Ghrelin , leptin and insulin resistance in Patients with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the prevalent diseases in women. Insulin resistance is a predominant clinical feature in this syndrome. Leptin and ghrelin have significant effects on PCOS. Studies in this field are limited with conflicting results, so this study was designed to evaluate serum leptin and ghrelin and their relationship with insulin resistance and anthropometric indices in women with PCOS. Objectives To investigate the relation between some metabolic hormones and evidence of polycystic ovary syndrome in addition to determine ratios
(serum fasting insulin /serum fasting leptin and fasting glucose/ leptin) and study their variability to be used as a predictive biochemical marker. Subjects and Methods
This case-control study was conducted from November 2012 till June 2013, with simple method sampling on a total of 69 women divided as 39 PCOS women and 30 healthy controls in Al-Khademian Imamian medical city and Higher institute for infertility and assisted reproductive techniques in Baghdad. Weight, height, waist and hip circumferences,
level of serum glucose, lipid profile, reproductive hormones,leptin, ghrelin, insulin, ferritin, and C- reactive protein (CRP) were measured. Body mass index (BMI),waist to hip ratio (WHR)and insulin resistance(by
HOMA-IR index and QUICKI-index) were calculated. Correlation between leptin, ghrelin and insulin esistance with other biomarkers were determined by SPSS software version 16.Results Serum leptin and insulin oncentrations were significantly higher in PCOS patients than control subjects with p value <0.001. Mean of leptin and insulin were respectively (26.48 ± 3.17 ng/ml) and (25.03± 3.09 μU/ml) in PCOS group and (10.1±0.66 ng/ml and 9.32 ± 0.38 μU/ml) in control group respectively. While serum ghrelin concentration was significantly lower in PCOS patients than control subjects with p value<0.001 (235.1 ± 17.36 pg/ml and 489.7 ± 53.4 pg/ml) respectively. Insulin resistance was found significantly higher in PCOS patients. Body mass index (BMI) of PCOS patients was significantly higher than control (31.83+0.82kg/ m2 vs. 26.21 +0.82 kg/m2; p <0.001).Fasting
blood glucose/ Fasting insulin ratio (FBG/ F. Insulin) was significantly correlated with testosterone (p value = 0.022, r = 0.370), while it was significantly negatively correlated with insulin (p value <0.001, r = - 0.766).
On the other hand prolactin was significantly correlated with Fasting blood glucose /Fasting leptin ratio (FBG/F. Leptin) (p value = 0.045, r = 0.376). Conclusion
Infertility in PCOS patients was found as a result from their metabolic hormonal disturbances and obesity is not the only cause because their BMI was ranging from normal to morbid obesity. Ghrelin hormone was significantly lower in patients group and it can be used as a new diagnostic marker in addition to insulin and leptin. Hyperprolactinemia was not the cause for their infertility but the increase in prolactin level resulted from ovary cysts. Fasting (G/L) ratio can be used in addition to IR-indexes in PCOS diagnosis. Finally, fasting (Ins/Lep) ratio was not significant to be
used in predicting PCOS.