Evaluation of metabolic parameters and aortic elasticity in normotensive children with premature adrenarche

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Eylem Topaktaş ◽  
Elif Erolu ◽  
Fatma Dursun ◽  
Heves Kırmızıbekmez
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary ◽  
Normal Weight ◽  
Metabolic Parameters ◽  
Atherogenic Index ◽  
Stiffness Index ◽  
Control Group ◽  
Warning Sign ◽  
Aortic Elasticity ◽  
Premature Adrenarche

Abstract Objectives Premature adrenarche may be associated with an intrauterine programmed metabolic syndrome which should be considered as a warning sign for coronary heart disease due to accelerated atherosclerosis, hypertension, type 2 diabetes mellitus (DM), and polycystic ovary syndrome. Methods Seventy-three patients with premature adrenarche were evaluated for metabolic parameters and aortic elasticity to evaluate the susceptibility to atherosclerosis and compared with a control group. The patients were examined in two groups as overweight and nonoverweight, and metabolic and cardiac parameters were also compared among these groups. Strain, distensibility, and stiffness index parameters were used to evaluate aortic elasticity. Results Biochemical parameters and cardiac measurements were not statistically different between patients and controls. They also did not differ between patients with normal weight and overweight groups. Atherogenic index and insulin resistance were closely related and a positive correlation between cholesterol and triglyceride, and ascending aortic stiffness was found. Conclusions The results may suggest that cholesterol and triglyceride-related arterial involvement is more involved in the pathogenesis of arterial stiffness. It can be considered that ‘being overweight’ or ‘having metabolic profile characterized by insulin resistance and dyslipidemia’ are the major coexisting factors influencing the vascular structure, rather than increased androgens and premature adrenarche itself.

scholarly journals Alarin: A Novel Circulating Peptide Hormone Linked to Luteinizing Hormone and Hiperandrogenismin Polycystic Ovary Syndrome

2018 ◽  
Vol 1 (1) ◽  
pp. 72-81
Author(s):  
Mehmet CALAN ◽  
Merve Bicer ◽  
Murat Alan ◽  
Pinar Alarslan ◽  
Asli Guler ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Luteinizing Hormone ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Peptide Hormone ◽  
Normal Weight ◽  
Metabolic Parameters ◽  
Ovary Syndrome ◽  
Cross Sectional ◽  
Circulating Levels

Alarin is a newly identified peptide hormone. It is implicated that alarinplays roles in regulation of energy metabolism and hypothalamo-pituitary-gonadal axis. Polycystic Ovary Syndrome (PCOS) is a common reproductive and metabolic disease in women during reproductive ages. Over-secretion of Luteinizing Hormone (LH) causes hyperandrogenism in women with PCOS. The purpose of the study was to determine the comparison of alarin levels in women with or without PCOS as well as to investigate the relationship between alarin and LH. Eighty-four women with PCOS and 84 age- and BMI- matched controls were recruited in this cross-sectional study. Circulating alarin levels were assessed via ELISA method. The hormonal and metabolic parameters of the recruited subjects were also determined. The circulating levels of alarin in PCOS subjects were higher than controls (6.11 ± 1.91 vs. 3.93 ± 1.60 ng/ml, P <0.001). Alarin showed a positive correlation with insulin resistance marker, BMI, LH and androgens. Moreover, alarin levels were elevated in women with PCOS having insulin resistance compared to those PCOS women without insulin resistance. In both control and PCOS groups, overweight subjects showed an elevation in circulating levels of alarin with respect to normal weight subjects. In the present study, Alarin level with the highest tertile dosage comparing to alarin level with the lowest tertile dosage could highly increase the probability of PCOS risk prevalence in women. Elevated alarin levels in women with PCOS were associated with not only LH and metabolic parameters but also high probability of having PCOS risk independently.

Adiponectin and leptin levels in normal weight women with polycystic ovary syndrome

2020 ◽  
Vol 41 (4) ◽  
Author(s):  
Murat Gözüküçük ◽  
Aslı Yarcı Gürsoy ◽  
Emre Destegül ◽  
Salih Taşkın ◽  
Hakan Şatıroğlu
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary ◽  
Statistical Significance ◽  
Free Testosterone ◽  
Normal Weight ◽  
Control Group ◽  
Study Group ◽  
Model Assessment ◽  
Homeostatic Model Assessment ◽  
The Difference

Abstract Objectives Since polycystic ovarian syndrome (PCOS) is prevalent in reproductive women with obesity and insulin resistance, adipocytokines are often accused and investigated for pathophysiology. The aim of this study was to evaluate the adiponectin and leptin levels in normal-weight women with PCOS. Methods Forty women with PCOS and 40 age and body mass index (BMI) matched controls were included in the study. Adiponectin and leptin levels in addition to other biochemical parameters were measured. Results Leptin levels were statistically significantly higher in the study group compared to the control group (6.53 ± 2.670 vs 3.37 ± 2.002 ng/mL, p < 0.001 respectively). Although Adiponectin levels were lower in the study group compared to the control group (28.89 ± 16.124 μg/mL vs 31.05 ± 20.507, p = 0.714 respectively) the difference did not reach statistical significance. Leptin levels were positively correlated with fasting glucose, fasting insulin, free testosterone levels and homeostatic model assessment of insulin resistance (HOMA-IR) values. Adiponectin levels were negatively correlated with BMI. Conclusions Adiponectin and leptin have been suggested to play a crucial role in the pathogenesis of PCOS. Different adipocytokine levels in the normal weight PCOS group compared to age and BMI matched controls support the idea that adipose tissue in this group of women has some distinctive features not only in high BMI subgroup but also in normal weight subgroup.

scholarly journals A Potential Pathological Role of Wingless Type1 Inducible Signaling Pathway Protein-1 and Betatrophin in Obese Women with Polyststic Ovary Syndrome

2020 ◽  
pp. 1-11
Author(s):  
Abrar Gomaa Abd-Elfatah Hassan ◽  
Mohammed Ali Mohammed Mohammed ◽  
Doaa Mohammed Mohammed Abd-Elatif ◽  
Ashraf Taha Abd-Elmouttaleb Mohammed
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Signaling Pathway ◽  
Polycystic Ovary ◽  
Pancreatic Beta Cell ◽  
Normal Weight ◽  
Control Group ◽  
Beta Cell Proliferation ◽  
Ovary Syndrome

Background: Polycystic Ovary Syndrome is a common female endocrinopathy. It is associated with adipokines dysfunctional secretion pattern and insulin resistance, which is considered as the main reason for its clinical feature. Wingless type1 inducible signaling pathway protein-1 is a novel adipokine that displays insulin resistance and adipose tissue inflammation where it strongly related to adipocyte accumulation and regeneration. Betatrophin has a potential role in pancreatic beta-cell proliferation and obesity and several studies showed inconsistent betatrophin levels in patients with diabetes and obesity but, its relation to polycystic ovary syndrome is unclear. Aim: Investigation of the role of serum wingless type1 inducible signaling pathway protein-1 and betatrophin in normal weight and obese patients with polycystic ovary syndrome. Studying their association with other markers, then determine whether obesity and insulin resistance is associated with them. Methods: Wingless type1 inducible signaling pathway protein-1 and betatrophin serum levels were measured in 44 patients with polycystic ovary syndrome (22 obese and 22 non-obese) and 44 matched control (22 obese and 22 non-obese) females using specific ELISA kits.  Results: Betatrophin and wingless type1 inducible signaling pathway protein-1 levels were elevated in the polycystic ovary syndrome group (49.4 pg/ml, 187.6 pg/ml) than in the control group (32.08 pg/ml, 108.4 pg/ml) respectively. Moreover, their levels were higher in the obese subgroup than in normal weight subgroup. There were positive correlations between wingless type1 inducible signaling pathway protein-1 and betatrophin in non-obese (r=0.89, p=0.0001***) and in obese (r=0.78, p=0.0001***) polycystic ovary syndrome groups. Conclusion: Betatrophin and wingless type1 inducible signaling pathway protein-1 are associated with adiposity and insulin resistance in polycystic ovary syndrome. Hence wingless type1 inducible signaling pathway protein-1 and betatrophin may play a role in the incidence of polycystic ovary syndrome. They may be valuable in diagnosis and prediction of polycystic ovary syndrome patients.

INTERRELATION OF rs9939609 POLYMORPHISM OF THE FTO GENE WITH CLINICAL AND METABOLIC PARAMETERS IN GIRLS WITH DIFFERENT FAT DEPOSITION TOPOGRAPHY: A PILOT STUDY

2021 ◽  
Vol 100 (2) ◽  
pp. 211-218
Author(s):  
T.A. Bairova ◽  
◽  
E.A. Sheneman ◽  
K.D. Ievleva ◽  
L.V. Rychkova ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adolescent Girls ◽  
Resistance Index ◽  
Normal Weight ◽  
Fat Deposition ◽  
Metabolic Parameters ◽  
Control Group ◽  
Oral Glucose ◽  
Thigh Circumference ◽  
Obese Adolescent

Objective of the research: to assess the relationship between rs9939609 FTO carriage and clinical and metabolic parameters in adolescent girls with different types of fat deposition to identify the A allele as a possible marker of abdominal fat deposition. Materials and methods: 254 adolescent girls (14–17 years): 101 girls (39%) with a body mass index (BMI) in the range of ±1 SDS included in the control group [age 16 (15–17) years], 153 girls with SDS>1 were included in the main group [age 15 (15–16) years], including 95 (62%) girls with overweight (SDS BMI from +1,0 to +2,0) [age 15 (14,5–17) years] and 58 (37%) obese girls (SDS BMI>2) [age 15 (14–16) years]. Study design: singlecenter prospective complete open controlled. Anthropometric studies using standard methods (body weight, height, BMI, waist circumference, waist-to-height ratio (WHtR), thigh circumference, fat fold thickness above the biceps, triceps muscles, on the chest front surface, at the scapula lower angle, in the abdomen area and mid-thigh area). Adipose tissue percentage (% of fat mass) was determined by the bioelectrical resistance method using a professional scale – a TANITATBF-410MA fat analyzer (Japan). Laboratory studies included determination of lipid spectrum (triglycerides, total cholesterol, high-density lipoprotein cholesterol), fasting plasma glucose, glycated hemoglobin, oral glucose tolerance test, insulin with calculation of the insulin resistance index HOMA-IR, and molecular genetic studies (rs9939609FTO). Results: the frequency of the A-allele rs9939609 FTO in the adolescent samples WHtR<0,5 and WHtR>0,5 (56,28%, χ2=10,66, p=0,0011) is higher than in the group of adolescents with normal weight (40,10%). Comparing the frequencies of alleles and genotypes between groups with WHtR<0,5 and WHtR>0,5 did not revealed any statistically significant differences (χ2=0,92, p=0,63; χ2=0,34, p=0,56). In carriers of the AA genotype with an abdominal type of fat deposition (WHtR>0,5) in comparison with carriers of a similar genotype of a gluteofemoral type of fat deposition (WHtR<0,5), the BMI SDS is higher (2,75±0,66 vs. 1,54±0,46, p=0,01) and HOMA-IR (6,55±8,09 vs. 2,59±1,34, p=0,04). Conclusion: the prevalence of the A allele rs9939609 FTO in the group of overweight and obese adolescent girls is higher than in the group of adolescents with normal weight. In adolescent girls, the A allele rs9939609 FTO is associated with excess fat accumulation (SDS BMI) and insulin resistance (HOMA-IR).

scholarly journals POS0561 OBESITY PHENOTYPES IN EARLY RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 515.1-515
Author(s):  
Y. Gorbunova ◽  
T. Popkova ◽  
L. Kondrateva ◽  
M. Cherkasova ◽  
E. Nasonov ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Waist Circumference ◽  
Metabolic Disorders ◽  
Normal Weight ◽  
Atherogenic Index ◽  
World Health ◽  
Early Ra ◽  
Metabolically Healthy

Background:Patients with rheumatoid arthritis (RA) and obesity have a lower risk of early death than patients with normal weight due to the so-called “obesity paradox”. Available publications discuss three phenotypes of obesity: classical obesity, metabolically healthy overweight/obesity, and latent obesity (normal weight associated with metabolic disorders, most importantly - with insulin resistance and adipocytokines imbalance).Objectives:To clarify the prevalence of obesity phenotypes and to identify factors predisposing to «latent obesity» in early RA without diabetes mellitus or hyperglycemia.Methods:The study included 35 pts (23 women, 12 men) with early RA (criteria ACR / EULAR, 2010), 56 [43,0; 60,0] years old, naïve to treatment with glucocorticoids and disease-modifying anti-rheumatics, without established diabetes mellitus. Pts were seropositive for IgM RF and anti-CCP, with highly active RA (DAS28 5,9 [5,2; 6,4]; SDAI 35,4 [27,0; 45,8], and CDAI 31,0 [26,0; 44,0]) scores, and median disease duration of 8.0 [6,0;15.0] months. Electrochemiluminescence assay Elecsys (Roche Diagnostics) was used to measure patients’ insulin levels, and ELISA (DBS – Diagnostics Biochem Canada Inc.) - for evaluation of serum leptin concentrations. Insulin resistance (IR) was defined as Homeostasis Model Assessment of Insulin Resistance index (HOMA-IR) ≥2,77. Leptin levels were considered elevated at values ≥11,1 ng/ml for women, ≥5,6 ng/ml for men. The overweight/obesity status was determined by World Health Organization criteria in pts with body mass index (BMI) ≥25kg/m2.Results:Overweight/obesity were documented in 19 (54, 3%) pts with early RA, 4/19 (21%) had high leptin levels and IR, 11/19 (58%) had isolated hyperleptinemia. Normal BMI was found in 16 (45,7%) pts with early RA, 2/16 (12,5%) had elevated leptin levels and IR, and 6/16 (37,5%) – only hyperleptinemia. Four (21%) out of 19 overweight and 8 (50%) out of 16 pts with normal BMI did not show any metabolic disorders (p=0,02). Сlassical obesity was found in 15 (43%), and latent obesity – in 8 (23%) pts with early RA. Leptin levels correlated with waist circumference (r=0,58, p=0,02), BMI (r=0,71, p=0,0006), ESR (r=0,5, p=0,02) in the overweight/obese pts, and with waist circumference (r=0,59, p=0,03), IgM RF (r=0,58, p=0,03), triglyceride levels (r=0,77, p=0,003), and atherogenic index (r=0,62, p=0,03) in pts with normal weight.Conclusion:The classical obesity phenotype associated with abdominal obesity and inflammation was the most common and prevailing over other phenotypes in early RA. Latent obesity was less common and was associated with an unfavorable lipid profile and accumulation of abdominal fat, therefore increasing the risk of cardiovascular diseases in RA. Metabolically healthy overweight/obesity in early RA was really a rare phenotype.Disclosure of Interests:None declared

Serum Vitamin D Binding Protein Level Associated with Metabolic Cardiovascular Risk Factors in Women with the Polycystic Ovary Syndrome

2018 ◽  
Vol 51 (01) ◽  
pp. 54-61 ◽  
Author(s):  
Justyna Kuliczkowska-Plaksej ◽  
Renato Pasquali ◽  
Andrzej Milewicz ◽  
Felicja Lwow ◽  
Diana Jedrzejuk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Polycystic Ovary ◽  
Serum Insulin ◽  
Normal Weight ◽  
Control Group ◽  
Vitamin D Binding Protein ◽  
Ovary Syndrome

AbstractThe objective of the study was to measure the levels of 25-hydroxyvitamin D [25(OH)D] and vitamin D binding protein (VDBP) and assess their relationships with cardiovascular risk factors in women with the polycystic ovary syndrome (PCOS). A group of 267 women, aged 20–35 years (24.7 ± 4.9): 167 with PCOS and 100 healthy women were divided according to body mass index. Biochemical and hormonal parameters were measured. Free and bioavailable 25(OH)D were calculated using the mathematical equations. The percentage of body fat and visceral fat deposit were assessed by DXA. In the normal weight control group total, free, bioavailable 25(OH)D (p<0.001 for all) were significantly higher than in its overweight/obese counterpart, while VDBP levels were comparable. In PCOS women total 25(OH)D (p<0.001), and VDBP (p –0.006) were lower in the overweight/obese subgroups than in the normal weight ones. In both groups serum VDBP levels correlated negatively with serum insulin and positively with sex hormone binding globulin. In PCOS group, in contrast to control group, VDPB was negatively correlated with abdominal fat deposit, BMI, fasting glucose and positively with HDL. Despite lower total 25(OH)D in obese PCOS women, all women with PCOS (lean and obese) had comparable free and bioavailable 25(OH)D, which might be a result of concomitantly lowered serum VDBP levels in obese PCOS women. VDBP might play important role in the regulation of availability of active fractions of 25(OH)D in PCOS women. VDBP seems to be associated with cardiovascular risk factors such as BMI, waist circumference, visceral fat, and fasting serum insulin in women with PCOS.

scholarly journals Serum Testosterone to Androstenedione Ratio Predicts Metabolic Health in Normal-Weight Polycystic Ovary Syndrome Women

2021 ◽  
Author(s):  
Daniel A Dumesic ◽  
Ayli Tulberg ◽  
Megan McNamara ◽  
Tristan R Grogan ◽  
David H Abbott ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Elevated Serum ◽  
Normal Weight ◽  
Model Assessment ◽  
Metabolic Function ◽  
Ovary Syndrome ◽  
Intravenous Glucose

Abstract Context Increased aldo-keto reductase 1C3 (AKR1C3)-mediated conversion of androstenedione (A4) to testosterone (T) promotes lipid storage in subcutaneous (SC) abdominal adipose in overweight/obese polycystic ovary syndrome (PCOS) women. Objective To examine whether an elevated serum T/A4 ratio, as a marker of enhanced AKR1C3 activity in SC abdominal adipose, predicts metabolic function in normal-weight PCOS women. Design Prospective cohort study. Setting Academic center. Patients Nineteen normal-weight PCOS women; 21 age- and body mass index-matched controls. Intervention(s) Circulating hormone/metabolic determinations, intravenous glucose tolerance testing, total body dual-energy x-ray absorptiometry, SC abdominal fat biopsy. Main Outcome Measure(s) Serum T/A4 ratios, hormone/metabolic measures and AKR1C3 expression of adipocytes matured in vitro were compared between female types; serum T/A4 ratios were correlated with serum lipids, adipose insulin resistance (adipose-IR), homeostatic model assessment of insulin resistance (HOMA-IR) and insulin sensitivity (Si). Results Increased serum T/A4 ratios (P=0.040) and log adipose-IR values (P=0.002) in PCOS women versus controls were accompanied by AKR1C3 mRNA overexpression of PCOS adipocytes matured in vitro (P=0.016). Serum T/A4 ratios in PCOS women, but not controls, negatively correlated with log triglycerides (TG: R=-0.65, P=0.002) and the TG index (R=-0.57, P=0.011). Adjusting for serum free T, serum T/A4 ratios in PCOS women remained negatively correlated with log TG (R=-0.57, P=0.013) and TG index (R=-0.50, P=0.036), respectively, without significant relationships with other metabolic measures. Conclusion An elevated serum T/A4 ratio, as a marker of enhanced AKR1C3 activity in SC abdominal adipose, predicts healthy metabolic function in normal-weight PCOS women.

scholarly journals MON-223 Adipose Insulin Resistance in Normal-Weight Women with Polycystic Ovary Syndrome

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Luis Hoyos ◽  
Karen Leung ◽  
Tristan Grogan ◽  
David Abbott ◽  
Gregorio Chazenbalk ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Normal Weight ◽  
Ovary Syndrome

scholarly journals Alarin/FSH Ratio Might Be A New Biological Marker in Polycystic Ovary Syndrome Women with Normal and Women with Obese

2019 ◽  
Vol 3 (5) ◽  
Keyword(s):  
Luteinizing Hormone ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Density Lipoprotein ◽  
Biological Marker ◽  
Dehydroepiandrosterone Sulfate ◽  
Normal Weight ◽  
Control Group ◽  
Total Testosterone ◽  
Ovary Syndrome

Neuropeptides coordinate and regulate physiological processes in all animals. Alarin is a 25 amino acid neuropeptide which promotes the secretion of luteinizing hormone (LH). It has been known that serum luteinizing hormone levels are increased in women with polycystic ovary syndrome. Therefore, purpose of this was to examine the association of circulating gonadotropin secretions, and alarin with women with polycystic ovary syndrome, and to compare these findings with those of control subjects in an effort to better understand the pathophysiology of PCOS. 28 participants with a diagnosis of PCOS with normal weight and 28 participants with a diagnosis of PCOS with obese and 28 control group participants were included in this case-control study. Hormone profiles of the participants (alarin, insulin, estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-SO4 ), lipid profiles total testosterone, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, cholesterol) and fasting blood sugar (FBS) values were measured. Results: Serum androgens were elevated in the PCOS. Blood LH was also elevated (P < 0.05) but was higher in PCOS than Control. Patients with PCOS had an increased alarin compared with controls. LH/FSH ratio and Alarin /FSH ratio were greater than 2.1, 2.4, respectively. The blood alarin levels were significantly correlated with the serum LH levels (r=0.492, p=0.002) and the LH/FSH ratios (r=0.450, p<0.001) and Alarin/ FSH ratios. The FSH/LH and alarin /FSH ratio were elevated in the PCOS. Based on these results, the FSH/LH and Alarin /FSH ratio appears to be a useful marker of PCOS.

Obesity in relation to clinical, endocrine and metabolic parameters in infertile women with polycystic ovary syndrome: the South Asian perspective

2021 ◽  
Vol 20 (4) ◽  
pp. 864-870
Author(s):  
Shakeela Ishrat ◽  
Marufa Hossain
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Polycystic Ovary Syndrome ◽  
South Asian ◽  
Polycystic Ovary ◽  
Metabolic Parameters ◽  
The South ◽  
Ovary Syndrome ◽  
Infertile Women

Background: Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive age women and it is a common cause of infertility in young women. Most of the infertile women with PCOS are overweight or obese. Obesity or excess fat aggravates the endocrine and metabolic dysfunction in women with PCOS. Weight management is the first line measure advised to infertile PCOS women who are overweight or obese. The objective of the study was to explore the association of obesity with the clinical, endocrine and metabolic parameters in infertile women with polycystic ovary syndrome in Bangladesh. Methodology: This was a cross sectional study of 126 consecutive infertile women with polycystic ovary syndrome attending the Infertility unit of the Department of Obstetrics and Gynecology at Bangabandhu Sheikh Mujib Medical University from January 2017 to December 2017.Obesity groups were defined by BMI thresholds specific for the South Asian population. Results: The mean body mass index (BMI) was 26.58±3.18 kg/m2and mean waist circumference was 91.07±9.5 cm. There was highly significant association of obesity with waist circumference and fasting insulin. BMI at or above 25kg/m2 was significantly associated with acanthosis nigricans, hyperandrogenemia and hyperinsulinemia, whereas BMI at or more than 23kg/m2 was significantly associated, in addition, with insulin resistance and metabolic syndrome. Conclusion: Obesity is associated with hyperandrogenemia, hyperinsulinemia, insulin resistance and metabolic syndrome in infertile women with polycystic ovary syndrome. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.864-870

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