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Brothers of women with polycystic ovary syndrome: a group with high risk for type 2 diabetes mellitus and cardiovascular diseases studied in Egyptian population.

INTRODUCTION

I Polycystic ovary syndrome Polycystic Ovary Syndrome Definition

Polycystic ovary syndrome (PCOS) is a condition characterized by the accumulation of numerous cysts (fluid-filled sacs) on the ovaries associated with high male hormone levels, chronic anovulation (absent ovulation),
 (PCOS PCOS polycystic ovary syndrome.
Polycystic ovarian syndrome (PCOS)
A condition in which the eggs are not released from the ovaries and instead form multiple cysts.

Mentioned in: Oophorectomy, Ovarian Cysts
) is a common endocrine and metabolic disorder affecting 5-10% of reproductive -aged women (1-2), characterized by hyperandrogenism, chronic anovulation anovulation /an·ov·u·la·tion/ (an?ov-u-la´shun) absence of ovulation.

an·o·vu·la·tion
n.
Suspension or cessation of ovulation.
, polycystic ovaries along with abdominal obesity and insulin resistance as frequent metabolic traits which in association with other features of the metabolic syndrome can lead to increased risk for type 2 diabetes type 2 diabetes
n.
See diabetes mellitus.
 and cardiovascular disease (CVD CVD Cardiovascular disease, see there ). (3-7)

Hyperandrogenemia, insulin resistance and dyslipidemia demonstrate a familial aggregation in the female first degree relatives of women with PCOS, suggesting a genetic basis of the syndrome. However, the exact pattern of inheritance has not yet been determined. (8-10) In addition, a previous study identified one PCOS susceptibility allele allele (əlēl`): see genetics.
allele

Any one of two or more alternative forms of a gene that may occur alternatively at a given site on a chromosome.
 in fibrillin-3 gene that is linked to and associated with hyperandrogenemia and markers of insulin resistance in PCOS women. (11)

Male metabolic phenotype in PCOS families is not well defined, while hyperandrogenemia appears to be the male reproductive phenotype. (12) It has been suggested that hyperandrogenemia plays a direct role in the development of associated metabolic abnormalities in female relatives of PCOS women (9,13); these data together with familial clustering of PCOS suggest that male relatives of PCOS women may develop similar metabolic defects and hence may be at increased risk of CVD. The aim of the present study was to assess insulin sensitivity and metabolic parameters in brothers of Egyptian women with PCOS.

SUBJECTS AND METHODS

In total 30 brothers of women with PCOS and 20 male control subjects were recruited in the study. The eligible for the study women were treated at the Outpatient Clinic of Diabetes and Endocrinology and Fertility unit of Mansoura University. The diagnosis of PCOS was made according to Rotterdam Revised Criteria (2004) (14) including oligo and/or anovulation, clinical and/or biochemical hyperandrogenemia and polycystic ovaries by ultrasound with exclusion of patients with hyperprolactinemia, congenital adrenal hyperplasia Congenital Adrenal Hyperplasia Definition

CAH is a genetic disorder characterized by a deficiency in the hormones cortisol and aldosterone and an over-production of the hormone androgen, which is present at birth and affects sexual development.
, known androgen secreting neoplasm neoplasm or tumor, tissue composed of cells that grow in an abnormal way. Normal tissue is growth-limited, i.e., cell reproduction is equal to cell death. , and thyroid disease. The control subjects were healthy men with age and BMI BMI body mass index.

BMI
abbr.
body mass index


Body mass index (BMI)
A measurement that has replaced weight as the preferred determinant of obesity.
 matching to the study group, with no first degree family history of PCOS or diabetes, and without personal history of hypertension. None of the participants was diabetic or had used insulin sensitizing sen·si·tize  
v. sen·si·tized, sen·si·tiz·ing, sen·si·tiz·es

v.tr.
1. To make sensitive: "The polarity principle . . .
 or lipid lowering drugs or any medication known to affect sex hormone metabolism.

All participants were subjected to complete medical and familial history. Weight and height of the subjects were measured while wearing light clothing and no shoes. BMI was calculated as weight (kg) divided by squared height (meter). Waist circumference was measured at the narrowest level between the costal margin and the iliac crest at the end of a normal expiration. Blood pressure was recorded following a 5 minutes rest period in the sitting position.

Blood samples were obtained after overnight fast from all subjects. Fasting plasma glucose levels were determined by enzymatic method. Fasting serum insulin was measured by enzyme immunoassay using MEDGENIX-INS-EASIA kit. (15) The homeostasis homeostasis

Any self-regulating process by which a biological or mechanical system maintains stability while adjusting to changing conditions. Systems in dynamic equilibrium reach a balance in which internal change continuously compensates for external change in a feedback
 model assessment of insulin resistance (HOMA-IR) was calculated according to the formula: fasting glucose (mmol/L) x fasting insulin ([micro]U/ml)/22.5. (16)

Total cholesterol and triglycerides Triglycerides
Fatty compounds synthesized from carbohydrates during the process of digestion and stored in the body's adipose (fat) tissues. High levels of triglycerides in the blood are associated with insulin resistance.
 were measured by enzymatic colorimetric col·or·im·e·ter  
n.
1. Any of various instruments used to determine or specify colors, as by comparison with spectroscopic or visual standards.

2.
 tests (Human-Germany). (17) HDL-C HDL-C high-density-lipoprotein cholesterol.  was determined by precipitation method (Human-Germany), then LDL-C LDL-C low-density-lipoprotein cholesterol  was calculated by Friedewald equation. (18) C-reactive protein (CRP C-reactive protein (CRP)
A protein present in blood serum in various abnormal states, like inflammation.

Mentioned in: Pelvic Inflammatory Disease

CRP,
n.pr See C-reactive protein.
) was measured by immunoprecipitation assay (Diagnostica Turbox, CRP). (19) Plasminogen activator inhibitor-1 (PAI-1) was measured by ELISA ELISA (e-li´sah) Enzyme-Linked Immuno-Sorbent Assay; any enzyme immunoassay using an enzyme-labeled immunoreactant and an immunosorbent.

ELISA
n.
. (20)

Serum testosterone and dehydroepiandrosterone sulfate (DHEA-SO4) were measured by solid phase competitive chemiluminescent chem·i·lu·mi·nes·cence  
n.
Emission of light as a result of a chemical reaction at environmental temperatures.



chem
 enzyme immunoassay, while sex hormone binding globulin Sex hormone-binding globulin (SHBG) is a glycoprotein that binds to sex hormones, specifically testosterone and estradiol. Other steroid hormones such as progesterone, cortisol, and other corticosteroids are bound by transcortin.  (SHBG SHBG sex hormone.

SHBG

sex hormone-binding globulin.

SHBG Sex hormone binding globulin, see there
) was measured by sandwich chemiluminescent enzyme immunoassay (IMMULITE/ IMMULITE 1000 analyzer, SIEMENS Medical Solutions Siemens Medical Solutions (Siemens Med) is a supplier to the healthcare industry, and is headquartered in Erlangen, Germany. Its U.S. division, Siemens Medical Solutions USA, Inc., is a Delaware corporation, with headquarters in Malvern, Pennsylvania.  

Diagnostics, Los Angeles, CA, 90045-6900 USA). Free testosterone was measured by direct quantitative determination by enzyme immunoassay (Direct ELISA kit, Diagnostic Biochem Canada Inc).

Statistical analysis

Statistical analysis was done using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance.  program version 10. To compare between groups, student t-test and Chi-square test were used. Correlation co-efficiency test was used to test for association between variables. P value was considered significant if less than 0.05.

RESULTS

PCOS brothers and control subjects were similar in terms of age and BMI, with no significant differences between the two groups as regards waist to hip ratio or systolic Systolic
The phase of blood circulation in which the heart's pumping chambers (ventricles) are actively pumping blood. The ventricles are squeezing (contracting) forcefully, and the pressure against the walls of the arteries is at its highest.
 and diastolic blood pressure Diastolic blood pressure
Blood pressure when the heart is resting between beats.

Mentioned in: Hypertension
 (Table 1).

Compared with control subjects, brothers had statistically significant higher fasting insulin (10.7+3.54 vs 7.9+2.74, P=0.004), higher HOMA-IR (2.35+1.079 vs 1.77+0.79, P=0.043), higher total cholesterol (186.9+23 vs 165.7+18, P=0.001), higher triglycerides (125.4+35 vs 106.9+27.15, P=0.048), higher LDL-C (112.4+25 vs 92+18, P=0.002) and lower HDL-C (45.6+5.9 vs 49.3+6.2, P=0.03) (Table 2).

PAI-1 and CRP levels were significantly higher in brothers compared to control group (41+12 vs 31.2+6.98, P=0.002 & 2.9+1.07 vs 2.31+0.86, P=0.046 respectively). DHEAS DHEAS Dehydroepiandrosterone Sulfate  levels were significantly higher in brothers of PCOS women than in control subjects (3063.7+732.9 vs 2599.6+609.1, P=0.023), no significant differences were found between both groups as regard total testosterone, free testosterone, or SHBG levels (Table 3).

Correlation analysis of HOMA-IR in brothers showed positive correlation with BMI (r=0.63, P<0.001), WHR WHR World Health Report
WHR Waist-to-Hip Ratio
WHR Welsh Highland Railway (UK)
WHR Western Hemisphere Region
WHR Watt Hour
WHR Witch Hunter Robin (anime)
WHR Waste Heat Recovery
 (r=0.68, P<0.001), PAI-1 (r=0.62, P<0.001), CRP (r=0.52, P<0.01), TG (r=0.72, P<0.001) and LDL-C (r=0.43, P=0.02), and negative correlation with HDL-C (r=-0.44, P=0.019) (Table 4).

DISCUSSION

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders found in humans. The syndrome presents with a wide range of symptoms and longterm health consequences. These include infertility, menstrual disturbances, enlarged cystic ovaries, hirsutism Hirsutism Definition

Excessive growth of facial or body hair in women is called hirsutism.
Description

Hirsutism is not a disease. The condition usually develops during puberty and becomes more pronounced as the years go by.
, acne, hormonal imbalance. (21)

Two of the major health consequences of women with PCOS include an increased prevalence of type 2 diabetes mellitus Type 2 diabetes mellitus
One of the two major types of diabetes mellitus, characterized by late age of onset (30 years or older), insulin resistance, high levels of blood sugar, and little or no need for supple-mental insulin.
 and cardiovascular diseases (CVD). CVD is a major lethal factor, particularly in men and type 2 DM occurs in 4% of men and the risk of death from CVD is thought to rise between 2.5-8 fold in diabetic population. In addition to an impact on mortality, the economic burden of CVD and type 2 DM is substantial. (22)

Any measures to identify at risk populations where appropriate interventions can be applied early to reduce the health and economic burden of CVD and type 2 DM are clearly a priority. Given the familial clustering of PCOS, their brothers would be an ideal group that could be targeted. More importantly, this would be at a young age, as women with PCOS usually present early in their reproductive life. The aim of our study was to focus on the risk of metabolic disorders (CVD and type 2 DM) specifically in brothers of women with PCOS, studying Egyptian participants.

Dyslipidemia (an accepted risk factor for CVD) may be the most common metabolic abnormality in PCOS. Therefore, the first degree relatives of PCOS subjects should be examined for dyslipidemia and treated with hypolipidemic treatment. In our study we found that brothers of women with PCOS have dyslipidemia, there were significant increase in total and LDL-cholesterol levels and in triglycerides levels and significant decrease in HDL-cholesterol compared to control group's men. There were significant positive correlations between HOMA-IR and LDL LDL - ["LDL: A Logic-Based Data-Language", S. Tsur et al, Proc VLDB 1986, Kyoto Japan, Aug 1986, pp.33-41]. , TC and TG but significant negative correlation with HDL-C in brothers of women with PCOS. Our above findings were similar to those reported in women with PCOS and are in consistent with the findings of Sam et al. ( 2006)9 who support the hypothesis that some metabolic features of PCOS are heritable her·i·ta·ble
adj.
1. Capable of being passed from one generation to the next; hereditary.

2. Capable of inheriting or taking by inheritance.
 and are not sex specific.

Insulin resistance is central to the pathogenesis of type 2 DM and PCOS with strong genetic basis and important implications for the management of both disorders. In our study brothers of women with PCOS showed insulin resistance, hypercoagulability and inflammation as represented by higher fasting insulin, HOMA-IR, PAI-1 and CRP than control, and similar results have recently been reported by Baillargeon and Carpentier in American populations. (23) Also we found significant correlations of HOMA-IR with lipid abnormalities, PAI-1 and CRP. These findings confirm the results of previous studies which suggested that hyperinsulinemia and insulin resistance may be an important marker in family members of PCOS patients. (24,25)

PCOS itself has been accepted as a major risk factor for the development of type 2 DM. DM screening in patients with PCOS is recommended by current American Diabetes Association The American Diabetes Association, or the ADA, is an American health organization providing diabetes research, information and advocacy. Founded in 1940, the American Diabetes Association conducts programs in all 50 states and the District of Columbia, reaching hundreds of  Guidelines. (26) Taken together, these findings suggest that normal glucose tolerance first degree relatives of women with PCOS can be predicted to be at risk for developing glucose intolerance. Similarly, the family history of heart disease is consistent with those studies which demonstrated several risk factors for heart disease in PCOS women such as obesity, insulin resistance, hyperlipidemia hyperlipidemia /hy·per·lip·id·emia/ (-lip?i-de´me-ah) elevated concentrations of any or all of the lipids in the plasma, including hypertriglyceridemia, hypercholesterolemia, etc. , and raised PAI-1. (5)

Whether insulin resistance in brothers of women with PCOS is genetic, programmed in utero or environmental is unclear. Xita and Tsatsoulis (27), reported a high prevalence of risk factors for cardiovascular disease in brothers but not in fathers of women with PCOS and this is in consistent with the fetal programming hypothesis. The in utero maternal environment from poor nutrition or androgen excess may program children of mothers with PCOS to develop the condition. It is also thought that these factors may interact with common polymorphic variants of genes determining androgen activity or genes that influence the availability of androgen to target tissues in PCOS. (28,29)

Our results suggest that there is a male biochemical reproductive phenotype in PCOS families. Circulating levels of the adrenal adrenal /ad·re·nal/ (ah-dre´n'l)
1. paranephric.

2. adrenal gland.

3. pertaining to an adrenal gland.


ad·re·nal
adj.
1.
 androgen DHEAS were significantly increased in brothers of PCOS women compared with control men. There were no other significant changes in reproductive hormone levels in the brothers of PCOS women, which may reflect a genetic defect in steroidogenesis steroidogenesis /ste·roi·do·gen·e·sis/ (ste-roi?do-jen´e-sis) production of steroids, as by the adrenal glands.steroidogen´ic

ste·roid·o·gen·e·sis
n.
The biological synthesis of steroids.
. (30) We did not find elevated testosterone levels in brothers of PCOS women. This might be because testosterone may feedback on the hypothalamic-pituitary axis to modulate its own secretion in women or because the substantially greater male testosterone production rates makes it difficult to discern subtle changes in circulating levels. (31)

In summary, brothers of women with PCOS have a metabolic phenotype consisting of dyslipidemia, insulin resistance, dyscoagulability and low grade inflammation and these results support the finding that, similar to PCOS patients, their first degree relatives also carry an increased risk of CVD and type 2 DM. Given the high prevalence of PCOS, male first degree relatives may represent an important new risk factor for CVD in men and should be considered a well identified group for primary preventive measures. From a point of view that is necessarily adopted by epidemiological studies, our outcomes in Egyptian populations seem to share the picture reported in different parts of the world. In a later phase of our research, we may need to highlight the key differences between the hormone profiles reported in the different continents.

REFERENCES

(1.) Asunciun M, Calvo RM, San Mill_n JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000;85:2434-2438.

(2.) Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-2749.

(3.) Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997;18:774-800.

(4.) Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome Polycystic ovarian syndrome (PCOS)
A condition in which the eggs are not released from the ovaries and instead form multiple cysts.

Mentioned in: Oophorectomy, Ovarian Cysts
. Metabolism 2003;52:908-915.

(5.) Legro RS. Polycystic ovary syndrome and cardiovascular disease a premature association. Endocr Review 2003;24:302-312.

(6.) Baillargeon JP. Use of insulin sensitizer sensitizer

see antigen.
 in polycystic ovarian syndrome. Curr Opin Investg Drugs 2005;6:1012-1022.

(7.) Hunter A, Vimplis S, Sharma A, Eid N, Atiomo W. To determine whether first-degree male relatives of women with polycystic ovary syndrome are at higher risk of developing cardiovascular disease and type II diabetes Type II diabetes
Type II diabetes is the most common form of diabetes and usually appears in middle aged adults. It is often associated with obesity and may be delayed or controlled with diet and exercise.

Mentioned in: Diabetic Ketoacidosis
 mellitus. J Gynecol 2007;27 (6): 591-596.

(8.) Yilmaz M, Bukan N, Ersoy R, Karakoc A, Yetkin I, Ayvaz G, et al. Glucose intolerance, insulin resistance and cardiovascular risk factors in first degree relatives of women with polycystic ovary syndrome. Hum Reprod 2005;20:2414-242

(9.) Sam S, Legro RS, Essah PA, Apridonidze T, Dunaif A. Evidence for metabolic and reproductive phenotypes in mothers of women with polycystic ovary syndrome. Proc Natl Acad Sci 2006;USA 103:7030-7035.

(10.) Yildiz BO, Yarali H, Oguz H, Bayraktar M. Glucose intolerance, insulin resistance, and hyperandrogenemia in first degree relatives of women with PCOS. Clin Endocr Metab 2003;88:2031-2036.

(11.) Urbanek M, Sam S, Legro RS, Dunaif A. Identification of a PCOS susceptibility variant in fibrillin-3 and Assoc with metabolic phenotype. J Endocrinol Metab 2007;92:4191-4198.

(12.) Legro RS, Kunselman AR, Demers L, Wang SC, Bentley-Lewis R, Dunaif A. Elevated dehydroepiandrosterone sulfate levels as the reproductive phenotype in the brothers of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2002;87:2134-2138.

(13.) Sam S, Legro RS, Bentley-Lewis R, Dunaif A. Dyslipidemia and metabolic syndrome in the sisters of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90:4797-4802.

(14.) The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-47.

(15.) Frier BM, Ashby JP, Nairn IM and Bairs JD. Plasma insulin, C-peptide and glucagons concentrations in patients with insulin independent diabetes treated with cholorpropamide. Diab Metab 1981;7(1): 45-49.

(16.) Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-419.

(17.) Schettler G, Nussel E.Arb Med Soz Med Prav Med 1975;10:25.

(18.) Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein in plasma, without use of the preparative pre·par·a·tive  
adj.
Serving or tending to prepare or make ready; preliminary.

n.
Something that prepares for or acts as a preliminary to something following.
 ultracentrifuge ul·tra·cen·tri·fuge
n.
A centrifuge that uses high-velocity rotations to achieve the separation of colloidal or submicroscopic particles.



ul
. Clin Chem 1972;18:499-502.

(19.) Fischer CL, Gill C, Forrester MG, Nakamura R. Quantitation of "acute-phase proteins" postoperatively. Value in detection and monitoring of complications. Am J Clin Path 1976;66:840-846.

(20.) Declerck P. Measurement of plasminogen activator inhibitor-1 in biological fluids with murine monoclonal antibody based enzyme linked immunosorbent immunosorbent /im·mu·no·sor·bent/ (-sor´bent) an insoluble support for antigen or antibody used to absorb homologous antibodies or antigens, respectively, from a mixture; the antibodies or antigens so removed may then be eluted in pure  assay. Blood 1989;71:220-225.

(21.) Lakhani K, Prelevic GM, Seifalian AM, Atiomo WU, Hardiman P. Polycystic ovary syndrome, diabetes and cardiovascular disease: risks and risk factors. PCOS, diabetes and CVD risk & risk factors. J Obstet Gynaecol. 2004 Sep; 24(6):613-21.

(22.) British Heart Foundation The British Heart Foundation is a charity organisation in the United Kingdom that funds research, education, care and awareness campaigns aimed to prevent heart diseases in humans.  Coronary Heart Statistics,2005. (Available at www.heartstat.org, first cited 29 October 2005).

(23.) Baillargeon JP, Carpentier AC. Brothers of women with polcystic ovary syndrome are characterized by impaired glucose tolerance Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. IGT may precede type 2 diabetes mellitus by many years. IGT is also a risk factor for mortality. , reduced insulin sensitivity and related metabolic defects. Diabetologia 2007;50(12):2424-32.

(24.) Yildiz BO, Goodarzi MO, Guo X, Rotter JI, Azziz R. Heritability heritability /her·i·ta·bil·i·ty/ (her?i-tah-bil´i-te) the quality of being heritable; a measure of the extent to which a phenotype is influenced by the genotype.

her·i·ta·bil·i·ty
n.
1.
 of dehydroepiandrosterone sulfate in women with polycystic ovary syndrome and their sisters. Fertil Steril 2006;86(6):1688-93.

(25.) Ehrmann DA, Kasza K, Azziz R, Legro RS, Ghazzi MN; PCOS/Troglitazone Study Group.Effects of race and family history of type 2 diabetes on metabolic status of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:66-71.

(26.) American Diabetes Association. Screening for diabetes. Diabetes Care 2002;25: 21-24.

(27.) Xita N and Tsatsoulis A. Fetal programming of PCOS by androgen excess: evidence from experimental, clinical and genetic association studies. Journal of Clin Endocr Metab 2006;91:1660-1666.

(28.) Dunaif A, Xia J, Book CB, Schenker E, Tang Z. Excessive insulin receptor serine serine (sĕr`ēn), organic compound, one of the 20 amino acids commonly found in animal proteins. Only the l-stereoisomer appears in mammalian protein.  phosphorylation phosphorylation, chemical process in which a phosphate group is added to an organic molecule. In living cells phosphorylation is associated with respiration, which takes place in the cell's mitochondria, and photosynthesis, which takes place in the chloroplasts.  in cultured fibroblasts Fibroblasts
A type of cell found in connective tissue; produces collagen.

Mentioned in: Skin Grafting
 and in skeletal muscle. A potential mechanism for insulin resistance in the polycystic ovary syndrome. J Clin Invest 1995;96: 801-810.

(29.) Jahanfar S, Eden JA, Warren P, Seppala M, Nguyen TV. A twin study of polycystic ovary syndrome. Fertil Steril 1995;63:478-486.

(30.) Legro RS, Driscoll D, Strauss JF 3rd, Fox J, Dunaif A. Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome. Proc Natl Acad Sci USA 1998; 95:14956-14960.

(31.) Mooradian AD, Morely JE, Korenman SG. Biological actions of androgens. Endocr Review 1987;8:1-28.

Fayez El-Kenawy (1), Hala Abd El-Hafez (1), Afaf Abd El-Hafez (1) Mohamed Ghoneim (1), Mohamed Atwa (2)

Departments of Internal Medicine (1) and Clinical Pathology (2) Mansoura University, Egypt

Corresponding author: Dr-Afaf abdel-Hafez Specialized Medical Hospital, Dept of Internal Medicine, Mansoura University, 60 El Gomhoria Street, Mansoura Zipcode 35516, Egypt
Table 1. Clinical data of PCOS brothers and control group.

            Brothers               Control           t        P
             (n=30)                (n=20)

Age    28.4 [+ or -] 6.9      29.9 [+ or -] 7.9    0.728     0.47
BMI    27.7 [+ or -] 5.27    26.08 [+ or -] 5.23   1.115     0.27
WHR      92 [+ or -] 0.044    0.91 [+ or -] 0.042  0.763     0.44
SBP   123.8 [+ or -] 13        120 [+ or -] 9      1.066     0.29
DBP      78 [+ or -] 7.5        75 [+ or -] 8      1.41      0.16

Table 2. Insulin resistance and lipid profile in PCOS brothers
and control group.

                                 Brothers               Control
                                  (n=30)                 (n=20)

F. insulin [micro] U/ml     10.7 [+ or -] 3.54      7.9 [+ or -] 2.74
HOMA-IR                     2.35 [+ or -] 1.079    1.77 [+ or -] 0.79
T.cholesterol mg/dl        186.9 [+ or -] 23      165.7 [+ or -] 18
LDL-C mg/dl                112.4 [+ or -] 25         92 [+ or -] 18
HDL-C mg/dl                 45.6 [+ or -] 5.9      49.3 [+ or -] 6.2
TG mg/dl                   125.4 [+ or -] 35      106.9 [+ or -] 27.15

                                    t                      P

F. insulin [micro] U/ml            3.01                  0.004
HOMA-IR                            2.07                  0.043
T.cholesterol mg/dl                3.54                  0.001
LDL-C mg/dl                        3.2                   0.002
HDL-C mg/dl                       -2.13                  0.03
TG mg/dl                           2.02                  0.048

Table 3. PAI-1, CRP and androgens in PCOS brothers and control group.

                        Brothers                 Control
                         (n=30)                   (n=20)

PAI-1 ng/ml          41 [+ or -] 12         31.2 [+ or -] 6.98
CRP mg/l            2.9 [+ or -] 1.07       2.31 [+ or -] 0.86
Total T. ng/dl    526.8 [+ or -] 13.4      513.8 [+ or -] 124.8
Free T. ng/dl     243.1 [+ or -] 88.4     228.87 [+ or -] 77.44
SHGB nmol/L       23.25 [+ or -] 9.67      27.43 [+ or -] 9.05
DHEA ng/ml       3063.7 [+ or -] 732.9    2599.6 [+ or -] 609

                           t                        P

PAI-1 ng/ml              3.303                    0.002
CRP mg/l                 2.04                     0.046
Total T. ng/dl           0.351                    0.72
Free T. ng/dl            0.584                    0.562
SHGB nmol/L             -1.535                    0.131
DHEA ng/ml               2.341                    0.023

Table 4. Correlation of HOMA-IR with some clinical and biochemical
parameters in brothers of PCOS women.

                 r            P

WHR             0.68        <0.001
BMI             0.63        <0.001
PAI-1           0.62        <0.001
CRP             0.52        <0.01
TG              0.72        <0.001
HDL-C          -0.44         0.019
LDL-C           0.43         0.02
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Title Annotation:ORIGINAL ARTICLE
Author:El-Kenawy, Fayez; El-Hafez, Hala Abd; El-Hafez, Afaf Abd; Ghoneim, Mohamed; Atwa, Mohamed
Publication:Archives: The International Journal of Medicine
Article Type:Report
Geographic Code:7EGYP
Date:Jan 1, 2009
Words:3179
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