Mehmet AĞAR, Murat ÖNAL, Halime ÇALI ÖZTÜRK

Evaluation of the relationship between insulin resistance and different phenotypes of polycystic ovary syndrome

Amaç: Polikistik over sendromu (PKOS) kadınlarda sık görülen bir endokrin bozukluktur. Hiperinsülinemi ve insülin direnci (IR), bu hastaları etkileyen en önemli metabolik anormalliklerdir. Bu çalışma, farklı PKOS fenotiplerine sahip hastalarda IR ile ilişkili değişkenleri araştırmayı amaçladı. Yöntemler: Bu retrospektif çalışmaya, Kasım 2020-Eylül 2022 tarihleri arasında XXXXXXXXXXXX hastanesinde PKOS tanısı alan 389 kadın dahil edildi. Hastalara ait bilgiler elektronik kayıtlarından toplandı. PKOS, Rotterdam kriterlerine göre teşhis edildi ve PKOS için dört fenotip dikkate alındı. İnsülin direnci için homeostatik model değerlendirmesi (HOMA-IR), IR'yi değerlendirmek için kullanıldı. Gruplar arasındaki farkı incelemek için Mann-Whitney U testi yapıldı. Bulgular: HOMA-IR'nin en yüksek değeri fenotip B grubu için, en düşük değeri fenotip C grubu içindi. Ancak gruplar arasındaki fark anlamlı değildi (p=0,221). Estradiol ve serbest T4 fenotip A grubunda anlamlı olarak yüksekti (p≤0.001). Tiroid uyarıcı hormon (TSH), prolaktin, anti-müllerian hormon (AMH), açlık insülini, total testosteron ve alyuvar dağılım genişliği (RDW) fenotip B grubunda anlamlı olarak yüksekti (p≤ 0.001). Toplam kolesterol, yüksek yoğunluklu lipoprotein (HDL), lökosit, bazofil ve monosit fenotip C grubunda anlamlı olarak yüksekti (p≤ 0.001). Ayrıca fenotip D grubunda MPV değerleri anlamlı olarak yüksekti (p≤ 0,001). Sonuç: Sonuçlar PKOS fenotip A ve B'de IR ile ilişkili değişkenlerin diğer fenotiplere göre daha yüksek olduğunu göstermiştir. Anahtar Kelimeler: Polikistik Over Sendromu, insülin direnci, HOMA-IR, RDW

Anahtar Kelimeler:

Polycystic Ovary Syndrome, insulin resistance, HOMA-IR, RDW

Evaluation of the relationship between insulin resistance and different phenotypes of polycystic ovary syndrome

Aims: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women. Hyperinsulinemia and insulin resistance (IR) are the most important metabolic abnormalities that affect these patients. This study aimed to investigate the variables related to IR in patients with different PCOS phenotypes. Methods: This retrospective study included 389 women diagnosed with PCOS in Bezmialem Hospital between november 2020 and september 2022. Information about patients was collected through their electronic records. PCOS was diagnosed based on the Rotterdam criteria, and four phenotypes of A (oligoovulation+ hyperandrogenism+PCO), B (oligoovulation+hyperandrogenism), C (hyperandrogenism +PCO), and D (oligoovulation+absent PCO) were considered for PCOS. The homeostatic model assessment for ınsulin resistance (HOMA-IR) was used to evaluate IR. The Mann-Whitney U test was performed to study the difference between the groups. Results: The highest value of HOMA-IR was for the phenotype B group, and the lowest value was for the phenotype C group. However, the difference between the groups was not significant (p=0.221). Estradiol and free T4 were significantly higher in the phenotype A group (p≤0.001). Thyroid-stimulating hormone (TSH), prolactin, anti-mullerian hormone (AMH), fasting insulin, total testosterone, and red blood cell distribution width (RDW) were significantly higher in the phenotype B group (p≤0.001). Total cholesterol, high density lipoprotein (HDL), leukocyte, basophil, and monocyte were significantly higher in the phenotype C group (p≤0.001). Also, MPV values were significantly higher in the phenotype D group (p≤0.001). Conclusion: The results showed that the variables related to IR in phenotypes A and B of PCOS are higher than in other phenotypes.

Keywords:

Polycystic ovary syndrome, insulin resistance, HOMA-IR, RDW,

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Alanya Tosun Ş, Gurbuz T, Cebi A, Tosun A, Gokmen O, Usta M. Association of increased levels of omentin-1 and carotid intima-media thickness with early signs of cardiovascular risk in patients with polycystic ovary syndrome: a prospective case control study. J Obstet Gynaecol Res. 2022;48(1):169-177. doi:10.1111/jog.15077
Dokuzeylül Güngör N, Güngör K, Yurci A, Cil K, Hatırnaz Ş. Ovarian drilling down-regulates endometrial nuclear factor-κB p65 expression in women with PCOS: a prospective case-control study. Turk J Obstet Gynecol. 2022;19(1):45-50. doi:10.4274/tjod.galenos.2022.44845
Dokuzeylül Güngör N, Güngör K. Ovarian stimulation drugs alter the metabolite content of the growing follicle: in vivo spectroscopic evaluation of follicle fluid. J Turk Ger Gynecol Assoc. 2021;22(2):132-138. doi:10.4274/jtgga.galenos.2020.2020.0104
Gungor ND, Gurbuz T, Onal M. Comparison of complication rates after transvaginal ultrasound-guided oocyte pick-up procedures with respect to ovarian response. Clin Exp Reprod Med. 2022;49(2):142-148. doi:10.5653/cerm.2021.04875
Gürbüz T, Gökmen O, Güngör ND. Polikistik over sendromu bulunan kadınlarda glikoz potasyum oranının tanısal değerinin insülin ile karşılaştırılması. Cukurova Med J 2021; 46: 381-386. doi: 10.17826/cumj.782931
Gürbüz T, Dokuzeylül Güngör N, Yurci A. Does intracytoplasmic sperm injection increase the risk of gestational diabetes in patients with polycystic over? Anatolian Curr Med J. 2021;3:53-58. doi:10.38053/acmj.837292
Gurbuz T, Alanya Tosun S, Cebi A, Gokmen O, Usta M. Investigating fetuin-a and paraoxonase-1 activity as markers in polycystic ovary syndrome based on body mass index: a prospective case-control study. Cureus. 2021;13(10):e18553. doi:10.7759/cureus.18553
Hatirnaz E, Hatirnaz S, Kanat-Pektas M. The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation. J Obstet Gynaecol Res. 2021;47:2684-91. doi: 10.1111/jog.14858
Yurci A, Dokuzeylül Güngör N, Güngör K, Hatırnaz Ş. Correlation of serum leptin and ghrelin levels with endocrine and reproductive parameters in women with clomiphene citrate resistant polycystic ovary syndrome. Turk J Obstet Gynecol. 2022;19(2):124-129. doi:10.4274/tjod.galenos.2022.84883
Subramaniam K, Tripathi A, Dabadghao P. Familial clustering of metabolic phenotype in brothers of women with polycystic ovary syndrome. Gynecol Endocrinol. 2019;35(7):601-603. doi:10.1080/09513590.2019.1566451
Wang X, Xu T, Liu R, et al. High-fiber diet or combined with acarbose alleviates heterogeneous phenotypes of polycystic ovary syndrome by regulating gut microbiota. Front Endocrinol (Lausanne). 2022;12:806331. doi:10.3389/fendo.2021.806331
Shirazi FKH, Khodamoradi Z, Jeddi M. Insulin resistance and high molecular weight adiponectin in obese and non-obese patients with polycystic ovarian syndrome (PCOS). BMC Endocr Disord. 2021;21(1):45. doi:10.1186/s12902-021-00710-z
Yang YL, Zhou WW, Wu S, et al. Intestinal flora is a key factor in insulin resistance and contributes to the development of polycystic ovary syndrome. Endocrinology. 2021;162(10):bqab118. doi:10.1210/endocr/bqab118
Eftekhar M, Mirhashemi ES, Molaei B, Pourmasumi S. Is there any association between vitamin D levels and polycystic ovary syndrome (PCOS) phenotypes?. Arch Endocrinol Metab. 2020;64(1):11-16. doi:10.20945/2359-3997000000177
Cutler DA, Pride SM, Cheung AP. Low intakes of dietary fiber and magnesium are associated with insulin resistance and hyperandrogenism in polycystic ovary syndrome: a cohort study. Food Sci Nutr. 2019;7(4):1426-1437. doi:10.1002/fsn3.977
De Diego MV, Gómez-Pardo O, Groar JK, et al. Metabolic impact of current therapeutic strategies in polycystic ovary syndrome: a preliminary study. Arch Gynecol Obstet. 2020;302(5):1169-1179. doi:10.1007/s00404-020-05696-y
Krentowska A, Kowalska I. Metabolic syndrome and its components in different phenotypes of polycystic ovary syndrome. Diabetes Metab Res Rev. 2022;38(1):e3464. doi:10.1002/dmrr.3464
Krentowska A, Łebkowska A, Jacewicz-Święcka M, et al. Metabolic syndrome and the risk of cardiovascular complications in young patients with different phenotypes of polycystic ovary syndrome. Endocrine. 2021;72(2):400-410. doi:10.1007/s12020-020-02596-8
Wang R, Gu Z, Wang Y, et al. A “one stop shop” decision tree for diagnosing and phenotyping polycystic ovarian syndrome on serum metabolic fingerprints. Adv Funct Mater 2022;32:220-230. doi: 10.1002/adfm.202206670
Kim JJ, Choi YM. Phenotype and genotype of polycystic ovary syndrome in Asia: ethnic differences. J Obstet Gynaecol Res. 2019;45(12):2330-2337. doi:10.1111/jog.14132
Mumusoglu S, Yildiz B. Polycystic ovary syndrome phenotypes and prevalence: differential impact of diagnostic criteria and clinical versus unselected population. Curr Opin Endocr Metab Rese. 2020;12:66-71. doi:10.1016/j.coemr.2020.03.004
Bjekić-Macut J, Vukašin T, Velija-Ašimi Z, et al. Polycystic ovary syndrome: a contemporary clinical approach. Curr Pharm Des. 2021;27(36):3812-3820. doi:10.2174/1381612827666210119104721
Tavares A, Rêgo Barros RC. The prevalence of metabolic syndrome in the different phenotypes of polycystic ovarian syndrome. a prevalência da síndrome metabólica nos diferentes fenótipos da síndrome do ovário policístico. Rev Bras Ginecol Obstet. 2019;41(1):37-43. doi:10.1055/s-0038-1676568