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Endocrine Section, First Department of Medicine, University of Athens Medical School, Laiko General Hospital, Goudi 115 27 Athens, Greece
Address all correspondence and requests for reprints to: E. Diamanti-Kandarakis, M.D., First Department of Medicine, Laiko General Hospital, 17 Agiou Thoma Street, 115 27 Athens, Greece.
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism,
chronic anovulation, and oligomenorrhea (O/M). PCOS has variable
clinical phenotypes, biochemical features, and metabolic abnormalities.
To determine the prevalence of PCOS in the Greek population as well as
the metabolic parameters, we performed a cross-sectional study of 192
women of reproductive age (17–45 yr), living on the Greek island of
Lesbos. They were divided into 4 groups according to the presence of
hirsutism (defined as a Ferriman-Gallwey score 
6) and O/M: group N
(n = 108), regular menses and absence of hirsutism; group 1
(n = 56), regular menses and hirsutism; group 2 (n = 10), O/M
and absence of hirsutism; and group 3 (n = 18), O/M and hirsutism.
Body mass index, waist to hip ratio, and mean blood pressure did not
differ among the studied groups. Hormonal profile was assessed by
measuring free testosterone (FT). The prevalence of PCOS, defined by
the presence of O/M and biochemical hyperandrogenism (FT 95th
percentile of the normal women), was estimated to be 6.77% (13 women
of 192). Higher FT levels were observed in group 3 (O/M and
hirsutism) compared with groups N (P < 0.00001)
and 1 (P < 0.0001) and in groups 1 (hirsutism) and
2 (O/M) compared with group N (P < 0.0001 and
P < 0.005, respectively). Sex hormone-binding
globulin levels were lower in women with PCOS and in groups 1 and 3
than those in group N (P < 0.002,
P < 0.02, and P < 0.002,
respectively) independently of the body mass index. The metabolic
profile was investigated by measurements of fasting glucose (FG),
fasting insulin (FI), and estimation of the fasting glucose to insulin
ratio (FG:I ratio). After covariance adjusted for the BMI, FI levels
were higher in group 3 and in women with PCOS than in the normal
(P < 0.005 and P < 0.002,
respectively) and the hirsute (P < 0.05 and
P < 0.02, respectively) women, whereas FG levels
did not differ among the studied groups. The FG:I ratio was lower in
group 3, group 1, and in women with PCOS than in normal women
(P < 0.05). Finally, a high incidence of family
history of diabetes mellitus (P = 0.001) and
menstrual disorders (P = 0.01) was observed in
women with PCOS, in contrast to the normal and hirsute women.
In conclusion, PCOS appears to be a particularly common endocrine disorder in the Greek population under study (prevalence, 6.77%); furthermore, it is associated with certain metabolic abnormalities. These data also suggest that the severity of the fasting hyperinsulinemia is associated with the severity of the clinical phenotype of hyperandrogenism independently of obesity.
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R. Azziz, K. S. Woods, R. Reyna, T. J. Key, E. S. Knochenhauer, and B. O. Yildiz The Prevalence and Features of the Polycystic Ovary Syndrome in an Unselected Population J. Clin. Endocrinol. Metab., June 1, 2004; 89(6): 2745 - 2749. [Abstract] [Full Text] [PDF]
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S. Taponen, H. Martikainen, M.-R. Jarvelin, U. Sovio, J. Laitinen, A. Pouta, A.-L. Hartikainen, M. I. McCarthy, S. Franks, M. Paldanius, et al. Metabolic Cardiovascular Disease Risk Factors in Women with Self-Reported Symptoms of Oligomenorrhea and/or Hirsutism: Northern Finland Birth Cohort 1966 Study J. Clin. Endocrinol. Metab., May 1, 2004; 89(5): 2114 - 2118. [Abstract] [Full Text] [PDF]
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S. Taponen, S. Ahonkallio, H. Martikainen, R. Koivunen, A. Ruokonen, U. Sovio, A-L. Hartikainen, A. Pouta, J. Laitinen, V. King, et al. Prevalence of polycystic ovaries in women with self-reported symptoms of oligomenorrhoea and/or hirsutism: Northern Finland Birth Cohort 1966 Study Hum. Reprod., May 1, 2004; 19(5): 1083 - 1088. [Abstract] [Full Text] [PDF]
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 E. W. C. M. van Dam, F. Roelfsema, J. D. Veldhuis, S. Hogendoorn, J. Westenberg, F. M. Helmerhorst, M. Frolich, H. M. J. Krans, A. E. Meinders, and H. Pijl Retention of estradiol negative feedback relationship to LH predicts ovulation in response to caloric restriction and weight loss in obese patients with polycystic ovary syndrome Am J Physiol Endocrinol Metab, April 1, 2004; 286(4): E615 - E620. [Abstract] [Full Text] [PDF]
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E. Diamanti-Kandarakis, C. Kouli, K. Alexandraki, and G. Spina Failure of Mathematical Indices to Accurately Assess Insulin Resistance in Lean, Overweight, or Obese Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., March 1, 2004; 89(3): 1273 - 1276. [Abstract] [Full Text] [PDF]
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E. Vanky, K.A. Salvesen, and S.M. Carlsen Six-month treatment with low-dose dexamethasone further reduces androgen levels in PCOS women treated with diet and lifestyle advice, and metformin Hum. Reprod., March 1, 2004; 19(3): 529 - 533. [Abstract] [Full Text] [PDF]
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R. Azziz, L. A. Sanchez, E. S. Knochenhauer, C. Moran, J. Lazenby, K. C. Stephens, K. Taylor, and L. R. Boots Androgen Excess in Women: Experience with Over 1000 Consecutive Patients J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 453 - 462. [Abstract] [Full Text] [PDF]
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The Rotterdam ESHRE/ASRM-sponsored PCOS consensus Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Hum. Reprod., January 1, 2004; 19(1): 41 - 47. [Abstract] [Full Text] [PDF]
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N. Xita, A. Tsatsoulis, A. Chatzikyriakidou, and I. Georgiou Association of the (TAAAA)n Repeat Polymorphism in the Sex Hormone-Binding Globulin (SHBG) Gene with Polycystic Ovary Syndrome and Relation to SHBG Serum Levels J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5976 - 5980. [Abstract] [Full Text] [PDF]
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R. S. Legro Polycystic Ovary Syndrome and Cardiovascular Disease: A Premature Association? Endocr. Rev., June 1, 2003; 24(3): 302 - 312. [Abstract] [Full Text] [PDF]
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B. O. Yildiz, H. Yarali, H. Oguz, and M. Bayraktar Glucose Intolerance, Insulin Resistance, and Hyperandrogenemia in First Degree Relatives of Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 2031 - 2036. [Abstract] [Full Text] [PDF]
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S. Taponen, H. Martikainen, M.-R. Jarvelin, J. Laitinen, A. Pouta, A.-L. Hartikainen, U. Sovio, M. I. McCarthy, S. Franks, and A. Ruokonen Hormonal Profile of Women with Self-Reported Symptoms of Oligomenorrhea and/or Hirsutism: Northern Finland Birth Cohort 1966 Study J. Clin. Endocrinol. Metab., January 1, 2003; 88(1): 141 - 147. [Abstract] [Full Text] [PDF]
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D. Cermik, B. Selam, and H. S. Taylor Regulation of HOXA-10 Expression by Testosterone in Vitro and in the Endometrium of Patients with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., January 1, 2003; 88(1): 238 - 243. [Abstract] [Full Text] [PDF]
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R. Homburg What is polycystic ovarian syndrome?: A proposal for a consensus on the definition and diagnosis of polycystic ovarian syndrome Hum. Reprod., October 1, 2002; 17(10): 2495 - 2499. [Abstract] [Full Text] [PDF]
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A. Balen and K. Michelmore What is polycystic ovary syndrome?: Are national views important? Hum. Reprod., September 1, 2002; 17(9): 2219 - 2227. [Abstract] [Full Text] [PDF]
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B. O. Yildiz, I. C. Haznedaroglu, S. Kirazli, and M. Bayraktar Global Fibrinolytic Capacity Is Decreased in Polycystic Ovary Syndrome, Suggesting a Prothrombotic State J. Clin. Endocrinol. Metab., August 1, 2002; 87(8): 3871 - 3875. [Abstract] [Full Text] [PDF]
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C. G. Solomon, F. B. Hu, A. Dunaif, J. E. Rich-Edwards, M. J. Stampfer, W. C. Willett, F. E. Speizer, and J. E. Manson Menstrual Cycle Irregularity and Risk for Future Cardiovascular Disease J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2013 - 2017. [Abstract] [Full Text] [PDF]
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R. S. Legro, A. R. Kunselman, L. Demers, S. C. Wang, R. Bentley-Lewis, and A. Dunaif Elevated Dehydroepiandrosterone Sulfate Levels as the Reproductive Phenotype in the Brothers of Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2134 - 2138. [Abstract] [Full Text] [PDF]
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 C. G. Solomon, F. B. Hu, A. Dunaif, J. Rich-Edwards, W. C. Willett, D. J. Hunter, G. A. Colditz, F. E. Speizer, and J. E. Manson Long or Highly Irregular Menstrual Cycles as a Marker for Risk of Type 2 Diabetes Mellitus JAMA, November 21, 2001; 286(19): 2421 - 2426. [Abstract] [Full Text] [PDF]
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E. Diamanti-Kandarakis, G. Spina, C. Kouli, and I. Migdalis Increased Endothelin-1 Levels in Women with Polycystic Ovary Syndrome and the Beneficial Effect of Metformin Therapy J. Clin. Endocrinol. Metab., October 1, 2001; 86(10): 4666 - 4673. [Abstract] [Full Text] [PDF]
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H. Joffe, A. E. Taylor, and J. E. Hall EDITORIAL: Polycystic Ovarian Syndrome--Relationship to Epilepsy and Antiepileptic Drug Therapy J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2946 - 2949. [Full Text] [PDF]
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L. Bilo, R. Meo, R. Valentino, C. Di Carlo, S. Striano, and C. Nappi Characterization of Reproductive Endocrine Disorders in Women with Epilepsy J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2950 - 2956. [Abstract] [Full Text] [PDF]
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H. F. Escobar-Morreale, B. Roldán, R. Barrio, M. Alonso, J. Sancho, H. de la Calle, and R. GarcÍa-Robles High Prevalence of the Polycystic Ovary Syndrome and Hirsutism in Women with Type 1 Diabetes Mellitus J. Clin. Endocrinol. Metab., November 1, 2000; 85(11): 4182 - 4187. [Abstract] [Full Text]
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