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Obstetrics & Gynecology 2007;110:594-600
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Plasma Urocortin Levels in the Diagnosis of Ovarian Endometriosis

Pasquale Florio, MD, PhD1, Fernando M. Reis, MD, PhD2, Paulo B. Torres, PhD1, Francesco Calonaci, MD1, Paolo Toti, MD3, Caterina Bocchi, MD1, Elizabeth A. Linton, BSc4 and Felice Petraglia, MD1

From the 1Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Obstetrics and Gynecology, University of Siena, Siena, Italy; 2Department of Obstetrics and Gynecology, University of Minas Gerais, Belo Horizonte, Brazil; 3Department of Human Pathology and Oncology University of Siena, Siena, Italy; and 4Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.

OBJECTIVE: Urocortin is a neuropeptide, member of the corticotropin-releasing hormone family, that is produced by the human endometrium. Ovarian endometrioma is a prevalent gynecologic disorder still lacking specific serum markers. In the present study we measured systemic levels of urocortin to assess the diagnostic performance of its determination in distinguishing endometriomas from other benign ovarian cysts.

METHODS: Plasma urocortin was measured by radioimmunoassay in women with ovarian endometrioma (n=40) and in women with benign, nonendometriotic ovarian cysts (n=40). The diagnostic accuracy of urocortin measurement was evaluated by receiver operating characteristic curve and compared with the standard marker, CA 125. To support the local origin of the peptide, we also evaluated its localization in endometriomas by immunohistochemistry and its concentrations in cyst fluid and peritoneal fluid of 12 women with endometrioma.

RESULTS: Plasma urocortin levels were twice as high in women with endometrioma (median 49 pg/mL, interquartile range 41–63 pg/mL) than in the control group (19 [15–23] pg/mL, P<.001) and significantly higher in the cystic content of endometriomas than in the peritoneal fluid and plasma (P<.05). The peptide was immunolocalized in endometrioma glands and stromal capillary vessels. Elevated plasma urocortin levels detected 88% of the cases of endometrioma with 90% specificity, whereas CA 125 detected only 65% of the cases with the same specificity.

CONCLUSION: Plasma urocortin is increased in women with endometriomas, and its measurement may be useful for the differential diagnosis of endometrioma compared with other benign ovarian cysts.

LEVEL OF EVIDENCE: II






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