Predictive value of ovarian stroma measurement for cardiovascular risk in polycyctic ovary syndrome: a case control study

Abstract

BackgroundTo verify the feasibility of ovarian stromal evaluation and correlate ovarian parameteres (echogenicity and volume) with hyperandrogenism, and both cardiovascular and metabolic risk factors in PCOS.MethodsTwenty four young PCOS patients and twelve age-matched control women were enrolled. Diagnosis of PCOS was based on the Rotterdam criteria. Ultrasound ovarian study included ovarian volume, stromal volume, stromal area and stromal area/total ovarian area ratio (S/A). Concerning hormones, insulin, LH, FSH, estradiol, androstenedione, testosterone, DHEAS, 17-hydroxy-progesterone, and SHBG were measured during the early follicular phase (days 2-5). Cardiovascular risk factors were represented by fasting plasma levels of glucose, lipids (total and HDL-cholesterol), plasminogen activator inhibitor 1 (PAI-1), von-Willebrand factor (vWF), and adiponectin. Carotid intima-media thickness (C-IMT) was measured as a parameter of cardiovascular risk.ResultsA positive correlation between the S/A ratio and plasma levels of testosterone (p < 0.05) and androstenedione (p < 0.05) was found. The stromal volume, stromal area and S/A ratio were also significantly and positively correlated with PAI-1, and vWF levels, and with IMT in PCOS women (P < 0.05).ConclusionsThis study shows that the ultrasound measurement of ovarian stroma is a predicting factor of hyperandrogenism degree, prothrombotic factors and cardiovascular risk in patients with PCOS.

Correlation of severity of hyperandrogenism with ovarian stroma to area ratio and stromal echogenicity in polycystic ovary syndrome patients

“…This suggests that there exist a good number of lean PCOS patients in the society. Our study demonstrated statistically significant distribution of BMI between the two groups (p=0.006) and this was consistent with the findings of Lam P et al and Loverro G. 8,9 Ovarian imaging is crucial for diagnosis of PCOS. Since PCOS by definition is a syndrome, the presence of polycystic ovaries alone is insufficient for the diagnosis since they are not always associated with it.…”

“…In our study, it was observed that stromal area was significantly higher in the PCOS group In our study total ovarian area identified as 6.69±1.52 cm 2 versus 6.96±1.01 cm 2 which were not statistically significant and findings were consistent with the observations by Fulghesu AM et al and Loverro et al 7,9 Though various studies have emphasized the role of ovarian stromal measurement but it is still in the research field.…”

“…We found a positive correlation of DHEAS with S/A ratio (r=0.565, p<0.0001) as oppose to the study conducted by Fulghesu AM et al 7 They observed it to best correlate with the Testosterone and Androstenedione levels and further confirmed S/A ratio to be the best indicator of hyperandrogenism. We demonstrated a positive and significant correlation between testosterone and S/A ratio (r=0.27, p=0.044) as observed by Loverro et al and Qiu Y et al 9,10 Stromal echogenicity can be assessed subjectively on ultrasound but it is non-reproducible and prone for interobserver variation .We assessed the echogenicity in the manner as described by Pache et al by giving a score 1 (normal), 2 (moderately increased) and 3 (frankly increased) by comparing with myometrium. 11 There was a statistically significant association of testosterone with score 1 and 3 with p<0.05 whereas association with DHEAS and score 3 was significantly associated.…”

Is ultrasound useful in the diagnosis of adolescents with polycystic ovary syndrome?

“…The androgens are required by the developing follicle and are transported to the granulosa cells for conversion into estrogens (19). Ovarian stromal hypertrophy is involved in the pathophysiology of the PCOS, but its acceptance as a criterion for diagnosis of PCOS remains controversial (20). The data strongly support the use of 3D ultrasound to assess S/A ratio in the diagnosis of PCOS, as it was found to be the parameter most closely correlated with androgen levels.…”

Effect of Oligopin Supplementation on Polycystic Ovary Syndrome: A Randomized Controlled Trial

“…A trans-abdominal ultrasound was performed by one of two well-trained radiologist a 3 MHz to 5.5 MHz curvilinear probe (acuson s2000, Siemens Medical Solutions, USA). Ovarian volume was calculated for each ovary using the prolate ellipsoid formula: π/6 *maximum diameter in transverse*anteroposterior * longitudinal axes (13). The total number of antral follicles (2 -10 millimeter in diameter) was counted (14).…”