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Anthropometric biomarkers for abnormal prenatal reproductive hormone exposure in women with Mayer-Rokitanksy-Küster-Hauser syndrome, polycystic ovary syndrome, and endometriosis

      Objective

      To study whether markers of prenatal exposure to reproductive hormones are related to Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, polycystic ovary syndrome (PCOS), and endometriosis.

      Design

      Case-control study. Comparison of sex hormone-related external genital and digital characteristics in cases and controls.

      Setting

      University hospital.

      Patient(s)

      We enrolled 172 women in four groups—women with MKRH, women with PCOS, women with endometriosis, and controls (43 in each group).

      Intervention(s)

      Measurement of two anthropometric biomarkers: anogenital distance and digit ratio.

      Main Outcome Measure(s)

      Anogenital distance was measured from the anus to the anterior clitoral surface (AGDac) and from the anus to the posterior fourchette (AGDaf). For the digit ratio we used a direct, as well as a computer-assisted graphic measurement to measure the length of the second and fourth digit.

      Result(s)

      After adjustment for body mass index and age, AGDac was the shortest in endometriosis and the longest in PCOS groups, with a mean difference of 10 mm (95% confidence interval 3.1–16.8). AGDaf but not AGDac measures were found to be significantly larger in the MRKH group, with a mean difference compared with controls of 2.6 mm (95% confidence interval 0.1–5.2). The digit ratio was not significantly different between the groups.

      Conclusion(s)

      In this study we did find limited evidence for androgen exposure during the development of MRKH. This is compatible with the hypothesis that the uterovaginal agenesis may have been the result of temporary prenatal exposure to altered gonadal hormone concentrations. For endometriosis and PCOS we confirm previously observed associations for anogenital distance reflecting possible estrogen-based and androgen-based intrauterine origins, respectively.

      Dutch Trial Registration Number

      NTR7492.
      Biomarcadores antropométricos para la exposición hormonal prenatal anormal en mujeres con síndrome de Mayer-Rokitansky-Küster-Hauser, síndrome de ovarios poliquísticos y endometriosis.

      Objetivo

      Estudiar si los marcadores de exposición prenatal a hormonas reproductivas están relacionados con síndrome Mayer-Rokitansky-Küster-Hauser (MRKH), síndrome de ovarios poliquísticos (PCOS), y endometriosis.

      Diseño

      Estudio de casos y controles. Comparación de las características digitales y genitales externos relacionados con hormonas sexuales en casos y controles.

      Entorno

      Hospital universitario.

      Pacientes

      Incluimos 172 mujeres en cuatro grupos, con MKRH, con PCOS, con endometriosis y controles (43 por grupo).

      Intervención(es)

      Medición de dos biomarcadores antropométricos: distancia ano-genital y ratio digital.

      Principales medidas de resultado(s)

      Distancia ano-genital fue medida desde el ano hasta la superficie clitorídea anterior (AGDac) y desde el ano a la horquilla vulvar posterior (AGDaf). Para el ratio digital usamos una medición directa, así como una gráfica asistida por ordenador de la longitud del segundo y cuarto dedo.

      Resultados

      La AGDac ajustada por edad e índice de masa corporal fue más corta en el grupo de endometriosis y más larga en el de PCOS, con una diferencia media de 10 mm (Intervalo de confianza al 95% de 3.1 -16.8). La medición de AGDaf pero no la AGDac fue significativamente más larga en el grupo MRKH con una diferencia media comparada con los controles de 2.6 mm (Intervalo de confianza al 95% de 0.1-5.2). El ratio digital no fue significativamente diferente entre grupos.

      Conclusión (es)

      En este estudio encontramos evidencia limitada de la exposición a andrógenos durante el desarrollo de MRKH. Esto es compatible con la hipótesis que la agenesia útero-vaginal puede haber sido el resultado de una exposición prenatal a concentraciones hormonales gonadales alteradas. En caso de la endometriosis y el síndrome de ovario poliquístico confirmamos de forma retrospectiva las asociaciones previamente observadas que la distancia anogenital refleja posibles orígenes intrauterinos secundarios a la exposición de estrógenos y andrógenos.

      Número de registro de ensayos holandés

      NTR7492

      Palabras clave

      síndrome Mayer-Rokitansky-Küster-Hauser, distancia ano-genital, relación digital, síndrome de ovarios poliquísticos, endometriosis.

      Key Words

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