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Insulin resistance (IR) plays a pivotal role in PCOS. Insulin-sensitizer agents such as metformin and inositols have been shown to improve the endocrine and metabolic aspects of PCOS. The purpose of this study is to compare their effects on the clinical and metabolic features of the women with PCOS. Fifty PCOS women with IR and/or hyperinsulinemia were randomized to treatment with metformin (1500 mg/day) or myo-inositol (4 g/day). IR was defined as HOMA-IR2.5, while hyperinsulinemia was defined as a value of AUC for insulin after a glucose load over the cutoff of our laboratory obtained in normal women. The Matsusa Index has been calculated. The women have been evaluated for insulin secretion, BMI, menstrual cycle length, acne and hirsutism, at baseline and after 6 months of therapy. The results obtained in both groups were similar. The insulin sensitivity improved in both treatment groups. The BMI significantly decreased and the menstrual cycle was normalized in about 50% of the women. No significant changes in acne and hirsutism were observed. The two insulin-sensitizers, metformin and myo-inositol, show to be useful in PCOS women in lowering BMI and ameliorating insulin sensitivity, and improving menstrual cycle without significant differences between the two treatments.

The aim of the study was to examine, in a sample of Italian women, the rate of discontinuation of use of hormonal contraception.In a retrospective cross-sectional study, data were collected from a chart review of 1809 women using or stopping the hormonal contraceptive prescribed by their physician. The name of the contraceptive and the reason for discontinuation were taken from the charts. The differences between the methods regarding reasons for discontinuation were analysed.Of the 1809 women examined, 34.9% had discontinued their hormonal contraception: 6.9% did so for non-method-related reasons, 20.5% due to minor side effects, 4.4% due to major side effects and 3.8% due to difficulties with compliance. Irregular bleeding, weight gain and headache were the main reasons reported for discontinuation. Pills containing 30 μg or 20 μg ethinylestradiol (EE) and the vaginal ring were the most used contraceptive methods. Women using the vaginal ring discontinued less frequently compared with pill users (p .005). Pills containing 20 μg and 30 μg EE had the same discontinuation rate. Venous thrombosis was the most frequently reported major side effect leading to discontinuation.About one-third of women who used modern hormonal contraceptives discontinued the method. Although the percentage of women who gave up as a result of minor side effects was lower than it used to be, and the use of low doses of EE by the vaginal route has decreased the rate of discontinuation, physicians should counsel women about the possibility of side effects and encourage them to seek advice before stopping.

To study whether adolescents with the classical form of polycystic ovary syndrome (PCOS) have alterations in metabolic and vascular structure and function. The effect of metformin was evaluated.Controlled study.University outpatient clinic.Eighteen nonobese adolescents with PCOS were enrolled. Seventeen healthy age-matched adolescents were recruited as control subjects.The metabolic profile and the endothelial structure and function were evaluated.Hormonal and lipid profile, blood pressure (BP) measurement, fasting glucose and insulin levels, C-reactive protein (CRP), homocysteine, tissue-type plasminogen activator, plasminogen activator inhibitor-1 (PAI-1), and plasmin-antiplasmin complexes (PAP) were measured. Flow mediated dilation (FMD), central pulse wave velocity (PWV), radial artery pulse wave, and common carotid intima-media thickness (IMT) were also assessed. Girls with PCOS were also studied 6 months after treatment with metformin (850 mg twice per day).Adolescents with PCOS were insulin resistant and/or hyperinsulinemic and they had higher BP values and levels of CRP and PAI-1 than the control subjects. The levels of tissue-type plasminogen activator and PAP were similar in both groups. FMD, PWV, and IMT were also similar. Metformin significantly (P .05) reduced insulin, BP, CRP, and PAI-1 levels. The PAP levels significantly (P .05) increased. Radial artery pulse wave was significantly reduced after metformin treatment. No modifications in FMD, PWV, and IMT were observed.Adolescents with classical PCOS have alterations in some surrogate markers of cardiovascular risk and they are ameliorated by metformin. No deterioration of vascular structure and function has been detected, probably because of the short duration of exposure to the disease.

Objective To study the threshold for increased ovarian size during different periods of adolescence. Design Cross sectional study with retrospective analysis. Setting University center. Patient(s) A total of 146 hyperandrogenic adolescent women and 72 healthy adolescent controls. Intervention(s) Intravaginal or transabdominal ovarian sonography. Main Outcome Measure(s) Determination of normal ovarian size during the different phases of adolescence calculated using the ellipsoid formula; calculation of threshold for increased ovarian size during different adolescent gynecologic ages and prevalence of increased ovarian size for hyperandrogenic girls at different gynecologic ages. Result(s) In adolescent women, the threshold for increased ovarian size was 11.5 cm 3 during first 2 years from menarche, 10.5 cm 3 during the third year from menarche, and 10 cm 3 during the fourth and fifth years from menarche. The prevalence of increased ovarian size in hyperandrogenic adolescents was around 50% from the third to fifth years from menarche and 35% during the first 2 years from menarche. Conclusion(s) After the first 2 years from menarche, the thresholds for increased ovarian size are similar to those used among adults. During first 2 years from menarche, ovarian size is larger, and differentiation between normal or increased ovarian sizes may be more difficult. In hyperandrogenic adolescent patients, the prevalence of increased ovarian size is relatively low (ranging from 35% to 50% during the different periods of adolescence). In these patients, increased ovarian size may have low sensitivity as a criterion for the diagnosis of possible polycystic ovary syndrome.

Objective In case series concerning the role of EEG after sleep deprivation (SD-EEG) in epilepsy, patients' features and protocols vary dramatically from one report to another. In this study, we assessed the usefulness of a simple SD-EEG method in well characterized patients. Methods Among the 963 adult subjects submitted to SD-EEG at our Center, in the period 2003–2010, we retrospectively selected for analysis only those: (1) evaluated for suspected epileptic seizures; (2) with a normal/non-specific baseline EEG; (3) still drug-free at the time of SD-EEG; (4) with an MRI analysis; (5) with at least 1year follow-up. SD-EEG consisted in SD from 2:00 AM and laboratory EEG from 8:00 AM to 10:30 AM. We analyzed epileptic interictal abnormalities (IIAs) and their correlations with patients' features. Results Epilepsy was confirmed in 131 patients. SD-EEG showed IIAs in 41.2% of all patients with epilepsy, and a 91.1% specificity for epilepsy diagnosis; IIAs types observed during SD-EEG are different in generalized versus focal epilepsies; for focal epilepsies, the IIAs yield in SD-EEG is higher than in second routine EEG. Conclusions This simple SD-EEG protocol is very useful in de novo patients with suspected seizures. Significance This study sheds new light on the role of SD-EEG in specific epilepsy populations.

La contraccezione ormonale e stata negli anni profondamente modificata nei suoi costituenti, dosaggi e regimi di somministrazione. E oggi possibile disporre di preparati che, accanto a un effetto contraccettivo ottimale, possono essere usati a scopo terapeutico per la cura di numerose patologie benigne (acne, dismenorrea grave, dolore pelvico, metrorragie, ecc.). Tra i vantaggi non contraccettivi sicuramente di rilievo e la protezione che la pillola contraccettiva esercita nei confronti del tumore dell’ovaio, endometrio e colon retto. A fronte di questi effetti positivi, i preparati ormonali attualmente disponibili risultano nel complesso privi di gravi effetti collaterali. Luso di basse dosi di etinilestradiolo e di progestinici privi di attivita androgenica ha portato infatti alla riduzione fino annullamento di effetti collaterali da sempre legati alla contraccezione estro-progestinica come la patologia cardiovascolare.

We report the loss of potential fertility in a 23-year-old nulliparous woman who attended the outpatient gynaecological endocrinology clinic for amenorrhea and hot flushes started after a laparoscopic surgery for dermoid cyst. During surgery an unilateral ovarian and fallopian tube agenesis were found. The hormonal evaluation was performed. The results evidenced high plasma levels of LH and FSH. Their values were 56.6 and 121.3 mUI/ml, respectively. The concentrations of plasma E2 were < 20 pg/ml and of AMH were

Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome consists of vaginal aplasia associated with other mullerian duct abnormalities. Its penetrance varies, as does the involvement of other organ systems. Type I MRKU syndrome is characterized by an isolated absence of the proximal two thirds of the vagina, whereas type II is marked by other malformations which include vertebral, cardiac, urologic (upper tract), and otologic anomalies. In both types, the extent of vaginal aplasia varies, ranging from virtually absent to a length much more inferior than the normal one (2–5 cm). MRKU syndrome usually remains undetected until the patient presents with primary amenorrhea despite normal female sexual development. It is important to underline the fact that this syndrome is the second most common cause of primary amenorrhea. Although this condition has psychologically devastating consequences, its anatomical defects can be surgically treated. In fact, following diagnosis, surgery allows patients to have normal sexual function while reproduction may be possible if assisted techniques are performed.

The prevalence of the metabolic syndrome (MBS) abnormalities in Italian adolescents with polycystic ovary syndrome (PCOS) was evaluated.Retrospective chart review.University outpatient clinic.Fifty-three adolescents with PCOS.Subjects underwent a physical evaluation. Fasting blood samples were taken for the evaluation of metabolic parameters.The prevalence of MBS abnormalities according to de Ferranti criteria was assessed.9.4% of adolescents with PCOS had the MBS (three abnormalities). Twelve girls (22.7%) had two abnormalities. Seventeen (32.1%) of PCOS girls have no MBS abnormalities. PCOS adolescents with the MBS were more obese, insulin resistant and they had significantly higher levels of total and free testosterone. The number of metabolic abnormalities correlated with free, total testosterone, free androgen index (FAI) and body mass index (BMI). Groups with two or three abnormalities were not differentiated by BMI, insulin, lipids, blood pressure, but they were differentiated by total and free testosterone and FAI. Adolescents with the MBS have higher total and free testosterone and FAI than girls with two MBS abnormalities.The MBS and its components are present in some adolescents with PCOS, placing them at increased risk for cardiovascular disease early in adulthood. Hyperandrogenemia is a risk factor for MBS independent of obesity.

Objective To evaluate the effects of a pill with drospirenone (3 mg) plus ethinyl E 2 (20 μg) (DRP/20EE) alone or associated with metformin or cyproterone acetate (CPA) on some metabolic cardiovascular risk factors in women with polycystic ovary syndrome (PCOS). Design Randomized, open-label clinical trial. Setting Academic medical clinic. Patient(s) Forty-eight hirsute women with PCOS. Intervention(s) Patients were randomized to treatment with DRP/20EE or with DRP/20EE plus metformin (1,500 mg/d) or with DRP/20EE plus CPA (12.5 mg/d, 10 days per cycle) for 6 months. Main Outcome Measure(s) Blood pressure, lipid profile, and indexes of glucose tolerance and insulin sensitivity were assessed before and after 6 months of treatment. Result(s) Body mass index and blood pressure were not modified by any treatment. Treatment with DRP/EE20 did not change the lipid profile; DRP/EE20 plus metformin significantly increased high-density lipoprotein cholesterol concentrations; DRP/EE20 plus CPA significantly increased triglycerides and total cholesterol. The area under the curve for insulin was significantly decreased by DRP/EE20 and DRP/EE20 plus metformin, but it was significantly increased by DRP/EE20 plus CPA. Treatment with DRP/EE20 plus CPA significantly increased the homeostasis model assessment of insulin resistance index and significantly reduced the glucose to insulin ratio index. Treatment with DRP/EE20 significantly increased the glucose to insulin ratio index. Conclusion(s) Treatment with DRP/EE20 improved insulin sensitivity in hirsute women with PCOS, with no deterioration of lipid profile. This effect was not ameliorated by the addition of metformin. The positive metabolic effects of DRP are abolished by the concomitant use of CPA.

Objective To evaluate the metabolic profiles of adolescents with different phenotypes of polycystic ovary syndrome (PCOS). Design Observational study. Setting University outpatient clinic. Patient(s) Adolescents with PCOS (n = 120) were divided into four groups: oligomenorrhea and hirsutism (O-H, n=50), oligomenorrhea, hirsutism, and polycystic ovaries (PCO-O-H, n=22), oligomenorrhea, hirsutism, and hyperandrogenemia (A-O-H, n=28), oligomenorrhea, and hirsutism, hyperandrogenemia, and polycystic ovaries (PCO-A-O-H, n=20). A control group of age-matched adolescents (n = 30) was included. Intervention(s) Subjects underwent physical and ultrasound evaluations; fasting blood samples were taken for the measurement of endocrine and metabolic parameters. Main Outcome Measure(s) The endocrine and metabolic profiles were evaluated. Result(s) Adolescents with PCOS showed reduced insulin sensitivity and dyslipidemia. Triglycerides, and total and low-density lipoprotein cholesterol were higher in the phenotypes with hyperandrogenemia. Insulin resistance and body mass index were not significantly different between PCOS phenotypes. Triglyceride positively and high-density lipoportein cholesterol levels negatively correlated with free testosterone and free androgen index. Conclusion(s) The risk of metabolic alterations may vary in adolescent PCOS patients with different phenotypes. Hyperandrogenemia is a risk factor for dyslipidemia. This information may be of relevance in counseling adolescents with PCOS.