Cortisol and polycystic ovarian syndrome – a systematic search and meta-analysis of case–control studies

Abstract

Background

Polycystic ovarian syndrome (PCOS) has become an emerging disorder affecting women of reproductive age group. Its intricate presentation of signs and symptoms makes it a disease of interest to research. While there are varied hypotheses related to its cause and pathogenesis, role of stress in this disease is yet to be grounded. There is emerging body of evidence on cortisol and PCOS, although it is currently equivocal.

Methods

Medline, Embase, Pubmed, Science Direct, Google Scholar, and Scopus were searched from March 1985 to March 2020 using MeSH terms. After dual quality assessments and data abstraction, the final articles were included for meta-analysis.

Results

Forty-one studies qualified for the analysis. Pooled meta-analysis showed that the level of cortisol was significantly higher in PCOS when compared to healthy controls (standard mean difference [SMD] = 0.83, 95% confidence interval [CI] = 0.42–1.23) with highly significant heterogeneity (I² = 94%). Subgroup analysis done based on type of sample stated high effect size for blood cortisol levels (SMD = 0.9, 95%CI = 0.32; 1.51) compared to overall effect.

Conclusions

This systematic review and meta-analysis on cortisol and PCOS have helped in generating evidence regarding the role of cortisol in the pathogenesis of PCOS and the use of cortisol estimation as a potential stress marker in PCOS.

皮质醇和多囊卵巢综合征——病例对照研究的系统检索和荟萃分析 摘要

背景：多囊卵巢综合征(PCOS)已成为一种影响育龄期女性的新兴疾病。由于复杂的体征和症状使其成为一种值得研究的疾病。虽然对其病因和发病机制有不同的假说, 但应激在这种疾病中的作用尚不确定。关于皮质醇和PCOS的证据越来越多, 尽管目前仍不明确。

方法：检索从1985年3月至2020年3月的Medline、Embase、Pubmed、Science Direct、Google Scholar和Scopus。经过双重质量评估和数据提取后, 将最终筛选出来的文章进行荟萃分析。

结果：41项研究符合分析要求。综合荟萃分析显示, 与健康对照组相比, PCOS患者的皮质醇水平显著升高（标准平均差异[SMD]=0.83,95%置信区间[CI]=0.42–1.23), 异质性及其显著(I2=94%)。根据样本类型进行的亚组分析表明, 与总体效果相比, 血液中皮质醇水平具有高效应量(SMD=0.9,95%CI=0.32；1.51)。

结论：本文对皮质醇和PCOS的系统回顾和荟萃分析有助于证明皮质醇在PCOS发病机制中的作用, 并将皮质醇估计作为PCOS中的潜在应激标志物。

Keywords:

• Cortisol
• meta-analysis
• PCOS
• stress

Disclosure statement

The authors disclose no conflict of interest.

Additional information

Funding

This work was supported by the Indian Council of Medical Research.