JOURNAL READING

NUR AMIRA 112013037

DR HARIANTO SpOG

RELATIONSHIP BETWEEN INSULIN RESISTANCE AND HIGH MOLECULAR WEIGHT ADIPONECTIN IN NORMAL WEIGHT
ADOLESCENT WITH POLYCYSTIC OVARY SYNDROME (PCOS) AND A MATERNAL HISTORY OF PCOS

TITLE

 To assess rate of insulin resistance

Relationship between insulin resistance and high
molecular weight adiponectin in normal weight
adolescent with polycystic ovary syndrome (PCOS) and a
maternal history of PCOS

OBJECTIVE

 Endocrine disorder of women reproductive age

Menstrual disorder starts in peripubertal period
(oligomenorrhea, dysfunctional uterine bleeding)
Hyperandrogenism (hirsutism, acne, oily skin,
androgenic alopecia)
Infertility
Patient with PCOS has risk of insulin resistancy ,
hyperinsulinemia, obesity, and cardiovascular diseases

PCOS

2 of 3 criteria
Oligo-ovulation /anovulation
Clinical or /and biochemical signs of hyperandrogenism
Polycystics ovaries by utrasound and exclusion of other
androgen excess disorder

 Adipocytokine (adipocyte derivative biologically active

molecue generated from adipose tissue)
Effective in the circulation as an
insulin sensitizer
anti inflammatory, and
anti atherosclerotic agent.

Classified by three groups :

low,
medium ,
high molecular weight adiponectin.

ADIPONECTIN

PLACE
Adolescent clinic of Etlik Zubeyda Hasim Womens
Health Teaching and Research Hospital, Ankara Turkey
April 2011- November 2011

MATERIALS AND METHOD

 Oligomenorrhea without menstrual bleeding frequency

longer than 35 days
Amenorrhea without menstrual bleeding longer than 6
months
Clinical hyperandrogenism hirsutis, acne, oily skin, an
androgenic alopecia

Inclusion criteria
PCOS diagnosed according to 2004 Rotterdem criteria
Age 15-20 years
BMI 18-25 kg/m2
Maternal History of PCOS
Control Group
Age and BMI matched adolescent with no family history
or diagnosis of PCOS or other reason and diseases.

Antropometric measurement
Subject wearing light clothing, without shoes.
Height and weight measured
BMI calculated in kg
Scoring of hirsutism (using modified Ferman Gallway System)
Score>8 =hirsutism
Alopecia (using Ludwig scoring)
Acne ( criteria Hayashi et all)

LUDWIG SCORING

HAYASHI ET ALL

ALOPECIA AND ACNE SCORING

PCOS 4 phenotypes
1: hyperandrogenism + OA ( anovulation) +PCOS
2: hyperandrogenism + OA
3: hyperandrogenism + PCOS
4: OA + PCOS

 Blood samples obtained in the morning after an

overnight fast on day 3 of initiated or spontaneous
menstrual cycle.
Measured free triodothronine, free thyroxin (FT4),
TSH, DHEAS, PRL, FSH, LH, E2, 17ahydroxyproestrone (17-OHP), free T, total T, total
cholesterol, triglyceride, low density lipoprotein (LDL),
high density lipoprotein (HDL) cholesterol, and HMW
adiponectin.

 Glucose + lipid profile measurement: using vitros

chemistry system
Serum FSH, LH, E2, PRL, P, total T, free T levels :
chemiluminescence method
DHEAS and 17-OHP levels were determined with the
radioimmunoassay method
HMW adiponectin Buhlmann multimeric Adiponectin
ELISA kit.
Insulin- DiaMetra ELISA kit with micro ELISA method

HORMONAL IMMUNOASSAYS

 Performed using statistical for social sciences.

Distribution of continuous variables checked using
Kolmogrov Smirnov Test

STATISTICAL ANALYSIS

Demographic charecteristics- presented in table 1

1 excluded because lost to follow up.
Groups were comparable regarding BMI and age.
The clinical sign of hyperandrogenism were significantly
higher in PCOS group than in control group.

RESULTS

 2nd hour glucose concentration in OGTT higher in the

PCOS group.
HMW adiponectin lower in PCOS group.
The insulin resistance was determined in 69% and 2.5 %
of adolescent in the PCOS and control group respectively.

 Insulin resistant PCOS adolescent level of HMW

adiponectin was lower
The adolescent + PCOS + biochemical
hyperandrogenism lower HMW adiponectin
The adolescent + PCOS + biochemical
hyperandrogenism higher HOMA-IR compared with The
adolescent + PCOS + biochemical normoandrogenism

 Normal weight , healthy adolescent with PCOS and

maternal history of PCOS higher insulin resistance,
lower HMW adiponectin than controls.
MAIN FINDINGS: IR can be found in normal weight adolescent with PCOS
(without metabolic disorder and obesity)
HMW adiponectin levels were negatively correlated with
IR.
Hyperandrogenism is associated with IR and low HMW
adiponectin in adolescent with PCOS.

 First degree relatives of women with PCOS have high

risk of developing PCOS symptoms and endocrine
disorders (obesity, IR, hyperlipidemia)
Cross sex: 9 peripubertal girls + first degree relatives
PCOS reduced by threefold compared to 10 age matched
controls :insulin sensitivity
Cross sex: 19 adolescent + mothers or sisters diagnosed
with PCOS demonstrated lower insulin sensitivity
compared to 21 healthy age matched controls.

 The women with PCOS have an 11 fold increase in the

prevalence of metabolic syndrome, and the risk enhanced
at young age.
Women with PCOS have an increased of impaired
glucose tolerance, type 2 diabetes, and metabolic
syndrome compared with controls.
Women with PCOS have a higher risk for early onset
of cardiovascular diseases.

Villa et all
Demonstrated that in adolescent with PCOS, the basal
insulin value and HOMA-IR higher than in non PCOS
group.
Impaired glucose tolerance is an indicator for
increased IR in nonobese adolescent with PCOS.
Therefore, screening of IR should be considered for
adolescent with PCOS independent of BMI

Oconnor et al.
Total, medium and low molecular weight adiponectin
concentrations did not differ between the PCOS group
and control.
HMW adiponectin concentrations were significantly
lower in the PCOS group.

 Conclusion, adolescent with PCOS had a significantly

increased rate of IR independent of BMI.
The HMW adiponectin levels were lower in normal
weight + adolescent + PCOS and inversely correlated
with IR.
The IR with low HMW adiponectin levels may indicate
the future development of metabolic disorders in
adolescent with PCOS, even in the absence obesity.