Evaluation of Lipid Ratios and Triglyceride-Glucose (TyG) Index as Risk Markers of Insulin Resistance in Iranian Polycystic Ovary Syndrome (PCOS) Woman

Background: Insulin resistance has a key role in the pathophysiology of polycystic ovary syndrome (PCOS). Previous investigations have informed that some lipid ratios could be a simple clinical indicator of insulin resistance (IR) in some disorders and ethnicities. We aimed to examine the correlation between triglyceride to HDL-cholesterol (TG/HDL-C), total cholesterol to HDL-cholesterol (TC/HDL-C) and fasting triglyceride-glucose (TyG) indices with IR (as measured by homeostasis model assessment of IR [HOMA-IR], quantitative insulin sensitivity check index [QUICKI] and fasting glucose to insulin ratio [FGIR]), and determine a good clinical predictor for IR in Iranian PCOS woman. Methods: We evaluated 305 PCOS women. After physical evaluations, biochemical parameters were measured using commercial kits and TG/HDL-C, TC/HDL-C and TyG indices were calculated using formula. Fasting insulin level measured using ELISA technique. IR was defined as a HOMA-IR value ≥2.63, FG-IR<8.25 and QUICKI <0.33. Results: The insulin-resistance and insulin-sensitive groups, which established by HOMA-IR, FG-IR and QUICKI values, were different in terms of TG/HDL-C, TC/HDL-C and TyG indices. These indices were associated with IR after adjusting for age and BMI. The under ROC curves (AUC) of TyG, TG/HDL-C and TC/HDL-C for predicting HOMA-IR index were 0.639, 0.619 and 0.623 respectively which were significant, with a p-value 0.012, 0.033 and 0.027, respectively. The AUC of TC/HDL-C (0.614) was significant (p-value 0.04) for predicting FG-IR.Conclusion: Our findings demonstrated that the elevated TyG, TG/HDL-C and TC/HDL-C were significantly associated with IR and could be utilized as indicators of IR among PCOS women in Iran.

SUN-008 Loss of Antimullerian Hormone Immunoreactivity Due to a Homozygous AMH Gene Mutation Rs10417628 in a Woman with Classical Polycystic Ovary Syndrome

Anti-Müllerian hormone (AMH), an inhibitor of primordial/small antral follicle development and Leydig cell androgen synthesis in mice, could exaggerate the polycystic ovary syndrome (PCOS) phenotype, given reports of PCOS-specific AMH loss-of-function mutations (1–3). This report describes a normal-weight PCOS woman with severely reduced AMH levels (index PCOS woman). It examines the molecular basis for her reduced serum AMH levels and also compares her endocrine characteristics to similar-weight PCOS women with detectable AMH. Twenty normo-androgenic ovulatory (control) and 13 age- and body mass index-matched PCOS women (19–35 years; 19–25 kg/m2) underwent transvaginal sonography and serum hormone measures. Wilcoxon rank-sum test compared clinical features of control and PCOS women with detectable AMH, which were then individually ranked by magnitude in all PCOS women. DNA analysis was performed by PCR amplification with direct gene sequencing. The identified mutation was introduced in hAMH-expression plasmids for functional analysis of AMH processing in HEK293 cells by Western blot and ELISA (pico-AMH assay, Ansh Labs, Webster, TX), and for bioactivity in KK-1/AMHR2 cells using a luciferase reporter. Unpaired t-test compared AMH-induced luciferase activity between wild type and mutant AMH. A homozygous AMH gene mutation rs10417628 involving a single base pair substitution in exon 5 (NG_012190.1:g.7705C&gt;T, p.(Ala515Val)) was identified in the index PCOS woman. PCOS women with detectable AMH had higher serum AMH (10.82 [6.74–13.40] ng/mL, Median [IQR]), total/free testosterone (T) (total T: 55.5 [49.5–62.5] ng/dL; fT: 5.65 [4.75–6.6] pg/mL) levels and greater total antral follicle numbers (AFNs) (46 [39–59] follicles) than controls (AMH: 4.03 [2.47–6.11] ng/ml; total T: 30 [24.5–34.5] ng/dL; fT: 2.2 [1.8–2.45] pg/mL; AFNs 16 [14.5–21.5] follicles, P&lt;0.05, all values), along with a trend toward LH hypersecretion (P=0.06). The index PCOS woman with the lowest AMH levels (0.1 ng/ml) did not have the highest serum total T/fT (total T: 89 ng/dL; fT: 7 pg/mL,) or LH levels nor the greatest AFN (43 follicles). In vitro analysis of cells expressing hAMH-515Val or hAMH-515Ala showed that hAMH515-Val, in contrast to hAMH515-Ala, was undetectable and severely reduced in the pico-AMH assay in cell lysates and supernatants, respectively. AMH protein processing and AMH-induced luciferase activity, however, did not differ between hAMH515Val and hAMH515Ala. Thus, homozygous AMH mutation rs10417628 in a PCOS woman can impair serum AMH immunoreactivity without affecting AMH bioactivity, perhaps because of conformational changes from the mutation that only interfere with its immunodetection but not its function. References: 1. Teixeira J, et al. Endocrinology 1999;140:4732 2. Gorsic LK et al. JCEM 2019;104:2855 3. Broekmans FJ, et al. Trends Endocrinol Metab 2008;19:340

Effect of Thyroid Disorder in Polycystic Ovarian Syndrome in the Women of Diyala Province

Background: Polycystic ovarian syndrome (PCOS) is the most endocrine disorder common effect (5-10) % in women at reproductive age. Thyroid dysfunction with PCOS is both representing parts of the endocrine system; this link leads to problems of ovulation and pregnancy. Aims: to investigate the prevalence of thyroid disorder in PCOS woman, and associate the outcome with obesity. Patient and method: This study was conducted in Al-batol Teaching Hospital in Baquba City /Iraq. The results reviewed included 63 women: 45 PCOS were diagnosed on the basis of Rotterdam criteria, 18 as control, aged 17- 44 year. The samples have been collected at second day of menstrual cycle, to test fT3, fT4, fTSH in serum. Information was collected for (Age, BMI, LH, and FSH) to be part of this study. Results: A significant increasing in fT3 was found in PCOS women comparison with control pvalue>0.05. T3 showed in significant differences between lean PCOS matched against control Pvalue < 0.05, along with statistically increasing of TSH level in (lean, overweight) PCOS comparison with control pvalue˂0.05. Conclusion: PCOS is associated with hypothyroidism. Obesity or overweight is a key factor leads to increased risk of thyroid disorder.

The cut off of Ferriman Gallwey score for PCOS in Asia and the degree of hyperandrogenism indicator

<p><strong>Objective:</strong> To determine the distribution of the Ferriman–Gallwey score in Asia and to study any association between hirsutism and endocrine markers, and also to find the cut off of F-G score. </p><p><strong>Background: </strong>Hirsutism is the most widely used clinical diagnostic criterion for hyperandrogenism, it is present in approximately 70% of PCOS women. Using the Ferriman- Gallwey (F-G) scoring systems for evaluation of hirsutism, the degrees of hyperandrogenism from different regions are distinct and have different cut off.</p><p><strong>Material and methods: </strong>A descriptive cross-sectional study was carried out at Dr. Cipto Mangunkusumo General Hospital Jakarta in 2015. Reproductive age women who commits with PCOS criteria were included in the study. Clinical data was taken by interview, physical examination and US examination. Patient’s blood was taken for FTI, and testosterone.</p><p><strong>Results: </strong>The data indicated that 32.4% PCOS woman shows clinical signs of hyperandrogenism, with the minimum score of hirsutism 2 and based on laboratory findings 34.3% subjects show high FTI and testosterone level. However not all patient with high androgen level have a high score of hirsutism. </p><p><strong>Conclusion:</strong> Clinical and laboratory finding of hyperandrogenism have a correlation to determine the score of Ferriman–Gallwey (F-G). The cut off is lower than European and west countries.</p>