Androgen excess disorders in women : polycystic ovary by Ricardo Azziz

By Ricardo Azziz

The sphere of androgen extra issues has complicated considerably because the unique booklet of this publication. The Androgen extra Society (AES) used to be based to assemble investigators within the box. a greater knowing of the screening, development, and molecular genetics of nonclassic adrenal hyperplasia (NCAH) has more suitable the scientific care and diagnostic accuracy of those sufferers. New standards for the analysis of the polycystic ovary syndrome (PCOS) have been proposed in Rotterdam, standards that experience ended in controversy and, optimistically, initiation of latest reports. The organization of insulin resistance with PCOS has been bolstered, and the position of metformin in tre- ing the infertility of the PCOS has been established. hazards for diabetes and, extra cont- versially, heart problems in girls with PCOS have bought enormous research. Our realizing of the epidemiology and monetary effect of those issues has improved, emphasizing their serious significance. those are yet a couple of highlights of the way the terrain has replaced in a comparatively short time period. according to those advances, the name of this publication has been revised to mirror the becoming value of PCOS because the so much known androgen extra illness in ladies, and arguably, because the one who may have the main severe antagonistic outcomes for normal overall healthiness. There are fewer chapters to supply a extra concentrated elucidation of the realm. a number of chapters have been penned through new (and younger) authors who're accomplishing state of the art learn within the box.

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DNA 1987;6:439–448. 28. Wang M, Roberts DL, Paschke R, Shea TM, Masters BSS, Kim JP. Three-dimensional structure of NADPH-cytochrome P450 reductase: Prototype for FMN-and FAD-containing enzymes. Proc Natl Acad Sci USA 1997;94:8411–8416. 29. Zhang L, Rodriguez H, Ohno S, Miller WL. Serine phosphorylation of human P450c17 increases 17,20-lyase activity: Implications for adrenarche and for the polycystic ovary syndrome. Proc Natl Acad Sci USA 1995;92:10619–10623. 30. Pandey AV, Miller WL. Regulation of 17,20-lyase activity by cytochrome b5 and by serine phosphorylation of P450c17.

3. 1. In the Ovary Ovarian theca and granulosa cells in individual follicular units synthesize both androgens and estrogens. The steroidogenic enzymes expressed in the theca or granulosa cells vary with the menstrual cycle (64). In the follicular phase, theca cells express StAR, P450scc, 3E-HSD-II, and P450c17 to produce androstenedione, some of which is converted to testosterone by 17E-HSD-V. Most thecal steroids diffuse to the granulosa cell, but some are secreted into the circulation. Rising thecal androstenedione production during the follicular phase plus increased expression of 17E-HSD-I and P450aro in the granulosa cells results in abundant estradiol production by the preovulatory follicle.

Although ablation of POR in mice results in embryonic lethality, numerous patients have been described as having POR mutations (36–40). Most of these patients came to medical attention because they had a severe skeletal malformation disorder termed Antley–Bixler syndrome in addition to having disordered adrenal and gonadal steroidogenesis with a pattern suggesting combined deficiencies of P450c17, P450c21, and P450aro. Careful analysis of the enzymology of all known mutants shows that all affect P450c17, with some affecting the 17,20-lyase activity to a greater degree than 17Dhydroxylase activity (40).

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