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ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 179-183

Hormonal, metabolic, and Vitamin D status variabilities among Saudi women with polycystic ovarian syndrome versus nonpolycystic ovarian syndrome controls: A retrospective study


Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia

Date of Submission21-Aug-2022
Date of Decision05-Oct-2022
Date of Acceptance10-Oct-2022
Date of Web Publication30-Nov-2022

Correspondence Address:
Ramya Ahmad Sindi
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah Street, Makkah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_91_22

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  Abstract 


Background: Vitamin D deficiency in Saudi Arabia is alarmingly high and can affect all human ages. However, the characteristic hormonal and metabolic features, and the systemic Vitamin D levels, among Saudi women with polycystic ovarian syndrome (PCOS) remain largely unknown. Aims: This retrospective study aimed to identify the hormonal, metabolic, and Vitamin D status variabilities among infertile Saudi women with PCOS versus those of non-PCOS fertile women as controls. Materials and Methods: The medical records of a total of 99 women (49 PCOS and 50 controls), with matched age and body mass index, were analyzed in this study. For each woman who met the study inclusion criteria, the analyzed parameters included the serum levels of 25-hydroxyvitamin D (25(OH) D), sex hormone-binding globulin (SHBG), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), androgen, total testosterone (TT), estradiol, progesterone, thyroid hormones, the fasting plasma glucose (FPG), and lipid profile concentrations. Results: Compared to the controls, women with PCOS had significantly lower levels of 25(OH) D, SHBG, FSH, and estradiol, but they had significantly higher levels of LH, androgen, TT, FPG, total cholesterol, and low-density lipoprotein cholesterol. There were no differences between the two groups regarding the other parameters. Conclusions: The present findings highlight the prevalence of sex hormones, metabolic, and Vitamin D status disturbances among Saudi women with PCOS. Large-scale retrospective and prospective studies are therefore essential to realize these findings.

Keywords: Metabolic disruptions, ovary, polycystic ovarian syndrome, serum 25-hydroxyvitamin D, sex hormones, Vitamin D deficiency


How to cite this article:
Sindi RA. Hormonal, metabolic, and Vitamin D status variabilities among Saudi women with polycystic ovarian syndrome versus nonpolycystic ovarian syndrome controls: A retrospective study. Saudi J Health Sci 2022;11:179-83

How to cite this URL:
Sindi RA. Hormonal, metabolic, and Vitamin D status variabilities among Saudi women with polycystic ovarian syndrome versus nonpolycystic ovarian syndrome controls: A retrospective study. Saudi J Health Sci [serial online] 2022 [cited 2023 Jan 28];11:179-83. Available from: https://www.saudijhealthsci.org/text.asp?2022/11/3/179/362382




  Introduction Top


Polycystic ovarian syndrome (PCOS) is a highly complexed endocrine and metabolic disorder which affects up to 20% of worldwide women at their reproductive age. Phenotypically, PCOS is a heterogeneous disorder, and it is clinically characterized by chronic oligoovulation and/or anovulation, irregular menstrual cycles, polycystic ovaries, and clinical and/or biochemical indices of hyperandrogenism, insulin resistance (IR), and other metabolic and hormonal deteriorations.[1],[2],[3]

Vitamin D is recently described as a pluripotent/multimodal hormone due to the widespread expression of its receptors in various human tissues, besides its ordinary physiological function in regulating Ca+2 and P+4 hemostasis and bone mineral metabolism.[4] Even though the definitive underlying etiology of PCOS did not conclude yet, multiple genetic, nutritional, and environmental factors are intertwined in PCOS pathogenicity, severity, and heterogeneity of its complications.[5],[6] To that end, several reports have postulated that 67%–85% of PCOS women have impaired Vitamin D status, and its deficiency has a predominant role in the development and exacerbation of ovarian dysfunctionality, sex hormones irregularities, IR, impaired blood glucose metabolism, and other endocrine-metabolic features of PCOS;[7],[8],[9],[10] assuming the screening essentiality of Vitamin D status in all reproductive women with PCOS.[11],[12] In that respect, Vitamin D deficiency in Saudi Arabia is alarmingly high and can affect all human ages with an approximate prevalence rate of 63%.[13] Nevertheless, the characteristic hormonal and metabolic features, and the systemic Vitamin D levels, among Saudi women with PCOS remain largely unknown.

Therefore, this retrospective study was designed to compare the sex hormonal, metabolic, and Vitamin D statuses of a population of infertile Saudi women with PCOS versus those of non-PCOS fertile control women.


  Materials and Methods Top


Study type, design, and participants

The present retrospective study was carried out by reviewing and analyzing the medical records of a total of 99 reproductive-aged Saudi women (20–49 years old) who were seeking health-care checkups at the Department of Clinics for Gynecology and Obstetrics in Jeddah region, Saudi Arabia, during January 2021 to April 2022. As per the World Health Organization (WHO) estimation, women of reproductive age are defined as 15–49 years.[14] The study participants included women who were diagnosed as they had PCOS (PCOS group, n = 49) and non-PCOS women (control group, n = 50) who had regular menstrual and ovulation cycles. For each study participant, the following data were collected: age, body mass index (BMI) value according to the WHO classification criteria,[15],[16] fasting plasma glucose (FPG), lipid profile concentrations, and the serum levels of sex hormone-binding globulin (SHBG), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), androgen, total testosterone (TT), estradiol, progesterone, thyroid-stimulating hormone (TSH), free thyroxin hormone (FT4), and 25-hydroxyvitamin D (25(OH)D). In this regard, 25(OH)D values of 20, 21–29, and ≥30 ng/mL were respectively considered as Vitamin D deficient, insufficient, and adequate statuses based on the Endocrine Society Clinical Practice Guidelines.[17]

Notably, diagnosis of PCOS by the obstetrics and gynecology specialists was based on the universal Rotterdam diagnostic criteria of PCOS which states that at least two of the following three characteristics confirm the positivity of a PCOS case: (1) chronic oligoovulation or anovulation, (2) clinical signs or biochemical indices of hyperandrogenism, and (3) morphological features of polycystic ovaries as determined on ultrasonography.[18] It also included the differential diagnosis of PCOS from other known causes of female infertility, for example, Cushing's syndrome, hyperprolactinemia, congenital adrenal hyperplasia, and malignancies secreting androgen hormones.[18] In addition, the study exclusion criteria also included pregnancy, diabetes mellitus, any PCOS or control women whose medical record did not contain her 25(OH)D level, and any women who received any Vitamin D supplement or hormonal/contraceptive treatment during 3 months before the enrollment. According to the previously published worldwide studies of PCOS, the minimum sample size sample was estimated as 50 women (i.e., 25 women per group) of 95% study power.[17]

Statistical analysis

Data analysis was carried out using SPSS Statistics Software Package for Windows, Version 18.0 (IBM Corp., Armonk, NY, USA). Means ± standard deviation was used to express continuous data, whereas numbers and percentages were used to express nominal variables. The Chi-square test and Student's t-test were respectively used for categorical data and continuous variables. The statistical significance was set at P < 0.05.


  Results Top


As shown in [Figure 1]a, the levels of 25(OH)D were significantly lower in women with PCOS as compared to its values in non-PCOS control women (21.3 ± 6.4 ng/mL versus 35.8 ± 5.2 ng/mL; P < 0.05). Furthermore, the participants of the PCOS group were re-classified into 8 women (16.3%), 36 women (73.5%), and 5 women (10.2%) who had adequate, insufficient, and deficient levels of Vitamin D, respectively. On the contrary, only three women (6%) in the control group were deficient in Vitamin D, whereas the reminding 47 women (94%) had adequate 25(OH)D levels [Figure 1]b.
Figure 1: (a) 25(OH)D concentration and its distribution among the women with PCOS compared to non-PCOS control women. (b) This classification is according to the Endocrine Society Clinical Practice Guidelines for 25(OH)D levels and interpretations of Vitamin D status. The 25(OH)D values of 20 (deficient), 21–29 (insufficient), and 49 and ≥30 ng/mL (adequate statuses). *P < 0.05. 25(OH)D: 25-hydroxyvitamin D, PCOS: Polycystic ovarian syndrome

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Regarding the hormonal findings, [Table 1] shows that LH, androgen, and testosterone hormone concentrations were significantly higher (P < 0.05), whereas FSH, estradiol, and SHBG levels were significantly lower (P < 0.05) in women with PCOS compared to non-PCOS control women. There were no statistical differences between the two groups regarding the circulating levels of progesterone, prolactin, and thyroid function hormones (TSH and FT4) [Table 1].
Table 1: Hormonal characteristics of the women with polycystic ovarian syndrome compared to nonpolycystic ovarian syndrome control women

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Finally, the biochemical findings of the present study [Figure 2] demonstrated that women with PCOS had an opportunity to be diabetic and to develop hyperlipidemia metabolic disorders, whereas they had significantly higher levels of FPG and indices of hypercholesteremia. The FPG level was 113.7 ± 9.6 mg/dL in PCOS women versus 92.5 ± 11.2 mg/dL in control women (P < 0.05). Similarly, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were 217.4 ± 15.6 mg/dL and 106.2 ± 14.6 mg/dL, in PCOS women versus 173.8 ± 11.2 mg/dL and 81.8 ± 7.5 mg/dL in control women, respectively (P < 0.05) [Figure 2].
Figure 2: Biochemical characteristics of the women with PCOS compared to non-PCOS control women. FPG; TC; LDL-C; HDL-C; and TTG. *P < 0.05. PCOS: Polycystic ovarian syndrome, FPG: Fasting plasma glucose, TC: Total cholesterol, LDL-C: Low-density lipoprotein cholesterol, HDL-C: High-density lipoprotein cholesterol, TTG: Total triglycerides

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  Discussion Top


This retrospective study measured the hormonal, metabolic, and Vitamin D status (25(OH)D levels) variabilities among a population of infertile Saudi women with PCOS versus those of aged and BMI-matched non-PCOS fertile women as controls. Overall, the results showed that women with PCOS had significantly lower levels of 25(OH)D, SHBG, FSH, and estradiol, but they had significantly higher levels of LH, androgen, TT, FPG, total cholesterol, and LDL-C, as compared to the non-PCOS control women.

The present findings are in constancy with those reported earlier by Li et al.[19] and Pal et al.[20] that Vitamin D deficiency is highly prevalent among PCOS women. Furthermore, Thomson et al. have previously reported that up to 67%–85% of women with PCOS had 25(OH)D levels <20 ng/mL.[7] Vitamin D depletion has gained increased interest over the recent years in the biomedical and health research of female reproductive disorders, including PCOS. The contributions of Vitamin D deficiency in increasing incidence and severity of IR, ovarian dysfunctionality, low SHBG production, and hormonal and metabolic imbalances in PCOS patients have been largely suggested.[7],[21],[22] In that regard, the associations between low 25(OH)D levels and ovarian folliculogenesis abnormalities,[4],[12],[23] inhibition of SHBG production from liver cells,[24] and excess testosterone and androgen production from their ordinary cells,[4],[12],[25] have been reported among PCOS patients worldwide. Furthermore, both hypovitaminosis D and IR cooperate together in the inhibition of SHBG production and induction of ovarian hyperandrogenism.[21]

The biochemical findings of the present study demonstrated that women with PCOS had an opportunity to be diabetic and to develop hyperlipidemia metabolic disorders, whereas they had significantly higher levels of FPG and indices of hypercholesteremia. In support, Joham et al.[26] and He et al.[27] have previously reported the inverse link between hyperglycemia and other metabolic deteriorations and 25(OH)D levels in PCOS. Similarly, Li et al. revealed a negative link between high-density lipoprotein cholesterol and 25(OH)D levels in PCOS women.[24] Furthermore, several earlier reports have raised the crucial role of impaired Vitamin D status in increasing the incidence of metabolic syndrome, IR, type II diabetes, hyperlipidemia, and cardiovascular diseases in PCOS.[4],[27],[28],[29] Mechanistically, low Vitamin D statuses have been supposed to be involved in pancreatic β-cell dysfunctionality, insulin receptors desensitization, and abnormalities in blood glucose and lipid metabolism among PCOS patients.[13],[23],[24],[27],[28],[29]

Study limitations

Indeed, till now, there are rare evidence related to the prevalence of PCOS among the Saudi female population – and the performances of their metabolic and hormonal profiles and Vitamin D status. In turn, the present findings can serve as an additive point in improving the diagnostic criteria and the therapeutic targets in PCOS patients. Despite these strengths, important limitations were inevitably identified in the present study and should be addressed in future. First, data from the present retrospective study were drawn from the medical records of a limited-size sample. Thus, it cannot represent the overall national prevalence and performance of PCOS in Saudi Arabia. Second, the possible influences of demographic data of participants, disease phenotyping and comorbidities, obesity, and BMI variable, on PCOS performance and its metabolic/hormonal deteriorations, which are collectively been reported in several worldwide literature, are not considered here. Third, and most importantly, due to a lack of information related to the serum insulin levels of study participants, the possible linking between 25(OH)D and IR; SHBG and IR, and IR and hyperandrogenemia are also not covered here. Coherently, to confirm the present findings, further large-scale and multicenter retrospective and prospective studies are essentially required, in which all aforementioned study weaknesses should be addressed.


  Conclusions Top


The present study suggests that Saudi women with PCOS have a high opportunity to present remarkable disruptions in their hormonal and metabolic parameters, and lower Vitamin D levels, compared to non-PCOS healthy women. However, future large-scale studies are essentially required to realize the present observations. In addition, randomized controlled Vitamin D supplement-based clinical trials are also needed to better understand how Vitamin D can influence the etiopathogenesis of PCOS and its performance among the Saudi female population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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