Polikistik over sendromunda anti-mullerian hormon ve vitamin D düzeylerinin değerlendirilmesi

Year 2020, Volume: 2 Issue: 1, 1 - 6, 30.03.2020

Senem Arda Düz , Görkem Tuncay , Abdullah Karaer

Abstract

Amaç: Bu çalışmanın amacı polikistik over sendromu (PKOS) ile serum anti-müllerian hormon (AMH) ve D vitamini düzeyleri arasında klinik açısından bir ilişki olup olmadığının araştırılmasıdır.
Gereç ve yöntem: Şubat 2016 ile Kasım 2016 tarihleri arasında 44 PKOS tanısı almış hasta ile normal menstrüel siklusları olan 44 hasta çalışmaya dahil edilmiştir. Hormonal parametreler, glukoz metabolizması parametreleri, klinik bulgu ve belirtiler, serum D vitamini ve AMH düzeyleri değerlendirilmiştir.
Bulgular: AMH düzeyleri, hirsutism skorları ve tokluk kan şekerleri iki grup arasında istatistiksel olarak anlamlı bir şekilde farklıydı. AMH ile luteinize edici hormon (LH)/folikül stimule edici hormon (FSH) oranı, insulin direnci homeostatik model değerlendirmesi (HOMA-IR), açlık kan şekeri ve hirsutizm skorları arasında pozitif korelasyon tespit edildi. PKOS grubunda serum AMH düzeyleri kontrol grubuna göre anlamlı olarak daha yüksek saptandı. Serum D vitamini seviyeleri her iki grupta düşük saptanmakla birlikte gruplar arasında D vitamin düzeyleri açısından fark yoktu.
Sonuç: Serum AMH seviyeleri ile LH/FSH oranı, hirsutism skoru, HOMA-IR ve açlık insulin düzeyleri arasında pozitif korelasyon bulunmuştur. Daha yüksek AMH seviyelerine sahip olan hastaların, PKOS olup da düşük AMH seviyesine sahip olanlara göre daha hiperandrojenik olduğu bulunmuştur. Bunların yanı sıra gruplar arasında, vitamin D düzeyleri açısından istatistiksel olarak anlamlı fark saptanmamıştır.

Keywords

anti-müllerian hormon, hisutizm, hiperandrojenizm, polikistik over sendromu, vitamin D

The determination of anti-mullerian hormone and vitamin D serum levels in polycystic ovary syndrome

Abstract

Aim: This study aimed to determine whether there is a relationship between serum anti-mullerian hormone (AMH) and vitamin D levels and the severity of polycystic ovary syndrome (PCOS).
Material and method: Forty-four women with PCOS and forty-four controls with regular ovulatory menstrual cycles were included in this study between February 2016 and November 2016. Hormonal parameters, glucose metabolism parameters, clinical signs, and symptoms and serum AMH and vitamin D levels were determined.
Results: AMH levels, hirsutism scores, and postprandial glucose levels were significantly different between the two groups. There were statistically significant positive correlations between AMH and luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio, homeostatic model assessment of insulin resistance (HOMA-IR), fasting glucose levels, and hirsutism scores. Serum AMH levels were significantly higher in women with PCOS compared to controls. The levels of vitamin D were found low in both groups, and there was no statistically significant difference between the two groups in vitamin D levels.
Conclusion: There were positive correlations between AMH levels and LH/FSH ratio, hirsutism scores, HOMA-IR, and the fasting insulin. The patients with higher AMH levels were more hyperandrogenic compared to patients with PCOS who have lower AMH levels. Nevertheless, there was no statistically significant difference between the two groups in vitamin D levels.

Keywords

anti-mullerian hormone, Hirsutism, Hyperandrogenism, Polycystic ovary syndrome, Vitamin D

References

• 1. Speroff L, Fritz MA. Clinical Gynecologic Endocrinology and Infertility, 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2005.
• 2. Wehr E, Pilz S, Schweighofer N, et al. Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome, Eur J Endocrinol 2009; 161:575-582.
• 3. Ahmad S. Prevalence of vitamin D deficiency in women with infertility due to polycystic ovary syndrome. RCOG World congress; 2013, June 24-26; Liverpool, UK. BJOG, 2013;120:208-209.
• 4. Li HW, Brereton RE, Anderson RA, Wallace AM, Ho CK. Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome. Metabolism 2011; 60:1475-1481.
• 5. Bhattacharya SM, Jha A. Association of vitamin D3 deficiency with clinical and biochemical parameters in Indian women with polycystic ovary syndrome. Int J Gynaecol Obstet 2013; 123:74-75.
• 6. Muscogiuri G, Mitri J, Mathieu C, et al. Mechanisms in endocrinology: vitamin D as a potential contributor in endocrine health and disease. Eur J Endocrinol 2014; 171:101-110.
• 7. Kotsa K, Yavropoulou MP, Anastasiou O, Yovos JG. Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome. Fertil Steril 2009; 92:1053-1058.
• 8. Selimoglu H, Duran C, Kiyici S, et al. The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome, J Endocrinol Invest 2010; 33:234-238.
• 9. Iliodromiti S, Kelsey TW, Anderson RA,  Nelson SM. Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab 2013; 98:3332-3340.
• 10. Dewailly D, Gronier H, Poncelet E, et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod 2011; 26:3123-3129.
• 11. Pigny P, Merlen E, Robert Y, et al. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab 2003; 88:5957-5962.
• 12. Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC. Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab 2004; 89:318-323.
• 13. Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D. Anti-Mullerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: Relationship with increased luteinizing hormone levels. Am J Physiol Endocrinol Metab 2009; 296: E238-243.
• 14. Cassar S, Teede HJ, Moran LJ, et al. Polycystic ovary syndrome and anti- Müllerian hormone: role of insulin resistance, androgens, obesity and gonadotrophins. Clin Endocrinol (oxf) 2014; 81:899-906.
• 15. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81:19-25.
• 16. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961; 21:1440–1447.
• 17. Wallace TM, Levy JC, Matthews DR. 2004. Use and abuse of HOMA modeling. Diabetes Care 2004; 27:1487–1495.
• 18. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357:266-281.
• 19. Vendola KA, Zhou J, Adesanya OO, Weil SJ, Bondy CA. Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest 1998; 101:2622-2629.
• 20. Kelsey TW, Wright P, Nelson SM, Anderson RA, Wallace WH. A validated model of serum anti-müllerian hormone from conception to menopause. PLoS One 2011;6:e22024.
• 21. La Marca A, Orvieto R, Giulini S, Jasonni VM, Volpe A, De Leo V. Mullerian-inhibiting substance in women with polycystic ovary syndrome: relationship with hormonal and metabolic characteristics. Fertil Steril 2004; 82:970-972.
• 22. Tokmak A, Kokanali D, Timur H, Kuntay Kokanali M, Yilmaz N. Association between anti-Mullerian hormone and insulin resistance in non-obese adolescent females with polycystic ovary syndrome. Gynecol Endocrinol 2016; 32:926-930.
• 23. Hahn S, Haselhorst U, Tan S, et al. Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2006; 114:577-583.
• 24. Lagunova Z, Porojnicu AC, Lindberg F, Hexeberg S, Moan J. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res 2009; 29:3713-3720.
• 25. Muscogiuri G, Policola C, Prioletta A, et al. Low levels of 25(OH)D and insulin-resistance: 2 unrelated features or a cause-effect in PCOS? Clin Nutr 2012; 31:476-480.
• 26. Teegarden D, Donkin SS. Vitamin D: emerging new roles in insulin sensitivity. Nutr Res Rev 2009; 22:82-92.
• 27. Glintborg D, Andersen M, Hagen C, Hermann AP. Higher bone mineral density in Caucasian, hirsute patients of reproductive age. Positive correlation of testosterone levels with bone mineral density in hirsutism. Clin Endocrinol (Oxf) 2005; 62:683-691.
• 28. Ardabili HR, Gargari BP, Farzadi L. Vitamin D supplementation has no effect on insulin resistance assessment in women with polycystic ovary syndrome and vitamin D deficiency. Nutr Res 2012; 32:195-201.