Polycystic ovary syndrome (PCOS) is a multifaceted condition characterized by chronic anovulation and excess ovarian activity, in contrast to other causes of anovulation that involve ovarian dormancy or primary insufficiency. Recent studies indicated that PCOS is associated with low-grade chronic inflammation and that women with PCOS are at increased risk of non-alcoholic fatty liver disease. The inflammatory and metabolic derangements associated with PCOS are explained in part by the coexistence of insulin resistance and obesity but are further fueled by the androgen excess. New insights into the regulation of hormones and cytokines in muscle and fat tissue support the concept that PCOS is a systemic syndrome. The therapeutic plan should be tailored to the patient phenotype, complaints, and reproductive desire. Of note, the aromatase inhibitor letrozole seems to be more effective than the reference drug clomiphene citrate to treat infertility due to PCOS. Integral management by a multidisciplinary team may help the patients to adhere to lifestyle interventions and thereby reduce body adiposity and recover their metabolic and reproductive health.

Histoplasma capsulatum infection involving the larynx is a rare manifestation, especially in immunocompetent individuals and a high index of suspicion is needed to establish the diagnosis correctly. We report a case of a 50-year-old Brazilian man who presented with progressive hoarseness and throat pain for 4 months. Laryngoscopy showed a supraglottic vegetant lesion, and the biopsies chronic granulomatous inflammation without any specific agent. A second laryngoscopy with biopsies was performed and after 17 days of incubation in specific medium, H. capsulatum was isolated. The patient was successfully treated with amphotericin B.

Objective: Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Subjects and methods: Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. Results: A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m 2 ). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Conclusion: Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS.

Background: An abnormal secretion of incretins, specially Glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and oxyntomodulin (OXM), have been described in subjects with Type 2 diabetes mellitus and PCOS. OXM has important actions in the metabolism including the ability to reduce food intake and improve insulin secretion reducing the liver fat accumulation. Metformin is an insulin-sensitizing hypoglycemic drug and is widely used in the treatment of PCOS. Whether treatment with metformin may affect circulating levels of OXM is not known and is the subject of this study. Design: a secondary analysis, randomized double-blind clinical trial. Methods: Forty-five patients with PCOS were recruited, divided into one group that received metformin (n=21) and one group who received placebo (n=24) to evaluate the levels of follistatin and oxyntomodulin before and after the use of metformin (1500mg/day). Blood levels of oxyntomodulin and follistatin were evaluated by ELISA tests. Results: At the end of the study, 20 patients were evaluated, 5 (25%) from the group using metformin and 15 (75%) from the placebo group. There was no significant difference in the variation in follistatin and oxyntomodulin levels between the metformin and placebo groups. There was a significant difference in follistatin levels among participants with hyperandrogenic and non-hyperandrogenic phenotype. There was no significant difference in oxyntomodulin levels in the different phenotypes. Conclusion: The use of metformin for 60 days did not alter follistatin and oxyntomodulin levels, and there was a significant difference between the follistatin values in hyperandrogenic and non-hyperandrogenic phenotypes. Trial registration: Brazilian Registration Platform for Clinical Studies - REBEC -ID RBR-47tvky / Brazilian Health Ministry- ID 17127713.2.0000.5149.