Clinical Chemistry
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Clinical Chemistry 52: 1209-1210, 2006; 10.1373/clinchem.2006.071076
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(Clinical Chemistry. 2006;52:1209-1210.)
© 2006 American Association for Clinical Chemistry, Inc.

Letters to the Editor

Association of Polycystic Ovary Syndrome and Fibromyalgia in a Patient with Primary Hyperparathyroidism: A Novel Triad? - Reply

Anargyros Kourtisa, David Rousso, Christos Balaris, Dimitrios Farmakiotis, Ilias Katsikis and Dimitrios Panidis

1 Division of Endocrinology, and Human Reproduction, Second Department of Obstetrics, and Gynecology, Aristotle University, of Thessaloniki, Thessaloniki, Greece

aAddress correspondence to this author at: Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 49 Konstantinoupoleos, 54642 Thessaloniki, Greece.


To the Editor:

We read the letter to the editor by Ashish A. Sule and Melvin K. Shing Leow with much interest, and we thank the authors for addressing some important issues. They describe a 40-year-old woman who presented with generalized worsening body aches over a period of 9 months that incapacitated her independent baseline functional status. This woman had polycystic ovary syndrome (PCOS) diagnosed several years earlier in a women’s infirmary when she presented with oligomenorrhea, hirsutism, obesity, and polycystic ovaries.

First, we recognize that we indeed mentioned in our report (1) (a) a positive correlation between parathyroid hormone (PTH) and testosterone concentrations independent of age and body mass index, and (b) higher PTH concentrations in patients with PCOS than in controls. It is possible, therefore, that increased PTH in PCOS is related to the associated hyperandrogenism, one of the critical traits of the syndrome. The results of our study are in agreement with previous data (2), supporting an association of increased PTH concentrations with obesity. Moreover, our findings indicate, for the first time, that PTH probably is also linked to PCOS-associated hyperandrogenism.

Sule and Leow take our hypothesis a step further, correlating PCOS syndrome with primary hyperparathyroidism. Although this is an interesting approach that runs along the lines of our data, it must be mentioned that in our study, in which a statistically sufficient number of persons were involved, no cases of primary hyperparathyroidism were observed and the PTH concentrations were well within the reference interval.

Regarding the hypothesized relationship between PCOS and fibromyalgia, although it sounds interesting, we believe that there are still not sufficient data to support it. An interesting area for further investigation would be the relationship between PCOS and other endocrinopathies. Indeed, apart from the possible association with primary hyperparathyroidism, diseases of the thyroid gland (3) or defects in adrenal steroidogenesis are observed at higher frequencies in women with PCOS (4). The involvement of other endocrine glands in this enigmatic entity remains to be further investigated.


Footnotes

Some of the authors of the article cited above respond:


References

  1. Panidis D, Balaris C, Farmakiotis D, Rousso D, Kourtis A, Balaris V, et al. Serum parathyroid hormone concentrations are increased in women with polycystic ovary syndrome. Clin Chem 2005;51:1691-1697.[Abstract/Free Full Text]
  2. Thys-Jacobs S, Donovan D, Papadopoulos A, Sarrel P, Bilezikian JP. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999;6:430-435.[CrossRef]
  3. Janssen OE, Mehlmauer N, Hahn S, Offner AH, Gartner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol 2004;150:363-369.[Abstract]
  4. Glintborg D, Hermann AP, Brusgaard K, Hangaard J, Hagen C, Andersen M. Significantly higher adrenocorticotropin-stimulated cortisol and 17-hydroxyprogesterone levels in 337 consecutive, premenopausal, Caucasian, hirsute patients compared with healthy controls. J Clin Endocrinol Metab 2005;90:1347-1353.[Abstract/Free Full Text]




This Article
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