS, waist circumference and insulin were higher and QUICKI lower than in controls (P<0.01). Trunk fat mass, % trunk fat, and lean mass were higher in PCOS compared to controls (P<0.01), while total bone mass and BMD were similar. IMT was increased in PCOS (P<0.01) but only 15% of PCOS patients had abnormal (> or = 0.9 mm) values. Lean mass correlated with fat parameters, insulin, QUICKI, and FAI, but not with total testosterone; and after adjustments for insulin and QUICKI, lean mass still correlated with fat mass (P<0.01) but not FAI. Lean mass correlated with IMT (P<0.01), but this was dependent on insulin. However, excluding those patients with abnormal IMT values, IMT correlated with lean mass independently of insulin. Bone mass correlated with lean and fat mass, but not with insulin or androgen. PCOS patients with 'pathological' IMT values had higher % trunk fat, lean mass, and insulin, lower QUICKI, and higher testosterone and FAI compared with those with normal IMT.Lean mass is increased in PCOS, while bone mass is similar to that of matched controls. The major correlates of lean mass are fat mass and insulin but not androgen. Lean mass also correlated with IMT, and although influenced by insulin, small changes in IMT may partially reflect changes in muscle mass, while clearly abnormal values relate to more severe abnormalities of PCOS.

10.1530/eje-09-0398

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Citations (76)

Advances in the Diagnosis and Treatment of PCOS

Current Pharmaceutical Design (2016)

Enrico Carmina Ettore Guastella Rosa Alba Longo

While the Rotterdam criteria look simple and easy to follow, in clinical practice diagnosis of PCOS may be problematic because of the use of inaccurate commercial androgen assays. Progresses in ovarian ultrasound and in AMH measurement have modified the way to make the diagnosis of PCOS and an update of Rotterdam criteria may be necessary. In classic severe form of PCOS, ovarian follicle count is a very reliable diagnostic criterion but AMH measurement may also present high diagnostic specificity and sensitivity. This finding is particularly important when no clinical signs of androgen excess are present and only commercial assays for androgen measurement are available. At the contrary, in mild PCOS phenotypes, sensitivity of AMH measurement is too low whileFNPO count maintains a high diagnostic sensitivity. However, at least in ovulatory hyperandrogenic PCOS phenotype, increased AMH values in association with enlarged ovarian size permit the diagnosis of ovulatory PCOS in 85% of these patients. Treatment of PCOS women has to be directed to get fertility or in patients not seeking fertility to solve or attenuate the psychological implications of androgen excess and of irregular menses and the risk of endometrial hyperplasia. The therapeutic protocols that are used in our department are presented.

Anovulation

Androgen Excess

Hyperandrogenism

10.2174/1381612822666160719105808

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Citations (17)

When periods stop: cardiovascular consequences of PCOS.

Enrico Carmina Manfredi Rizzo Enrico Carmina Ettore Guastella Márcia dos Santos Rizzo

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Physiological estrogen replacement may enhance the effectiveness of the gonadotropin-releasing hormone agonist in the treatment of hirsutism.

The Journal of Clinical Endocrinology & Metabolism (1994)

Enrico Carmina A Jannî Rogerio A. Løbo

GnRH agonists (GnRH-A) have been used for the treatment of hirsutism in women with ovarian hyperandrogenism. However, significant side-effects, including vasomotor symptoms and bone loss, have prevented the long term use of this therapy. In this study, we evaluated the effects of low dose (physiological) estrogen replacement on the side-effects and clinical and hormonal parameters of 22 hirsute women with ovarian hyperandrogenism when treated with a long-acting GnRH-A, Decapeptyl. Ten patients with Ferriman-Gallwey (FG) scores averaging 13.4 +/- 1.5 were randomly assigned to be treated with Decapeptyl alone (3.75 mg, im, every 28 days for 6 months), and 12 other patients with FG scores averaging 13.3 +/- 1 received Decapeptyl with estrogen (conjugated equine estrogens, 0.625 mg) for 21 days and medroxyprogesterone acetate (10 mg) for 10 days (days 12-21). After 6 months, LH was suppressed in both groups, whereas FSH was significantly reduced only in the group receiving GnRH-A with estrogen (2.5 +/- 4 vs. 4.8 +/- 0.6 IU/L; P < 0.01). Serum androgen levels were reduced in both groups, although the reduction of testosterone and unbound testosterone was greater in the group receiving hormonal replacement [1.73 +/- 0.3 vs. 2.57 +/- 0.4 nmol/L for testosterone (P < 0.05); 8.3 +/- 1 vs. 14.6 +/- 2.8 pmol/L for unbound testosterone (P < 0.05)]. The reduction in hirsutism scores was greater with hormonal replacement (FG scores, -4.1 +/- 0.3 vs. -2.5 +/- 0.3; P < 0.05), whereas the polycystic appearance of ovaries by ultrasound was decreased in both groups. Amenorrhea and vasomotor symptoms were observed only with GnRH-A alone. Serum osteocalcin rose significantly with GnRH-A alone, reflecting a change in bone turnover (0.49 +/- 0.05 to 0.64 +/- 0.09 nmol/L; P < 0.05), but was unchanged with hormonal replacement. Patients receiving hormonal replacement had treatment extended to 1 yr. A further improvement of hirsutism, with scores dropping into the normal range (4.9 +/- 0.7), as well as a normalization of ovarian morphology were evident at this time. In conclusion, low dose (physiological) estrogen replacement may enhance the effects of GnRH-A treatment, while preventing most of the side-effects encountered with GnRH-A alone. This may allow more prolonged treatment, which is necessary for hirsutism.

hirsutism

Gonadotropin-releasing hormone agonist

Hyperandrogenism

Medroxyprogesterone

Triptorelin

10.1210/jcem.78.1.8288696

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Citations (36)