Polikistik over sendromu (PKOS) obezite, hiperinsülinemi, dislipidemi ve kronik düşük dereceli inflamasyonla ilişkili kronik ve heterojen bir hastalıktır. Adipsin çoğunlukla yağ dokusundan salgılanan bir proteindir ve alternatif tamamlayıcı sistemin hız sınırlayıcı enzimi olan tamamlayıcı faktör D'nin yapısal bir homologudur. Bu çalışmanın amacı PCOS'lu ergenlerde adipsin seviyelerini ve obezite ile ilişkisini araştırmaktır. Çalışmamıza 40 normal kilolu PCOS'lu çocuk ve 40 obez PCOS'lu çocuk ve 40 normal kilolu sağlıklı çocuk katıldı. Her bir gruptaki ergenlerin adipsin seviyeleri sabah açlık kan örneklerinde ticari bir ELISA kiti ile ölçüldü. Adipsin seviyeleri gruplar arasında istatistiksel olarak anlamlı farklılıklar gösterdi (p<0,001). Normal kilolu PCOS'lu ergenlerin adipsin seviyeleri hem obez PCOS'lu hem de sağlıklı kontrollerden daha yüksekti. PCOS grubunda adipsin seviyeleri ile VKİ arasında negatif bir korelasyon gözlendi (r=-0,457, p<0,001). Sonuç olarak adipsinin normal kilolu PKOS'lu ergenlerde bağımsız bir risk faktörü olarak değerlendirilebileceği ve diğer semptomları olan normal kilolu çocuklarda PKOS tanısının konulmasında yardımcı olabileceği düşünülebilir.
Gazi University Research Fund (Project No: TDK-2023-8311)
References
Burgert, T. P. (2024). PCOS and common androgen abnormalities in adolescents. N. K. Tyson, NASPAG Essentials of Pediatric & Adolescent Gynecology (s. 190-204). Elsevier.
Butler, A. E., Moin, A. S. M., Sathyapalan, T., & Atkin, S. L. (2022). Components of the Complement Cascade Differ in Polycystic Ovary Syndrome. International Journal of Molecular Sciences, 23(20), 12232. https://doi.org/10.3390/ijms232012232
Byeon, H. J., Chae, M. K., Ko, J., Lee, E. J., Kikkawa, D. O., Jang, S. Y., & Yoon, J. S. (2023). The Role of Adipsin, Complement Factor D, in the Pathogenesis of Graves' Orbitopathy. Investigative ophthalmology & visual science, 64(11), 13. https://doi.org/10.1167/iovs.64.11.13
Chang, K. J., Chen, J. H., & Chen, K. H. (2024). The Pathophysiological Mechanism and Clinical Treatment of Polycystic Ovary Syndrome: A Molecular and Cellular Review of the Literature. International journal of molecular sciences, 25(16), 9037. https://doi.org/10.3390/ijms25169037
Chedraui, P., Pérez-López, F. R., Escobar, G. S., Palla, G., Montt-Guevara, M., Cecchi, E., Genazzani, A. R., Simoncini, T., & Research Group for the Omega Women's Health Project (2014). Circulating leptin, resistin, adiponectin, visfatin, adipsin and ghrelin levels and insulin resistance in postmenopausal women with and without the metabolic syndrome. Maturitas, 79(1), 86–90. https://doi.org/10.1016/j.maturitas.2014.06.008
Cook, K. G. (1985). A developmentally regulated mRNA from 3T3 adipocytes encodes a novel serine protease homologue. Proceedings of the National Academy of Sciences of the United States of America, , Oct;82(19):6480-4.
Cook, K. S., Min, H. Y., Johnson, D., Chaplinsky, R. J., Flier, J. S., Hunt, C. R., & Spiegelman, B. M. (1987). Adipsin: a circulating serine protease homolog secreted by adipose tissue and sciatic nerve. Science (New York, N.Y.), 237(4813), 402–405. https://doi.org/10.1126/science.3299705
Dare, A., & Chen, S. Y. (2024). Adipsin in the pathogenesis of cardiovascular diseases. Vascular pharmacology, 154, 107270. https://doi.org/10.1016/j.vph.2023.107270
Duleba, A. J., & Dokras, A. (2012). Is PCOS an inflammatory process ?. Fertility and sterility, 97(1), 7–12. https://doi.org/10.1016/j.fertnstert.2011.11.023
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015). Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocrine reviews, 36(5), 487–525. https://doi.org/10.1210/er.2015-1018
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015). Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocrine reviews, 36(5), 487–525. https://doi.org/10.1210/er.2015-1018
Flegal, K. M., Wei, R., Ogden, C. L., Freedman, D. S., Johnson, C. L., & Curtin, L. R. (2009). Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. The American journal of clinical nutrition, 90(5), 1314–1320. https://doi.org/10.3945/ajcn.2009.28335
Flier, J. S., Cook, K. S., Usher, P., & Spiegelman, B. M. (1987). Severely impaired adipsin expression in genetic and acquired obesity. Science (New York, N.Y.), 237(4813), 405–408. https://doi.org/10.1126/science.3299706
Gulati, A. K., Kaplan, D. W., & Daniels, S. R. (2012). Clinical tracking of severely obese children: a new growth chart. Pediatrics, 130(6), 1136–1140. https://doi.org/10.1542/peds.2012-0596
Gürsoy Calan, O., Calan, M., Yesil Senses, P., Unal Kocabas, G., Ozden, E., Sari, K. R., Kocar, M., Imamoglu, C., Senses, Y. M., Bozkaya, G., & Bilgir, O. (2016). Increased adipsin is associated with carotid intima media thickness and metabolic disturbances in polycystic ovary syndrome. Clinical endocrinology, 85(6), 910–917. https://doi.org/10.1111/cen.13157
Hertle, E., van Greevenbroek, M. M., & Stehouwer, C. D. (2012). Complement C3: an emerging risk factor in cardiometabolic disease. Diabetologia, 55(4), 881–884. https://doi.org/10.1007/s00125-012-2462-z
Ibáñez, L., Oberfield, S. E., Witchel, S., Auchus, R. J., Chang, R. J., Codner, E., Dabadghao, P., Darendeliler, F., Elbarbary, N. S., Gambineri, A., Garcia Rudaz, C., Hoeger, K. M., López-Bermejo, A., Ong, K., Peña, A. S., Reinehr, T., Santoro, N., Tena-Sempere, M., Tao, R., Yildiz, B. O., … Lee, P. A. (2017). An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Hormone research in paediatrics, 88(6), 371–395. https://doi.org/10.1159/000479371
Ibáñez, L., & de Zegher, F. (2023). Adolescent PCOS: a postpubertal central obesity syndrome. Trends in molecular medicine, 29(5), 354–363. https://doi.org/10.1016/j.molmed.2023.02.006
Kelly, A. S., Barlow, S. E., Rao, G., Inge, T. H., Hayman, L. L., Steinberger, J., Urbina, E. M., Ewing, L. J., Daniels, S. R., & American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology (2013). Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation, 128(15),1689-1712 .https://doi.org/10.1161/CIR.0b013e3182a5cfb3
Lo, J. C., Ljubicic, S., Leibiger, B., Kern, M., Leibiger, I. B., Moede, T., Kelly, M. E., Chatterjee Bhowmick, D., Murano, I., Cohen, P., Banks, A. S., Khandekar, M. J., Dietrich, A., Flier, J. S., Cinti, S., Blüher, M., Danial, N. N., Berggren, P. O., & Spiegelman, B. M. (2014). Adipsin is an adipokine that improves β cell function in diabetes. Cell, 158(1), 41–53. https://doi.org/10.1016/j.cell.2014.06.005
Milek, M., Moulla, Y., Kern, M., Stroh, C., Dietrich, A., Schön, M. R., Gärtner, D., Lohmann, T., Dressler, M., Kovacs, P., Stumvoll, M., Blüher, M., & Guiu-Jurado, E. (2022). Adipsin Serum Concentrations and Adipose Tissue Expression in People with Obesity and Type 2 Diabetes. International journal of molecular sciences, 23(4), 2222. https://doi.org/10.3390/ijms23042222
Neyzi, O., Bundak, R., Gökçay, G., Günöz, H., Furman, A., Darendeliler, F., & Baş, F. (2015). Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. Journal of clinical research in pediatric endocrinology, 7(4), 280–293. https://doi.org/10.4274/jcrpe.2183
Patel, S. (2018). Polycystic Ovary Syndrome (PCOS), an Inflammatory, Systemic, Lifestyle Endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology , 182, 27-36.
Saleh, F. L., Starkman, H., Furness, A., Pfeifer, S. M., & Kives, S. (2024). Polycystic Ovary Syndrome in Adolescents. Obstetrics and gynecology clinics of North America, 51(4), 679–693. https://doi.org/10.1016/j.ogc.2024.08.005
Salhah, H., Bonny, A., Benedict, J., & Nahata, L. (2024). Fertility Perspectives and Concerns in Adolescents With PCOS Compared to Controls. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 75(5), 836–841. https://doi.org/10.1016/j.jadohealth.2024.06.021
Scherer P. E. (2019). The many secret lives of adipocytes: implications for diabetes. Diabetologia, 62(2), 223–232. https://doi.org/10.1007/s00125-018-4777-x
Siddiqui, S., Mateen, S., Ahmad, R., & Moin, S. (2022). A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS). Journal of assisted reproduction and genetics, 39(11), 2439–2473.https://doi.org/10.1007/s10815-022-02625-7
Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of Obesity and Severe Obesity in US Children, 1999-2016. Pediatrics, 141(3), e20173459. https://doi.org/10.1542/peds.2017-3459
Tanılır Çağıran, F., Kali, Z. (2024). Serum Adipsin Levels of Lean and Overweight Women with Polycystic Ovary Syndrome. Türk Üreme Tıbbı ve Cerrahisi Dergisi, 8(2), 42-47. https:// doi.org/10.24074/tjrms.2023-100135
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clinical endocrinology, 89(3), 251–268. https://doi.org/10.1111/cen.13795
Tsutsumi, R., & Webster, N. J. (2009). GnRH pulsatility, the pituitary response and reproductive dysfunction. Endocrine journal, 56(6), 729–737. https://doi.org/10.1507/endocrj.k09e-185
Vejrazkova, D., Lischkova, O., Vankova, M., Stanicka, S., Vrbikova, J., Lukasova, P., Vcelak, J., Vacinova, G., & Bendlova, B. (2017). Distinct response of fat and gastrointestinal tissue to glucose in gestational diabetes mellitus and polycystic ovary syndrome. Physiological research, 66(2), 283–292. https://doi.org/10.33549/physiolres.933366
White, R. T., Damm, D., Hancock, N., Rosen, B. S., Lowell, B. B., Usher, P., Flier, J. S., & Spiegelman, B. M. (1992). Human adipsin is identical to complement factor D and is expressed at high levels in adipose tissue. The Journal of biological chemistry, 267(13), 9210–9213.
Witchel, S. F., Oberfield, S., Rosenfield, R. L., Codner, E., Bonny, A., Ibáñez, L., Pena, A., Horikawa, R., Gomez-Lobo, V., Joel, D., Tfayli, H., Arslanian, S., Dabadghao, P., Garcia Rudaz, C., & Lee, P. A. (2015). The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Hormone research in paediatrics, 83(6):376–389. https://doi.org/10.1159/000375530
Yang, J., & Chen, C. (2024). Hormonal changes in PCOS. The Journal of endocrinology, 261(1), e230342. https://doi.org/10.1530/JOE-23-0342
Serum Adipsin Levels in Obese and Normal Weight Adolescents with Polycystic Ovary Syndrome
Year 2024,
Volume: 6 Issue: 3, 107 - 116, 31.12.2024
Polycystic ovary syndrome (PCOS) is a chronic and heterogeneous disease associated with obesity, hyperinsulinemia, dyslipidemia and chronic low-grade inflammation. Adipsin is a protein that is mostly secreted from adipose tissue and is a structural homolog of complement factor D, the rate-limiting enzyme of the alternative complement system. The aim of this study was to investigate adipsin levels in adolescents with PCOS and their relationship with obesity. 40 normal weight--children with PCOS and 40 obese-children with PCOS, and 40 normal weight healthy children participated in our study. Adipsin levels of adolescents in each group was measured in morning fasting blood samples by a commercial ELISA kit. Adipsin levels showed statistically significant differences between the groups. (p<0.001). Normal-weight PCOS adolescents had higher adipsin levels than both obese PCOS and healthy controls. A negative correlation was observed between adipsin levels and BMI in the PCOS group (r=-0,457, p<0,001). In conclusion, adipsin can be considered as an independent risk factor in normal weight adolescents with PCOS and may help in the diagnosis of PCOS in normal weight children with other symptoms.
The study protocol was approved by the Ethical Committe of Gazi University (dated 12.09.2022, ref.no:685)
Supporting Institution
Gazi University
Project Number
Gazi University Research Fund (Project No: TDK-2023-8311)
References
Burgert, T. P. (2024). PCOS and common androgen abnormalities in adolescents. N. K. Tyson, NASPAG Essentials of Pediatric & Adolescent Gynecology (s. 190-204). Elsevier.
Butler, A. E., Moin, A. S. M., Sathyapalan, T., & Atkin, S. L. (2022). Components of the Complement Cascade Differ in Polycystic Ovary Syndrome. International Journal of Molecular Sciences, 23(20), 12232. https://doi.org/10.3390/ijms232012232
Byeon, H. J., Chae, M. K., Ko, J., Lee, E. J., Kikkawa, D. O., Jang, S. Y., & Yoon, J. S. (2023). The Role of Adipsin, Complement Factor D, in the Pathogenesis of Graves' Orbitopathy. Investigative ophthalmology & visual science, 64(11), 13. https://doi.org/10.1167/iovs.64.11.13
Chang, K. J., Chen, J. H., & Chen, K. H. (2024). The Pathophysiological Mechanism and Clinical Treatment of Polycystic Ovary Syndrome: A Molecular and Cellular Review of the Literature. International journal of molecular sciences, 25(16), 9037. https://doi.org/10.3390/ijms25169037
Chedraui, P., Pérez-López, F. R., Escobar, G. S., Palla, G., Montt-Guevara, M., Cecchi, E., Genazzani, A. R., Simoncini, T., & Research Group for the Omega Women's Health Project (2014). Circulating leptin, resistin, adiponectin, visfatin, adipsin and ghrelin levels and insulin resistance in postmenopausal women with and without the metabolic syndrome. Maturitas, 79(1), 86–90. https://doi.org/10.1016/j.maturitas.2014.06.008
Cook, K. G. (1985). A developmentally regulated mRNA from 3T3 adipocytes encodes a novel serine protease homologue. Proceedings of the National Academy of Sciences of the United States of America, , Oct;82(19):6480-4.
Cook, K. S., Min, H. Y., Johnson, D., Chaplinsky, R. J., Flier, J. S., Hunt, C. R., & Spiegelman, B. M. (1987). Adipsin: a circulating serine protease homolog secreted by adipose tissue and sciatic nerve. Science (New York, N.Y.), 237(4813), 402–405. https://doi.org/10.1126/science.3299705
Dare, A., & Chen, S. Y. (2024). Adipsin in the pathogenesis of cardiovascular diseases. Vascular pharmacology, 154, 107270. https://doi.org/10.1016/j.vph.2023.107270
Duleba, A. J., & Dokras, A. (2012). Is PCOS an inflammatory process ?. Fertility and sterility, 97(1), 7–12. https://doi.org/10.1016/j.fertnstert.2011.11.023
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015). Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocrine reviews, 36(5), 487–525. https://doi.org/10.1210/er.2015-1018
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015). Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocrine reviews, 36(5), 487–525. https://doi.org/10.1210/er.2015-1018
Flegal, K. M., Wei, R., Ogden, C. L., Freedman, D. S., Johnson, C. L., & Curtin, L. R. (2009). Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. The American journal of clinical nutrition, 90(5), 1314–1320. https://doi.org/10.3945/ajcn.2009.28335
Flier, J. S., Cook, K. S., Usher, P., & Spiegelman, B. M. (1987). Severely impaired adipsin expression in genetic and acquired obesity. Science (New York, N.Y.), 237(4813), 405–408. https://doi.org/10.1126/science.3299706
Gulati, A. K., Kaplan, D. W., & Daniels, S. R. (2012). Clinical tracking of severely obese children: a new growth chart. Pediatrics, 130(6), 1136–1140. https://doi.org/10.1542/peds.2012-0596
Gürsoy Calan, O., Calan, M., Yesil Senses, P., Unal Kocabas, G., Ozden, E., Sari, K. R., Kocar, M., Imamoglu, C., Senses, Y. M., Bozkaya, G., & Bilgir, O. (2016). Increased adipsin is associated with carotid intima media thickness and metabolic disturbances in polycystic ovary syndrome. Clinical endocrinology, 85(6), 910–917. https://doi.org/10.1111/cen.13157
Hertle, E., van Greevenbroek, M. M., & Stehouwer, C. D. (2012). Complement C3: an emerging risk factor in cardiometabolic disease. Diabetologia, 55(4), 881–884. https://doi.org/10.1007/s00125-012-2462-z
Ibáñez, L., Oberfield, S. E., Witchel, S., Auchus, R. J., Chang, R. J., Codner, E., Dabadghao, P., Darendeliler, F., Elbarbary, N. S., Gambineri, A., Garcia Rudaz, C., Hoeger, K. M., López-Bermejo, A., Ong, K., Peña, A. S., Reinehr, T., Santoro, N., Tena-Sempere, M., Tao, R., Yildiz, B. O., … Lee, P. A. (2017). An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Hormone research in paediatrics, 88(6), 371–395. https://doi.org/10.1159/000479371
Ibáñez, L., & de Zegher, F. (2023). Adolescent PCOS: a postpubertal central obesity syndrome. Trends in molecular medicine, 29(5), 354–363. https://doi.org/10.1016/j.molmed.2023.02.006
Kelly, A. S., Barlow, S. E., Rao, G., Inge, T. H., Hayman, L. L., Steinberger, J., Urbina, E. M., Ewing, L. J., Daniels, S. R., & American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology (2013). Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation, 128(15),1689-1712 .https://doi.org/10.1161/CIR.0b013e3182a5cfb3
Lo, J. C., Ljubicic, S., Leibiger, B., Kern, M., Leibiger, I. B., Moede, T., Kelly, M. E., Chatterjee Bhowmick, D., Murano, I., Cohen, P., Banks, A. S., Khandekar, M. J., Dietrich, A., Flier, J. S., Cinti, S., Blüher, M., Danial, N. N., Berggren, P. O., & Spiegelman, B. M. (2014). Adipsin is an adipokine that improves β cell function in diabetes. Cell, 158(1), 41–53. https://doi.org/10.1016/j.cell.2014.06.005
Milek, M., Moulla, Y., Kern, M., Stroh, C., Dietrich, A., Schön, M. R., Gärtner, D., Lohmann, T., Dressler, M., Kovacs, P., Stumvoll, M., Blüher, M., & Guiu-Jurado, E. (2022). Adipsin Serum Concentrations and Adipose Tissue Expression in People with Obesity and Type 2 Diabetes. International journal of molecular sciences, 23(4), 2222. https://doi.org/10.3390/ijms23042222
Neyzi, O., Bundak, R., Gökçay, G., Günöz, H., Furman, A., Darendeliler, F., & Baş, F. (2015). Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. Journal of clinical research in pediatric endocrinology, 7(4), 280–293. https://doi.org/10.4274/jcrpe.2183
Patel, S. (2018). Polycystic Ovary Syndrome (PCOS), an Inflammatory, Systemic, Lifestyle Endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology , 182, 27-36.
Saleh, F. L., Starkman, H., Furness, A., Pfeifer, S. M., & Kives, S. (2024). Polycystic Ovary Syndrome in Adolescents. Obstetrics and gynecology clinics of North America, 51(4), 679–693. https://doi.org/10.1016/j.ogc.2024.08.005
Salhah, H., Bonny, A., Benedict, J., & Nahata, L. (2024). Fertility Perspectives and Concerns in Adolescents With PCOS Compared to Controls. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 75(5), 836–841. https://doi.org/10.1016/j.jadohealth.2024.06.021
Scherer P. E. (2019). The many secret lives of adipocytes: implications for diabetes. Diabetologia, 62(2), 223–232. https://doi.org/10.1007/s00125-018-4777-x
Siddiqui, S., Mateen, S., Ahmad, R., & Moin, S. (2022). A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS). Journal of assisted reproduction and genetics, 39(11), 2439–2473.https://doi.org/10.1007/s10815-022-02625-7
Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of Obesity and Severe Obesity in US Children, 1999-2016. Pediatrics, 141(3), e20173459. https://doi.org/10.1542/peds.2017-3459
Tanılır Çağıran, F., Kali, Z. (2024). Serum Adipsin Levels of Lean and Overweight Women with Polycystic Ovary Syndrome. Türk Üreme Tıbbı ve Cerrahisi Dergisi, 8(2), 42-47. https:// doi.org/10.24074/tjrms.2023-100135
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clinical endocrinology, 89(3), 251–268. https://doi.org/10.1111/cen.13795
Tsutsumi, R., & Webster, N. J. (2009). GnRH pulsatility, the pituitary response and reproductive dysfunction. Endocrine journal, 56(6), 729–737. https://doi.org/10.1507/endocrj.k09e-185
Vejrazkova, D., Lischkova, O., Vankova, M., Stanicka, S., Vrbikova, J., Lukasova, P., Vcelak, J., Vacinova, G., & Bendlova, B. (2017). Distinct response of fat and gastrointestinal tissue to glucose in gestational diabetes mellitus and polycystic ovary syndrome. Physiological research, 66(2), 283–292. https://doi.org/10.33549/physiolres.933366
White, R. T., Damm, D., Hancock, N., Rosen, B. S., Lowell, B. B., Usher, P., Flier, J. S., & Spiegelman, B. M. (1992). Human adipsin is identical to complement factor D and is expressed at high levels in adipose tissue. The Journal of biological chemistry, 267(13), 9210–9213.
Witchel, S. F., Oberfield, S., Rosenfield, R. L., Codner, E., Bonny, A., Ibáñez, L., Pena, A., Horikawa, R., Gomez-Lobo, V., Joel, D., Tfayli, H., Arslanian, S., Dabadghao, P., Garcia Rudaz, C., & Lee, P. A. (2015). The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Hormone research in paediatrics, 83(6):376–389. https://doi.org/10.1159/000375530
Yang, J., & Chen, C. (2024). Hormonal changes in PCOS. The Journal of endocrinology, 261(1), e230342. https://doi.org/10.1530/JOE-23-0342
Emiral, Ç., Buluş, D., Yaşartekin, Y., Akaydın, S. (2024). Serum Adipsin Levels in Obese and Normal Weight Adolescents with Polycystic Ovary Syndrome. Journal of Gazi University Health Sciences Institute, 6(3), 107-116. https://doi.org/10.59124/guhes.1604306