Hasan SÜT, Cem TERECE, Sevcan Arzu ARINKAN, Murat MUHCU

Obez Olan ve Olmayan Polikistik Over Sendromlu Kadınlarda İnsulin Rezistansı ve İnsulin Rezistansının Hormonel Parametrelerle Korelasyonu

Amaç: Obez olan ve olmayan polikistik over sendromlu (PKOS) kadınlarda insulin rezistansı ve insulin rezistansının hormonel parametrelerle korelasyonunu araştırmayı amaçladık. Gereçler ve Yöntem: Polikliniğe başvuran, 21 ile 40 yaşları arasında klinik ve endokrinolojik özelliklerine dayanılarak PKOS tanısı konulan ve çalışma şartlarını sağlayan 78 hasta çalışmaya dahil edildi. PKOS tanısı Rotterdam yeniden gözden geçirilmiş tanı kriterlerine göre konuldu. Hastalar, obez olan lar (Vücut Kitle İndeksi 25 üzerinde olanlar) ve Obez olmayan lar (Vücut Kitle İndeksi 25 altında olanlar) olarak iki grupta incelendi. Bulgular: Obez olan grupta bakılan QUİCKİ ve Açlık glukoz / Açlık insulin düzeyleri anlamlı düsük, HOMA-İR anlamlı olarak yüksek saptandı. Obez olan grupta LH düzeyi ve LH / FSH oranının HOMA-IR ve QUİCKİ ile korele olduğu sap tandı. Obez olmayan grupta LH / FSH oranının HOMA-IR ve QUİCKİ ile korele olduğu ve yine obez olmayan grupta total testosteron düzeyinin QUİCKİ ile korele olduğu saptandı. FSH düzeyinin insulin rezistansı ile korele olmadığı görüldü. Sonuç: PKOS lu tüm hastaların insülin rezistansı açısından taranmasını önermekteyiz. Obez olan PKOS lu hastalarda LH düzeyinin insulin rezistansını öngörmede önemli olabileceğini düşünmekteyiz.

Correlation of Insulin Resistance with Hormonal Parameters in Polycystic Ovary Sydrom Patients Regarding to Obesity

Objective: The aim of our study was to investigate the corre lation between insulin resistance and hormonal parameters of insulin resistance on the non-obese and obese patients with polycystic ovary syndrome (PCOS). Material and Methods: 78 women patient with age range 21 to 40 diagnosed with PCOS based on the clinical and endoc rine features were included to our study. PCOS was diagnosed according to the reviewed Rotterdam criteria. PCOS patients were studied in two groups: Obese patients (the patients that body mass indexes over 25) non-obese patients (the patients that body mass indexes under 25). Results: It has been detected, fasting insulin, total testosterone and HbA1c levels were significantly higher and also HDL level was significantly lower in the obese group. Besides, QUICKI and fasting glucose / fasting insulin level have been detected significantly low, HOMA-IR was significantly higher in the obese group. In the non-obese group LH / FSH ratio is correlated with HOMA-IR and QUICKI and also total testosterone levels are correlated with QUICKI. Besides, it has been noted that the insulin resistance is not correlated with FSH level. PCOS pa tients Impaired glucose tolerance and the prevalence of DM are 5 times greater than the general population. PCOS is seen more frequently in type 2 DM patients. Conclusion: We suggest insulin resistance screening in all PCOS patients. However, if this is not possible, at least all pa tients that VKI levels over 25, should be screened. We think that, LH level in obese patients with PCOS is important to pre dict the insulin resistance.

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1. Orio Jr F, Palomba S, Cascella T, De Simone B, Di Biase S, Russo T, Labella D, Zullo F, Lombardi G, Colao A. Early impairment of endothelial structure and function in young normal-weight women with polycystic ovary syndrome. The Journal of Clinical Endocrino logy & Metabolism. 2004;89 (9):4588-93.
2. Sperof L, Fritz MA. Clinical gynecologic endocrinology and infertility: Lippincott Williams & Wilkins; 2005.
3. Ovesen P, Moller JE, Ingerslev HJ, Jørgensen JO, Mengel A, Schmitz O, Alberti KG, Moller N. Normal basal and insulin-sti - mulated fuel metabolism in lean women with the polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. 1993;77 (6):1636-40.
4. Kirschner MA, Samojlik E, Drejka M, Szmal E, Schneider G, Ertel N. Androgen-estrogen metabolism in women with upper body versus lower body obesity. The Journal of Clinical Endocrinology & Metabolism. 1990;70 (2):473-9.
5. Adams J, Polson DW, Franks S. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed). 1986;293 (6543):355-9.
6. Kidson W. Polycystic ovary syndrome: a new direction in tre atment. The Medical Journal of Australia. 1998;169 (10):537-40.
7. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with poly - cystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. 1998;83 (8):2694-8.
8. Hatun Ş. Cocukluk çağında obezite ve insülin rezistansı. Turkjem 2003;7 (2):23-6.
9. Georgopoulos NA, Saltamavros AD, Vervita V, Karkoulias K, Adonakis G, Decavalas G, Kourounis G, Markou KB, Kyriazopou lou V. Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associ - ated with insulin resistance. Fertility and sterility. 2009;92 (1):250- 5.
10. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Im perial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes care. 1999;22 (1):141-6.
11. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glu cose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affcted women. The journal of clinical endocrino logy & metabolism. 1999;84 (1):165-9.
12. Peppard HR, Marfori J, Iuorno MJ, Nestler JE. Prevalence of polycystic ovary syndrome among premenopausal women with type 2 diabetes. Diabetes care. 2001;24 (6):1050-2.
13. Gokcel A, Baltali M, Tarim E, Bagis T, Gumurdulu Y, Karakose H, Yalcin F, Akbaba M, Guvener N. Detection of insulin resistance in Turkish adults: a hospital‐based study. Diabetes, Obesity and Metabolism. 2003;5 (2):126-30.
14. Stenchever MA, Macintyre MN, Jarvis JA, Hempel JM. Cy - togenetic evaluation of 41 patients with Stein-Leventhal syndrome. Obstetrics & Gynecology. 1968;32 (6):794-801.
15. Şimşir C, Koçak M, Çalişkan E, Yalvaç S, Turan H, Haberal A. Polikistik Over Sendromu Olgularında Metformin Tedavisinin Hiperandrojenizm veİnsülin Rezistansına Etkisi. Turkiye Klinikleri Journal of Gynecology and Obstetrics. 2002;12 (2):134-8.
16. Alkan N. Polikistik Over Sendromlu Kadınlarda Kan CRP, Homosistein Düzeyleri, Obezite ve insülin Rezitansı Arasındaki iliş - kinin Araştırılması. Uzmanlık Tezi, Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi. 2006;2:5-45.
17. Hřbí̌k J, Janout V, Malinč́ova J, Horáova D, Č́̌k L. Detection of insulin resistance by simple quantitative insulin sen sitivity check index QUICKI for epidemiological assessment and prevention. The Journal of Clinical Endocrinology & Metabolism. 2002 Jan 1;87 (1):144-.
18. Bagis HT, Hacıvelioğlu S, Haydardedeoğlu B, Şimşek E, Çok T, Parlakgümüş A, Poçan G. Prevalance Of Insulın Resıstance, Im paired Glucose Tolerans Test And Diabetes Mellitus In Women With Polcystic Ovary Syndrome; Analysis Of 235 Patients.
19. Shoupe D, Lobo RA. The inflence of androgens on insulin resis tance. Fertility and sterility. 1984;41 (3):385-8.
20. Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. The Journal of Clinical Endocrinology & Metabolism. 1980;50 (1):113- 6.