Roux-en-Y Gastric Bypass Surgery in Patients with Polycystic Ovary Syndrome and Metabolic Syndrome

Türkmen, Şahruh; Ahangari, Alebtekin; Bäckström, Torbjörn

doi:10.1007/s11695-015-1729-0

Cited by 28 publications

(25 citation statements)

References 42 publications

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“…In a recently published study of women with morbid obesity, androgen status normalized after gastric bypass surgery, but the hormonal changes did not reverse metabolic abnormalities [24]. The present study assessed the gonadal domain in women, with the prevalence of hyperandrogenemia and PCOS not differing significantly between treatment groups.…”

Section: Discussionmentioning

confidence: 80%

The association between severity of King’s Obesity Staging Criteria scores and treatment choice in patients with morbid obesity: a retrospective cohort study

et al. 2016

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BackgroundThe King’s Obesity Staging Criteria (KOSC) comprises of a four-graded set of health related domains. We aimed to examine whether, according to KOSC, patients undergoing bariatric surgery differed from those opting for conservative treatment.MethodsWe graded 2142 consecutive patients with morbid obesity attending our centre from 2005-10 into the following KOSC domains: airway/apnoea, body mass index (BMI), cardiovascular risk (CV-risk), diabetes mellitus, economic complications, functional limitations, gonadal dysfunction, and perceived health status/body image. Both patients and physicians agreed upon treatment choice through a shared decision making process.ResultsA total of 1329 (62%) patients opted for lifestyle intervention and 813 (37%) for bariatric surgery as their first treatment choice. The patients treated with bariatric surgery were younger (42 vs. 44 years, p < 0.001), had a higher BMI (45.4 vs. 43.8 kg/m2, p < 0.001) and had a lower ten year estimated CV-risk (9.4 vs. 10.7%, p = 0.004) than the lifestyle intervention group. Compared with having BMI < 40 kg/m2, BMI ≥ 40 kg/m2 was associated with 85% increased odds of bariatric surgery (OR 1.85 [95% CI 1.48, 2.30]). Conversely, patients with ≥20% ten year CV-risk, had lower odds of bariatric surgery than patients with <20% CV-risk (0.68 [0.53, 0.87]).ConclusionBMI was the strongest KOSC-domain associated with subsequent bariatric surgery after a shared decision making process. Prospective studies are required to assess whether the use of KOSC can help guide patients and clinicians to identify the most appropriate choice of treatment for morbid obesity.

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Section: Discussionmentioning

confidence: 80%

The association between severity of King’s Obesity Staging Criteria scores and treatment choice in patients with morbid obesity: a retrospective cohort study

et al. 2016

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“…By the end of the study, there were still six anovulatory patients [29]. Testosterone and SHBG normalized in all patients, but serum progesterone and allopregnanolone levels only increased in ovulatory patients [29]. However, total ovarian volume at six months posed no difference between the two patient groups [29].…”

Section: Reviewmentioning

confidence: 88%

“…At six months after surgery, mean BMI significantly decreased (47.15±7.57 kg/m 2 baseline vs. 35.46±7.04 kg/m 2 at six months) and all metabolic syndrome-related biomarkers, minus serum HDL levels and diastolic blood pressure, were normalized [29]. By the end of the study, there were still six anovulatory patients [29]. Testosterone and SHBG normalized in all patients, but serum progesterone and allopregnanolone levels only increased in ovulatory patients [29].…”

Section: Reviewmentioning

confidence: 95%

“…A more focused study by Turkmen et al evaluated the metabolic change in 13 obese women with PCOS for six months after undergoing RYGB [29]. At six months after surgery, mean BMI significantly decreased (47.15±7.57 kg/m 2 baseline vs. 35.46±7.04 kg/m 2 at six months) and all metabolic syndrome-related biomarkers, minus serum HDL levels and diastolic blood pressure, were normalized [29]. By the end of the study, there were still six anovulatory patients [29].…”

Section: Reviewmentioning

confidence: 99%

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A Review of the Impact of Bariatric Surgery in Women With Polycystic Ovary Syndrome

Lee¹,

Mathew²,

Jose³

et al. 2020

Cureus

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Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in reproductive-age women that causes infertility. Obesity and insulin resistance are closely tied to the pathophysiology of PCOS. Current first-line treatments include lifestyle modifications, hormone modulators, and laparoscopic ovarian drilling, but little attention has been given to bariatric surgery as a viable option. A detailed review of the literature regarding the outcomes of obese women with PCOS after bariatric surgery is necessary. All studies were found in the PubMed database, limited to females and humans, and selected due to relevancy and quantitative data. Bariatric surgery promotes significant weight loss within one year, which is associated with amelioration of insulin resistance, hyperandrogenism, menstrual irregularity, and ovulatory dysfunction. Surgery successfully mediates the regression of PCOS and promotes successful pregnancy. Thus, we recommend the consideration of bariatric surgery as part of the main treatment considerations in obese patients with PCOS. However, more focused and comprehensive research with better study designs are still needed in the future to investigate PCOS and bariatric surgery.

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“…A recent study has proposed that lipid accumulation product and visceral adiposity index are better markers of IR risk for cardiovascular disease than simple lipid ratios (53). There is a school of thought that suggests that the metabolic abnormalities associated with IR and obesity are probably more important, mechanistically, than hyperandrogenemia for the anovulation in PCOS women (54,55). There is some evidence suggesting women with typical PCOS, i.e., associated hyperandrogenemia, have a heritable component for β-cell defect and impaired glucose tolerance (56).…”

Section: Pcos and Metsmentioning

confidence: 99%

Association of polycystic ovary syndrome with metabolic syndrome and gestational diabetes: Aggravated complication of pregnancy

Yao

Bian

Zhao

2017

Experimental and Therapeutic Medicine

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Polycystic ovary syndrome (PCOS) affects 5–20% of the reproductive age women globally. PCOS is diagnosed by the presence of hyperandrogenism, oligo-anovulation, and polycystic morphology of at least one ovary. Insulin resistance (IR), hyperinsulinemia and associated metabolic abnormalities including metabolic syndrome play a significant role in the development of PCOS. The chances of developing MS in PCOS women was shown to increase by almost 14-fold in patients with increasing body mass index. Even in the absence of overt obesity, a preferential deposition of intra-abdominal fat is noted in PCOS women and this intra-abdominal fat leads to impaired insulin action and functional IR and hyperandrogenism. Functional ovarian hyperandrogenism of ovaries was suggested to be a consequence of IR, which activates androgen synthesizing enzyme, cytochrome p450-c17α-hydroxylase, in ovarian theca cells and causes elevated oxidative stress accompanied by lower antioxidant status in ovaries, which contribute to PCOS pathogenesis. The elevated levels of luteinizing hormone that accompany the early stages of hyperandrogenemia, accelerate ovarian functional deterioration, which is further aggravated by hyperinsulinemia, in PCOS women. The risk of developing gestational diabetes in PCOS women is approximately three times greater, as compared to non-PCOS women, due to IR and hyperinsulinemia. Typical insulin-sensitizing drugs such as metformin, have been used to curtail IR and hyperinsulinemia in pregnant PCOS women, with varying results indicating the complexity of the disease and the need for better controlled studies and additional efforts for PCOS-specific drug discovery.

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Roux-en-Y Gastric Bypass Surgery in Patients with Polycystic Ovary Syndrome and Metabolic Syndrome

Abstract: In PCOS patients, normalisation of metabolic dysfunction may be incomplete by 6 months after RYGB surgery, and the start of ovulatory menstrual cycles may indicate normalisation of metabolic dysfunction.

Cited by 28 publications

References 42 publications

The association between severity of King’s Obesity Staging Criteria scores and treatment choice in patients with morbid obesity: a retrospective cohort study

The association between severity of King’s Obesity Staging Criteria scores and treatment choice in patients with morbid obesity: a retrospective cohort study

A Review of the Impact of Bariatric Surgery in Women With Polycystic Ovary Syndrome

Association of polycystic ovary syndrome with metabolic syndrome and gestational diabetes: Aggravated complication of pregnancy

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