The Role Of Ovarian Volume in The Prediction Of Insulin Resistance in Polycystic Ovarian Syndrome

Year 2015, Volume: 12 Issue: 4, 148 - 152, 01.07.2015

Cenk Gezer , Atalay Ekin Naciye Sinem Gezer Ulaş Solmaz Emre Mat Cüneyt Eftal Taner Mehmet Özeren

Abstract

Aim: The aim of this study was to divide the patients with polycystic ovarian syndrome in to subgroups to according to various clinical and laboratory findings and to demonstrate the correlation between ovarian volume and insulin resistance and to determine the value of ovarian volume in predicting insulin resistance.Material and Methods: In our study, 47 patients with PCOS and 25 control subjects without any menstrual disorders or clinical and biochemical hyperandrogenism were included. In all subjects, insulin resistance was determined by measurement of fasting insulin and “Homeostatik Model Assessment” index. Androgenic status was assessed with free androgen index . Ovarian volume measurement was also performed for each participant by ultrasound. Patients were divided into two groups of ovarian volume, including those above and below the 10 ml. Collected data were analyzed by using Student’s t-test and Spearman’s correlation analysis.Results: The difference in mean ovarian volume, fasting glucose, FAI and HOMA index between PCOS and control group was statistically significant. When high and low ovarian volume patients were compared, the rate of insulin resistance was 100% and10%, the rate of hyperandrogenemia was 96% and 46% respectively. Both rates between two groups were found to be statistically significant.Conclusion: The results of this study demonstrated that, volumetric assessment of the ovaries in all PCOS patients whether or not obese, would be the appropriate approach to predict the long-term metabolic disease predisposition caused by insulin resistance. Also, all PCOS patients with increased ovarian volume need to be studied for insulin resistance.

Keywords

PCOS, insulin resistance, HOMA, ovarian volume

Polikistik Over Sendromunda Over Hacminin İnsülin Direncini Öngörmedeki Rolü

Abstract

Amaç: Bu çalışmada amacımız, PKOS tanısı alan hastaları değişik klinik ve laboratuvar bulgularına göre alt gruplara ayırarak, PKOS tanı kriterlerinden biri olan artmış overyan hacmin, insülin direnci ile ilişkisini araştırmak ve insülin direncini öngörmedeki değerini saptamaktı.Gereç ve Yöntemler: Çalışmamıza PKOS olan 47 hasta ve menstrüel düzensizliği veya klinik ve biyokimyasal olarak hiperandrojenizmi olmayan 25 kontrol olgusu dahil edildi. Tüm olgularda insülin direnci, açlık insülini ve “Homeostatik Model Assessment” indeksine göre, androjen düzeyi ise serbest androjen indeksine göre değerlendirildi. Hastaların over hacimleri ultrasonografi ile her iki overin üç boyutta ölçümleri alınarak hesaplandı. Hastalar ortalama over hacmi 10 ml altında olanlar ve 10 ml ve üstü olanlar olmak üzere iki gruba ayırıldı. Toplanan verilerin istatistiksel değerlendirilmesinde Student’s t test ve Pearson korelasyon testleri kullanıldı.Bulgular: PKOS tanısı konulmuş hastalar ve kontrol grubu arasında HOMA indeksi, ortalama over hacmi, açlık kan şekeri, FAI açısından anlamlı derecede fark saptandı. PKOS grubunda over hacmi artmış hastaların %96’sında hiperandrojenemi ve %100’ünde insülin direnci saptanırken, over hacmi normal olanların %46’sında hiperandrojenemi ve %10’unda insülin direnci saptandı. İki grup arasındaki fark istatistiksel olarak anlamlı bulundu.Sonuç: Bu çalışma, uzun vadeli metabolik hastalıklara predispozisyon oluşturan insülin direncinin öngörülebilmesi için, obez olsun veya olmasın her PKOS hastasında, over hacminin değerlendirilmesi ve over hacmi artmış olan tüm PKOS hastalarının insülin direnci yönünden araştırılması gerektiğini göstermektedir.

Keywords

PKOS, insülin direnci, HOMA, over hacmi

References

• Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselec- ted population. J Clin Endocrinol Metab 2004;89:2745-9.
• Rosenfield RL. Clinical review: Identifying children at risk for polycystic ovary syndrome. J Clin Endocrinol Metab 2007;92:787-96.
• Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycys- tic ovary syndrome. Hum Reprod Update 2008;14:367-78.
• Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Me- tab1980;50:113-6.
• Lanzone A, Fulghesu AM, Cucinelli F, Guido M, Pavone Y, Caruso A, Man- cuso S. Preconceptional and gestational evaluation of insulin secretion in patients with polycystic ovary syndrome. Hum Reprod 1996;11:2382-6.
• Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health ris- ks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19:41-7.
• Qu HQ, Li Q, Rentfro AR, Fisher-Hoch SP, McCormick JB.The definition of insulin resistance using HOMA-IR for Americans of Mexican descent using machine learning.PLoS One 2011;6:21041.
• Christensen JT, Boldsen J, Westergaard, JG. Ovarian volume in gyneco- logically healthy women using no contraception, or using IUD or oral contraception. Acta Obstet Gynecol Scand 1997;76:784-9.
• Pache TD, de Jong FH, Hop WC, Fauser BC. Association between ovarian changes assessed by transvaginal sonography and clinical and endocri- ne signs of the polycystic ovary syndrome. Fertil Steril 1993;59:544-9.
• Pasquali R, Stener-Victorin E, Yildiz BO, Duleba AJ, Hoeger K, Mason H, Homburg R, Hickey T, Franks S, Tapanainen JS, Balen A, Abbott DH, Diamanti-Kandarakis E, Legro RS. PCOS Forum: research in polycys- tic ovary syndrome today and tomorrow. Clin Endocrinol (Oxf) 2011; 74:424-33.
• Codner E, Villarroel C, Eyzaguirre FC, López P, Merino PM, Pérez-Bravo F, Iñiguez G, Cassorla F. Polycystic ovarian morphology in postmenarchal adolescents. Fertil Steril 2011;95:702-6.
• Adams JM, Taylor AE, Crowley WF Jr, Hall JE. Polycystic ovarian morp- hology with regular ovulatory cycles: insights into the pathophysiology of polycystic ovarian syndrome. J J Clin Endocrinol Metab 2004;89:4343- 50.
• Hahn S, Halteren W, Roesler S, Schmidt M, Kimmig R, Tan S, Mann K, Janssen OE. The combination of increased ovarian volume end follicle number is associated with more severe hyperandrogenism in German women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2006;114:175-81.
• Sindelka G, Skrha J, Cibula D, Pranzy M. Effect of insulin in polycystic ovary syndrome. Cas Lek Cesk 2002;141:769-72.
• Dunaif A, Segal KR. Futterweit W, Dobrjansky A. Profound peripheral in- sulin resistance independent of obesity in polycystic ovary syndrome. Diabetes 1989;38:1165-74.
• Cresswell J, Fraser R, Bruce C, Egger P, Phillips D, Barker DJ. Relations- hip between polycystic ovaries, body mass index and insulin resistance. Acta Obstet Gynecol Scand 2003;82:61-4.
• Falsetti L, Eleftheriou G. Hyperinsulinemia in the polycystic ovary syndro- me: a clinical, endocrine and echographic study in 240 patients. Gynecol Endocrinol 1996;10:319-26.
• Gennarelli G, Holte J, Berglund L, Berne C, Massobrio M, Lithell H. Predi- ction model for insulin resistance in the polycystic ovary syndrome. Hum Reprod 2000;15:2098-102.
• Kelly CJ1, Lyall H, Petrie JR, Gould GW, Connell JM, Rumley A, Lowe GD, Sattar N. A specific elevationin tissue plasminogen activator antigen in women with polycystic ovarian syndrome. J Clin Endocrinol Metab 2002;87:3287-90.
• Dunaif A, Segal KR, Shelley DR, Green G,Dobrjansky A, Licholai T. Evi- dence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992;41:1257-66.