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In order to estimate whether women with polycystic ovary syndrome (PCOS) have an increased risk of developing myocardial infarction, a risk factor model was applied on 33 women with PCOS and 132 age matched referents. The risk factor model was established from independent risk factors for myocardial infarction in a prospective population study of 1462 women in Göteborg, Sweden. The independent risk factors were age, manifest hypertension, manifest diabetes mellitus, central obesity measured as increased waist to hip circumference ratio and serum triglyceride concentration. A considerably increased risk (relative risk of 7.4) of developing myocardial infarction was observed for women with PCOS compared to age-matched referents. Since the risk factors include variables correlated to obesity, the results indicate that advice on dietary restriction is an important part of the treatment once the diagnosis is established.

Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 300: E37-E45, 2011. First published October 13, 2010; doi:10.1152/ajpendo.00495.2010.-Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, oligo/amenorrhea, and polycystic ovaries. We aimed to determine whether low-frequency electroacupuncture (EA) would decrease hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention. We randomized 84 women with PCOS, aged 18 -37 yr, to 16 wk of low-frequency EA, physical exercise, or no intervention. The primary outcome measure changes in the concentration of total testosterone (T) at week 16 determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat. Secondary outcome measures were changes in menstrual frequency; concentrations of androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites; and acne and hirsutism. Outcomes were assessed at baseline, after 16 wk of intervention, and after a 16-wk follow-up. After 16 wk of intervention, circulating T decreased by Ϫ25%, androsterone glucuronide by Ϫ30%, and androstane-3␣,17␤-diol-3-glucuronide by Ϫ28% in the EA group (P ϭ 0.038, 0.030, and 0.047, respectively vs. exercise); menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group (P ϭ 0.018 vs. exercise). After the 16-wk follow-up, the acne score decreased by Ϫ32% in the EA group (P ϭ 0.006 vs. exercise). Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention. Low-frequency EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea. acupuncture; androgens; estrogens; exercise; glucuronidated androgen metabolites; oligomenorrhea; sex steroid precursors POLYCYSTIC OVARY SYNDROME (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by clinical or biochemical hyperandrogenism, oligo/amenorrhea, and polycystic ovaries with or without increased ovarian volume (4). The most constant and prominent feature is hyperandrogenism, manifested by hirsutism, persistent acne, and biochemical abnormalities (4), including elevated levels of androgens, sex steroid precursors, and glucuronidated androgen metabolites as well as estrogens (22).There is no gold standard for the long-term treatment of women with PCOS who do not attempt to conceive (1). Treatments for hyperandrogenism and menstrual disturbances include oral contraceptives, insulin sensitizers, and lifestyle interventions. Combined low-dose oral contraceptives are recommended as the primary treat...

We identified increased gender-atypical behavior in women with CAH that could be correlated to the CYP21A2 genotype. This speaks in favor of dose-dependent effects of prenatal androgens on the development of higher brain functions. The impact of the disease on upbringing and interpersonal relationships did not correlate with disease severity, indicating that other factors, such as coping strategies, are important for psychosocial adaptation. This illustrates the need for psychological support to parents and patients.

Sverrisdóttir YB, Mogren T, Kataoka J, Janson PO, StenerVictorin E. Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth? Am J Physiol Endocrinol Metab 294: E576-E581, 2008. First published January 15, 2008 doi:10.1152/ajpendo.00725.2007.-Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disturbance among women of reproductive age and is proposed to be linked with size at birth and increased prevalence of cardiovascular disease. A disturbance in the sympathetic nervous system may contribute to the etiology of PCOS. This study evaluates sympathetic outflow in PCOS and its relation to size at birth. Directly recorded sympathetic nerve activity to the muscle vascular bed (MSNA) was obtained in 20 women with PCOS and in 18 matched controls. Ovarian ultrasonographic evaluation, biometric, hormonal, and biochemical parameters were measured, and birth data were collected. Women with PCOS had increased MSNA (30 Ϯ 8 vs. 20 Ϯ 7 burst frequency, P Ͻ 0.0005) compared with controls. MSNA was positively related to testosterone (r ϭ 0.63, P Ͻ 0.005) and cholesterol (r ϭ 0.55, P ϭ 0.01) levels in PCOS, which, in turn, were not related to each other. Testosterone level was a stronger predictor of MSNA than cholesterol. Birth size did not differ between the study groups. This is the first study to directly address sympathetic nerve activity in women with PCOS and shows that PCOS is associated with high MSNA. Testosterone and cholesterol levels are identified as independent predictors of MSNA in PCOS, although testosterone has a stronger impact. The increased MSNA in PCOS may contribute to the increased cardiovascular risk and etiology of the condition. In this study, PCOS was not related to size at birth. birth weight; testosterone; insulin resistance; metabolic syndrome; cardiovascular disease; autonomic nervous system POLYCYSTIC OVARY SYNDROME (PCOS), the most common female endocrine disorder, is a complex and heterogenic disease with unknown etiology (28). PCOS is characterized by reproductive disturbances including chronic anovulation, hyperandrogenism, and polycystic ovaries (28). Although ovarian hyperandrogenemia, which is the most consistent endocrine feature of PCOS, probably plays a key role in its etiology (1, 12), hyperinsulinemia and insulin resistance, as well as abdominal obesity, are also thought to be important etiological factors in PCOS (2, 6). Women with PCOS often develop hypertension, which may involve an increased risk of developing other cardiovascular diseases (4), and seem to have increased psychological distress and a decreased quality of life (17).

Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Lowfrequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol 297: R387-R395, 2009. First published June 3, 2009 doi:10.1152/ajpregu.00197.2009We have recently shown that polycystic ovary syndrome (PCOS) is associated with high muscle sympathetic nerve activity (MSNA). Animal studies support the concept that low-frequency electroacupuncture (EA) and physical exercise, via stimulation of ergoreceptors and somatic afferents in the muscles, may modulate the activity of the sympathetic nervous system. The aim of the present study was to investigate the effect of these interventions on sympathetic nerve activity in women with PCOS. In a randomized controlled trial, 20 women with PCOS were randomly allocated to one of three groups: low-frequency EA (n ϭ 9), physical exercise (n ϭ 5), or untreated control (n ϭ 6) during 16 wk. Direct recordings of multiunit efferent postganglionic MSNA in a muscle fascicle of the peroneal nerve before and following 16 wk of treatment. Biometric, hemodynamic, endocrine, and metabolic parameters were measured. Low-frequency EA (P ϭ 0.036) and physical exercise (P ϭ 0.030) decreased MSNA burst frequency compared with the untreated control group. The low-frequency EA group reduced sagittal diameter (P ϭ 0.001), while the physical exercise group reduced body weight (P ϭ 0.004) and body mass index (P ϭ 0.004) compared with the untreated control group. Sagittal diameter was related to MSNA burst frequency (Rs ϭ 0.58, P Ͻ 0.005) in the EA group. No correlation was found for body mass index and MSNA in the exercise group. There were no differences between the groups in hemodynamic, endocrine, and metabolic variables. For the first time we demonstrate that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS. polycystic ovary syndrome; sympathetic nerve activity; testosterone; insulin resistance; metabolic syndrome; cardiovascular disease POLYCYSTIC OVARY SYNDROME (PCOS) is one of the most common female endocrine disorders affecting ϳ10% of women of reproductive age, and is strongly associated with hyperandrogenism and ovulatory dysfunction (8,46). PCOS increases the risk of metabolic disturbances such as abdominal obesity, hyperinsulinaemia, and insulin resistance, which can lead to type 2 diabetes, and dyslipidemia (8, 46), as well as hypertension which may lead to the development of other cardiovascular diseases (35).Despite extensive research, the primary etiology remains unknown, although both environmental and genetic factors are implicated (17). Existing evidence suggests the ovarian theca cells, the major source of androgen production and secretion (22) to play a key role in the etiology. Also, the hypothalamicpituitary axis (50) and defective insulin a...

The overall quality of life in adult women with CAH is affected both by the type of mutation and operative procedure. Indications for clitoroplasty should be restrictive. Medical, surgical, and psychological treatment should be centralized.