Correlation of severity of hyperandrogenism with ovarian stroma to area ratio and stromal echogenicity in polycystic ovary syndrome patients
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20151610Keywords:
Hyperandrogenism, Stroma echogenicity, Ovarian stroma, S/A ratioAbstract
Background: Polycystic ovary syndrome is one of the most common endocrine disorders of reproductive age group. Rotterdam consensus although includes ovarian volume in diagnosis of PCOS but its ovarian stroma area that corresponds histological and thus its clinical features.
Methods: A prospective study conducted on 55 PCOS cases and 55 age and weight matched healthy volunteers. Detailed medical, menstrual history and examination for clinical hyperandrogenism and anthropometry was done. Fasting venous blood samples were obtained on day 2 for androgen profiles. All the patients were subjected to pelvic ultrasound and also a 3D ultrasound was done. The S/A (ovarian stroma to area ratio) were obtained by outlining the peripheral profile of the stroma with a caliper and similarly total ovarian area by outlining in the maximum plane section. Stromal echogenicity was assessed semi quantatively.
Results: S/A exhibits positive and significant correlation with DHEAS (r = 0.565, p<0.05), testosterone (r = 0.272, p<0.05) and negative but insignificant correlation with hirsuitism score with(r = -0.07, p>0.05) in cases, whereas stoma echogenicity was increased in 78.2% cases and 20% controls and correlated significantly with DHEAS levels and not H score, probably due to small sample size.
Conclusions: S/A bears a positive significant correlation with androgenic parameters studied and can be considered as one of the best predictor of hyperandrogenism. The stroma echogenicity measured semiquantatively can act as a clue for PCOS diagnosis. Their measurement and follow up during course of treatment may show significant role in defining the severity, progression or regression of the disease.
References
Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181–91.
Nelson-Degrave VL, Wickenheisser JK, Hendricks KL, Asano T, Fujishiro M et al. Alterations in mitogen-activated protein kinase and extracellular regulated kinase signaling in theca cells contribute to excessive androgen production in polycystic ovary syndrome. Mol Endocrinol. 2005;19:379-90.
Nelson VL, Legro RS, Strauss JF 3rd, McAllister JM. Augmented androgen production is a stable steroidogenic phenotype of propagated theca cells from polycystic ovaries. Mol Endocrinol. 1995;13: 946-57.
Gilling-Smith C, Story H, Rogers V, Franks S. Evidence for a primary abnormality of thecal cell steroidogenesis in the polycystic ovary syndrome. Clin Endocrinol (Oxf). 1997;47:93-9.
Robert WA, Manfreddy R, Sheri C,Enrico C. Lipid levels in Polycystic Ovary Syndronme: systematic review and meta-analysis. Fertility and Sterility. 2011;95:1073-8.
Dewailly D, Robert Y, Helin I, Ardaens Y, Thomas-Desrousseaux P, Lemaitre L et al. Ovarian Stromal Hypertrophy in Hyperandrogenic women. Clin Endorinol (oxf). 1994;41(5):557-62.
Fulghesu AM, Angioni S, Frau E, Belosi C, Apa R, Mioni R, Xamin N et al. Ultrasonography in PCOS-measuring Ovarian Stroma and Relationship with Circulating Androgens. Human Reproduction. 2007; 22(9):2501–8.
Lam P, Fenning RN, Cheung L, Haines C. Three-dimensional ultrasound features of the polycystic ovary in Chinese women. Ultrasound Obstet Gynecol . 2009;34:196–200.
Loverro G, Pergola G, Naro ED, Tartagni M, Lavopa C, Caringella AM. Predictive value of ovarian stroma measurement for cardiovascular risk in polycystic ovary syndrome: a case control study. J Ovarian Reserve . 2010;3:25-9.
Qiu Y, Liu J, Zhou YF, Gui WW, Liu SW, Wang FL et al. Ultrasound criterion for the diagnosis of polycystic ovary syndrome: ovarian stroma/total area ratio. Zhonghua Fu Chan Ke Za Zhi.2004:39(9):595-7.
Pache TD, Hop WC, Wladimiroff JW, Schipper J and Fauser BCJM. Transvaginal sonography and abnormal ovarian appearance in menstrual cycle disturbances. Ultrasound Med Biol. 1991;17:589-93.
