KatCarney

Homocysteine's Role in PCOS Unclear.
OB/GYN News, Dec 15, 2000, by Nancy Walsh

WASHINGTON -- The search continues for a marker such as elevated plasma homocysteine that would help clinicians clinch the diagnosis of polycystic ovary syndrome, Dr. E. Scott Sills said at the FIGO World Congress of Gynecology and Obstetrics.

While experts disagree about the diagnostic criteria for this complex disorder and its pathology remains poorly understood, it has become clear that PCOS can have profound long-term consequences other than infertility, particularly because of its frequent association with dyslipidemia, hyperinsulinemia, and cardiovascular disease.

An elevated level of plasma homocysteine is one potential diagnostic marker for PCOS that has come under investigation. "Our clinical team decided to look at a possible connection between homocysteine and PCOS because homocysteine has emerged as a novel clinical marker for vasculopathies," said Dr. Sills of Georgia Reproductive Specialists, Atlanta.

Because impaired follicular vascularity is characteristic of PCOS, Dr. Sills and his colleagues speculated that homocysteine might also be contributing to the vascular abnormalities, insufficient oxygenation, and resulting poor egg quality in the polycystic ovary.

They conducted an observational, cross-sectional study of 54 women who had come to their clinic for infertility evaluation. A total of 36 had polycystic-appearing ovaries on sono-graphic evaluation; the remainder functioned as controls for the study, he said at the meeting, also sponsored by the American College of Obstetricians and Gynecologists.

There were no significant differences in plasma homocysteine levels between the women with polycystic-appearing ovaries and controls; both groups had a median level of 7 [micro]mol, L. Androgen levels were all low to normal.

These findings do not rule out homocysteine as a possible marker for PCOS. "Our study was just the opening salvo in the inquiry into the relationship between homocysteine and the follicular derangements that are seen in these women, Dr. Sills said in an interview.

While findings in PCOS patients can include menstrual irregularities, androgen elevations, hirsutism, dyslipidemia, and insulin resistance, the degree of expression of the syndrome is highly variable.

"As we learn more about PCOS, I think we're going to find that it's an interlocking continuum of endocrinologic derangements, such as diabetes, to which it is a close cousin," Dr. Sills said during the conference.

PCOS patients whose body weight is normal are less likely to exhibit insulin resistance, for example.

Further studies therefore should be undertaken with larger populations and with different study criteria specifically stratifying patients according to androgen status, hirsutism, and history of miscarriage, he added.

Studies also are needed to identify a possible genetic basis, and whether it is coded for by a single gene or is polygenic, Dr. Sills said.

COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group

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