RESUMEN
It has been reported that polycystic ovary syndrome (PCOS) is very frequently associated with obesity, insulin resistance and hyperinsulinemia. However, metabolic disorders may lead to suppression of reproductive hormone secretion during undernutrition and in obesity. Some neuropeptides, such as neuropeptide Y (NPY) and galanin, modulate the control of appetite and play an important role in the mechanism of luteinizing hormone-releasing hormone (LHRH) secretion. NPY and galanin regulate appetite via both central and peripheral mechanisms. The interaction between central and peripheral signals for the control of food intake is due to leptin. Leptin can modulate the activity of NPY and other peptides in the hypothalamus that are known to affect eating behavior. In order to evaluate the relationship between NPY, galanin and leptin, 28 women with PCOS, 32 obese women (non-PCOS) and 19 lean healthy women (control group) were investigated. Obese women with PCOS were divided into two groups: PCOS (A) overweight (body mass index, BMI 26-30 kg/m2), and PCOS (B) obese (BMI 31-40 kg/m2). Plasma NPY, galanin and leptin concentrations were measured by radioimmunoassay. Plasma leptin levels in obese women with PCOS (groups A and B) were significantly higher than those in the control group (p < 0.05, p < 0.05, respectively). A significant positive correlation between plasma leptin and BMI in women with PCOS was found (r = 0.427, p < 0.01). A positive correlation was demonstrated between leptin and testosterone in PCOS (r = 0.461, p < 0.01). Plasma galanin concentrations in PCOS were higher than in the control group but the differences were not significant. Plasma NPY levels were significantly elevated in both non-obese (normal) and obese women with PCOS (group A) (p < 0.01, p < 0.005, respectively). However, in obese non-PCOS women plasma NPY levels gradually increased with increase in BMI. No significant correlations were found between galanin, NPY and percentage change in response of LH to LHRH, as well as between NPY and insulin, and galanin and testosterone. Plasma insulin concentrations in women with PCOS (group B) were significantly higher than in the control group (p < 0.001). Increased plasma NPY levels are found in both obese and non-obese women with PCOS. The increase in NPY is independent of the increase in BMI. In obese women with PCOS, plasma leptin is increased compared with control lean women. Serum insulin concentration is increased in obese women with PCOS. A positive correlation exists between leptin and BMI as well as between leptin and testosterone in women with PCOS. These results may suggest that the feedback system in the interaction between leptin and NPY is disturbed in PCOS.
Asunto(s)
Galanina/sangre , Insulina/sangre , Leptina/análisis , Neuropéptido Y/sangre , Obesidad/complicaciones , Síndrome del Ovario Poliquístico/fisiopatología , Adolescente , Adulto , Índice de Masa Corporal , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Técnicas para Inmunoenzimas , Hormona Luteinizante/sangre , Obesidad/sangre , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/complicaciones , Prolactina/sangre , Radioinmunoensayo , Testosterona/sangreRESUMEN
Several in-vitro studies have shown that endothelins (ET) may inhibit synthesis of progesterone and prevent luteinization of granulosa cells. In the present study, a specific radioimmunoassay was used to evaluate the correlation between concentrations of active (21 residue) ET and ovarian steroids in 47 samples of human follicular fluid (FF) following gonadotrophin stimulation for in-vitro fertilization (IVF) protocols. An isoform non-selective antibody was used in the radioimmunoassay, which recognized the C-terminal structure of the 21 residue ET, and therefore did not crossreact with their weakly active precursors - big ET. In pooled samples of follicular fluid (FF), the concentration of 21 amino acid ET correlated negatively with diameter of the follicles (r = -0.31, P < 0.05) and progesterone concentrations in FF (r = -0.56, P < 0. 001). A positive relationship (non-significant) was found between ET and testosterone concentrations. No correlation between ET and oestradiol was observed. The within-patient correlation coefficients were also evaluated in women from whom three or more samples of FF were obtained. ET were markedly inversely correlated with follicle size in all cases, and with progesterone in five of seven women. Five of seven patients also showed significant positive correlation of ET with testosterone. The results demonstrate clinical evidence that active ET play an important role in regulation of follicle development, especially in the inhibition of premature luteinization of granulosa cells.
Asunto(s)
Endotelinas/metabolismo , Líquido Folicular/metabolismo , Menotropinas/uso terapéutico , Folículo Ovárico/anatomía & histología , Progesterona/metabolismo , Adulto , Endotelinas/química , Estradiol/sangre , Femenino , Fertilización In Vitro , Humanos , Hormona Luteinizante/sangre , Progesterona/sangre , Testosterona/metabolismoRESUMEN
The paper discusses the problem of treating Asherman's syndrome, which due to common procedures in gynaecology and obstetrics becomes more and more frequent occurrence in gynaecological practice. The genesis of this syndrome is often a result of a too intensive excochleation of the uterus, accompanying infection and lack of endometrial reaction to oestrogens. The authors discussed 14 cases of patients in whom, after excochleation of the uterus, there appeared intrauterine adhesions followed by amenorrhoea. The therapy consisted in removing the adhesions by means of a hysteroscope and inserting an intrauterine device the shape of which was selected depending on the character and localization of adhesions and applying oestrogens locally into the uterus cavity. In order to have the menstrual cycle reconstructed, the patients were administered orally hormones during 4 successive artificially reconstructed cycles. Among the patients undergoing therapy, 86% of them began to menstruate again and 57% of them got pregnant. The use of hysteroscopy reduced maximally the risk of breaking the continuity of the uterus during the resection of large adhesions. Inserting a proper device prevented the recurrence of adhesions and local administering oestrogens into the uterine cavity provided good conditions for the reconstruction of the endometrium.