Pituitary-Ovarian Responses to Nafarelin Testing in the Polycystic Ovary Syndrome

Barnes, Randall B.; Rosenfield, Robert L.; Burstein, Stephen; Ehrmann, David A.

doi:10.1097/00006254-199003000-00017

Cited by 38 publications

(62 citation statements)

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“…Evaluation of the ovaries and measurement of ovarian volumes of all cases were performed by transvaginal ultrasound using a Siemens Sonoline Adara (Siemens Healthcare) 6.5 MHz transvaginal probe. Regularly menstruating women were scanned in the early follicular phase (cycle days [3][4][5]. Progestin was administered to the PCOS cases with oligomenorrhea or amenorrhea.…”

Section: Methodsmentioning

confidence: 99%

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Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome

Köşüş¹,

Köşüş²,

Kamalak³

et al. 2012

Gynecological Endocrinology

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The aim of this study was to examine the effect of adrenal versus ovarian androgen (dehydroepiandrosterone sulfate/total testosterone [DHEAS/TT]) on clinical presentation and related metabolic disturbances in Turkish women with polycystic ovarian syndrome (PCOS). Two hundred eighty PCOS cases were taken into the study. For all cases, the DHEAS/TT ratio was calculated. The median value of this ratio was 4.40. Patients with an androgen ratio lower than 4.40 were included in Group 1 and cases with a ratio higher than 4.40 were Group 2. The two groups were compared in terms of hormonal, biochemical and clinical parameters. Body mass index and waist circumference were lower, the Ferriman-Gallwey score was higher and the cycle length was shorter in Group 2. High DHEAS level was associated with better lipid profiles and lower levels of inflammatory markers, meaning good metabolic control in these women, in spite of increased hirsutism rates. In patients with PCOS, both androgens are usually high in proportion to each other. Therefore, it would be more meaningful to use the DHEAS/TT ratio for an assessment of the metabolic and phenotypic effects of PCOS.

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Section: Methodsmentioning

confidence: 99%

“…Although the main source of androgen is the ovary [4], adrenal androgens such as dehydroepiandrosterone sulfate (DHEAS) [5], are also elevated in 36%-50% of women with PCOS. In previous studies, it was shown that high DHEAS is associated with a good metabolic profile and presence of acne more than high total testosterone (TT) [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome

Köşüş¹,

Köşüş²,

Kamalak³

et al. 2012

Gynecological Endocrinology

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show abstract

“…Spontaneous LH pulse frequency is increased, which is particularly striking in overnight studies since these women typically lack the normal nocturnal slowing of pulse frequency that is the residual effect of ovulation in the previous cycle (McCartney et al, 2002; Taylor et al, 1997). LH pulse amplitude is also increased (Kazer et al, 1987; Waldstreicher et al, 1988), which is reflected in the size of the pulse induced promptly by GnRH (Arroyo et al, 1997) or GnRH agonist administration (Barnes et al, 1989). LH secreted early (30–60 min) in response to GnRH or GnRH agonist injection subcutaneously represents the readily releasable gonadotrope pool of preformed LH (GnRH agonist, being long-acting, then stimulates synthesis and release of a second, slowly releasable gonadotropin pool) (Bremner and Paulsen, 1974; Redding et al, 1972; Rosenfield et al, 1996; Zimmer et al, 2010).…”

Section: Relationship Of Nutritional Status To Neuroendocrine Funcmentioning

confidence: 99%

Evidence that obesity and androgens have independent and opposing effects on gonadotropin production from puberty to maturity

Rosenfield

Bordini

2010

Brain Research

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Optimal fat mass is necessary for normal gonadotropin levels in adults, and both undernutrition and overnutrition suppress gonadotropins: thus, the gonadotropin response to relative adipose mass is biphasic. Adult obesity is associated with blunted luteinizing hormone (LH) pulse amplitude that is partially attributable to increased LH clearance rate. Testosterone appears to have a biphasic effect on gonadotropin production in females. Moderate elevations of testosterone appear to stimulate LH production at both the hypothalamic and pituitary level, while very high levels of testosterone suppress LH. Thus, obesity per se appears to suppress gonadotropin production, and moderate hyperandrogenemia in women appears to stimulate LH. The ordinary hypergonadotropic hyperandrogenism of obese women appears to be an exception to this model because it is usually due to polycystic ovary syndrome (PCOS), a condition in which intrinsic functional ovarian hyperandrogenism and excess adiposity share a common origin that involves insulin-resistant hyperinsulinemia. LH elevation seems to be secondary to hyperandrogenemia and is absent in the most obese cases. Overweight early pubertal girls have significant blunting of sleep-related LH production, which is the first hormonal change of puberty. The data are compatible with the possibility that excess adiposity may paradoxically subtly suppress hypothalamic-pituitary-gonadal function in early puberty although it is known to contribute to the early onset of puberty.

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“…The test has been used in the setting of PCOS. 56 The original test was performed using nafarelin, 56 but other GnRH agonists may be used with no substantial differences. Generally, leuprolide (500 or 1000 μg) is given subcutaneously in the morning between the fifth and the eighth day of the cycle.…”

Section: Gonadotropin-releasing Hormone-agonist Testmentioning

confidence: 99%

Laboratory Assessment

Carmina¹,

Stanczyk²,

Løbo³

2014

Yen &Amp; Jaffe's Reproductive Endocrinology

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Pituitary-Ovarian Responses to Nafarelin Testing in the Polycystic Ovary Syndrome

Cited by 38 publications

References 0 publications

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome

Evidence that obesity and androgens have independent and opposing effects on gonadotropin production from puberty to maturity

Laboratory Assessment

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