Correlation of hyperprolactinemia, Subclinical hypothyroidism with Polycystic Ovary Syndrome and infertility
Abstract
Background: Polycystic ovarian syndrome (PCOS) is a hyperandrogenic condition characterized by polycystic ovarian morphology and chronic oligo-anovulation. When it is combines with hypothyroidism and hyperprolactinemia, this condition can have severe consequences, may even lead to infertility.
Case Presentation: This case study illustrates the complexity of PCOS and the significance of a multidisciplinary approach to its diagnosis and therapy. The patient is a 24-year-old non diabetic nonsmoker female with PCOS who has been attempting to conceive for seven years. The patient presented to the hospital with irregular menstrual cycles and a desire to become pregnant. The patient had previously been unsuccessfully treated with Clomid and letrozole. The patient's BMI was determined to be 23. 3 and a pelvic scan indicated PCO ovaries. Laboratory results revealed
hyperprolactinemia (53 ng/ml) and subclinical hypothyroidism (TSH 12.6 uIU/ml, T4 0.54 ng/dL- TPO
antibodies:187 IU/mL, Anti thyroglobulin antibodies 235 IU/mL), but a pituitary gland MRI was normal. Thyroid US features going with Hashimoto thyroiditis. The patient's PCOS symptoms were initially managed with metformin and Duphaston, and then Cabergoline was introduced to address hyperprolactinemia. The patient became pregnant shortly following hyperprolactinemia medication. Prenatal screenings revealed elevated fasting glucose levels and gestational diabetes. The patient's blood sugar was initially controlled by Metformin, but she later required multiple insulin doses to maintain control. The patient was scheduled for induction of labor at 38 weeks, but a lower segment emergency cesarean surgery was performed due to fetal distress.
Conclusion: Regular monitoring and management of both PCOS and related conditions such as hypothyroidism and hyperprolactinemia are crucial to ensure the best outcome for the patient. Additionally, we suggest Metformin, Duphaston, Cabergoline to treat PCOS patient having subclinical hypothyroidism and hyperprolactinemia.
Keywords: Polycystic ovarian syndrome, subclinical hypothyroidism, hyperprolactinemia, gestational diabetes.
Downloads
References
2. Peddemul A, Tejovath S, Hassan D, K KP, Sikandar R, Kahlon SS, et al. Influence of Subclinical Hypothyroidism on Women With Polycystic Ovary Syndrome: A Literature Review. Cureus. 2022; 14(8):e28468. https://doi.org/10.7759/cureus.28468
3. Deswal R, Nanda S, Dang AS. Association of Luteinizing hormone and LH receptor gene polymorphism with susceptibility of Polycystic ovary syndrome. Systems Biology in Reproductive Medicine. 2019; 65(5):400-8. https://doi.org/10.1080/19396368.2019.1595217
4. Khattak M, Sultana N, Usman R, Khattak U, Zafar U, Salman H. Luteinizing hormone to follicle stimulating hormone ratio in patients with polycystic ovary syndrome. Journal of Ayub Medical College Abbottabad. 2020; 32(2):255-8.
5. Hsu M-I. Changes in the PCOS phenotype with age. Steroids. 2013; 78(8):761-6. https://doi.org/10.1016/j.steroids.2013.04.005
6. Zeng X, Xie Y-j, Liu Y-t, Long S-l, Mo Z-c. Polycystic ovarian syndrome: correlation between hyperandrogenism, insulin resistance and obesity. Clinica chimica acta. 2020; 502:214-21. https://doi.org/10.1016/j.cca.2019.11.003
7. Nayak PK, Mitra S, Sahoo J, Mahapatra E, Agrawal S, Lone Z. Relationship of subclinical hypothyroidism and obesity in polycystic ovarian syndrome patients. Journal of family medicine and primary care. 2020; 9(1):147. https://doi.org/10.4103/jfmpc.jfmpc_654_19
8. Fatima M, Amjad S, Ali Sr HS, Ahmed T, Khan S, Raza M, et al. Correlation of subclinical hypothyroidism with polycystic ovary syndrome (PCOS). Cureus. 2020; 12(5). https://doi.org/10.7759/cureus.8142
9. Bonakdaran S, Milani N, Mazloumkhorasani Z, Hosseinzadeh M, Kabiri M. Is There a Relation between Hypothyroidism and Polycystic Ovary Syndrome and its Metabolic Components? Current Diabetes Reviews. 2022. https://doi.org/10.2174/1573399818666220426090324
10. Kumar S, Kotur P. Effects of hypothyroidism in Indian women of reproductive age group-A review. Indian Journal of Obstetrics and Gynecology Research. 2020; 7(1):1-6. https://doi.org/10.18231/2394-2754.2019.0001
11. Thapa S, Bhusal K. Hyperprolactinemia. StatPearls [Internet]: StatPearls Publishing; 2021.
12. Delcour C, Robin G, Young J, Dewailly D. PCOS and Hyperprolactinemia: what do we know in 2019? Clinical Medicine Insights: Reproductive Health. 2019; 13:1179558119871921. https://doi.org/10.1177/1179558119871921
13. Aldahmani K, AlMalki M, Beshyah S. A rational approach to the evaluation and management of patients with hyperprolactinemia. Ibnosina Journal of Medicine and Biomedical Sciences. 2020; 12(02):90-7. https://doi.org/10.4103/ijmbs.ijmbs_38_20
14. Pekić S, Stojanoska MM, Popovic V. Hyperprolactinemia/prolactinomas in the postmenopausal period: challenges in diagnosis and management. Neuroendocrinology. 2019; 109(1):28-33. https://doi.org/10.1159/000494725
15. Michail M, Ioannis K, Charoula M, Alexandra T, Eleftheria H. Clinical manifestations, evaluation and management of hyperprolactinemia in adolescent and young girls: a brief review. Acta Bio Medica: Atenei Parmensis. 2019; 90(1):149.
16. Franks S, Hardy K. What causes anovulation in polycystic ovary syndrome? Current Opinion in Endocrine and Metabolic Research. 2020; 12:59-65. https://doi.org/10.1016/j.coemr.2020.03.001
17. Abinaya S, Siva D, Sabitha R, Achiraman S. An overview of hyperandrogenism in PCOS and the prospective underlying factors. Res J Life Sci Bioinform Pharmac Chem Sci. 2019; 1(5):179-86.
18. Ahtamovna ZZ. Secondary infertility in women of reproductive age with hypothyroidism. ACADEMICIA: An International Multidisciplinary Research Journal. 2022; 12(5):649-53. https://doi.org/10.5958/2249-7137.2022.00424.4
19. Hasegawa Y, Kitahara Y, Osuka S, Tsukui Y, Kobayashi M, Iwase A. Effect of hypothyroidism and thyroid autoimmunity on the ovarian reserve: A systematic review and meta‐analysis. Reproductive Medicine and Biology. 2022; 21(1):e12427. https://doi.org/10.1002/rmb2.12427
20. Ansari MS, Almalki MH. Primary hypothyroidism with markedly high prolactin. Frontiers in Endocrinology. 2016; 7:35. https://doi.org/10.3389/fendo.2016.00035
21. Gierach M, Bruska-Sikorska M, Rojek M, Junik R. Hyperprolactinemia and insulin resistance. Endokrynologia Polska. 2022. https://doi.org/10.5603/EP.a2022.0075
22. Saei Ghare Naz M, Mousavi M, Mahboobifard F, Niknam A, Ramezani Tehrani F. A Meta-Analysis of Observational Studies on Prolactin Levels in Women with Polycystic Ovary Syndrome. Diagnostics. 2022; 12(12):2924. https://doi.org/10.3390/diagnostics12122924
23. Filho RB, Domingues L, Naves L, Ferraz E, Alves A, Casulari LA. Polycystic ovary syndrome and hyperprolactinemia are distinct entities. Gynecol Endocrinol. 2007; 23(5):267-72. https://doi.org/10.1080/09513590701297708
24. Mills G, Badeghiesh A, Suarthana E, Baghlaf H, Dahan MH. Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies. Human Reproduction. 2020; 35(7):1666-74. https://doi.org/10.1093/humrep/deaa099
25. Meng J, Zhu Y. Efficacy of simvastatin plus metformin for polycystic ovary syndrome: A meta-analysis of randomized controlled trials. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021; 257:19-24. https://doi.org/10.1016/j.ejogrb.2020.11.070
26. Kim CH, Chon SJ, Lee SH. Effects of lifestyle modification in polycystic ovary syndrome compared to metformin only or metformin addition: a systematic review and meta-analysis. Scientific reports. 2020; 10(1):1-13. https://doi.org/10.1038/s41598-020-64776-w
27. Guan Y, Wang D, Bu H, Zhao T, Wang H. The effect of metformin on polycystic ovary syndrome in overweight women: a systematic review and meta-analysis of randomized controlled trials. International journal of endocrinology. 2020; 2020. https://doi.org/10.1155/2020/5150684
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
.