Consultant Endocrinologist Golden Hospital, Jalandhar, India Jalandhar, Punjab, India
Objective: Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects ~5 to 10% of women of reproductive age. Studies have reported increased body iron stores in overweight and obese women with PCOS contributing to the insulin resistance and β-cell dysfunction, but there is less information about ferritin levels in non-obese young subjects with PCOS specially in India. The study was planned to evaluate body ferritin level and its association with other hormones and insulin resistance in non-obese young subjects with PCOS.
Methods: It was a cross sectional study and the participants were 70 young non-obese subjects (age 18-25 years) diagnosed as PCOS based on Modified Rotterdam criteria and attending the OPD of an endocrine speciality hospital in the Indian state of Punjab. Age-matched 35 healthy controls were also included. All participants underwent clinical evaluation including anthropometry and had detailed investigations including fasting plasma glucose, insulin, serum ferritin, iron, testosterone, 17 OH-P and DHEAS. HOMA-IR was estimated by the standard equation. The statistical analysis was performed using SPSS software.
Results: Mean age of the participants with PCOS was 21.6±3.7 years and mean BMI was 20.3±2.3. Serum insulin and testosterone levels were significantly higher in subjects with PCOS as compared to controls (p < 0.001). The serum ferritin levels were higher was in PCOS subjects compared to controls (p < 0.001). Serum ferritin levels had a significant positive correlation with insulin (p-0.002), HOMA-IR (p < 0.001) and testosterone levels (p-0.01).
Discussion/Conclusion: PCOS is associated with insulin resistance specially in obese subjects. Increased ferritin level is an associated feature in obese PCOS subjects having features of insulin resistance. Iron induced cellular oxidative stress contributes to the insulin resistance. Studies regarding ferritin levels in non-obese PCOS have shown variable results ranging from normal to high ferritin levels, according to the ethnicity of the population studied. We have found that the young Indian non obese PCOS subjects have higher ferritin levels which correlates with serum insulin, HOMA-IR and testosterone levels. The ‘Asian Indian phenotype’, characterized by high levels of metabolically active abdominal fat and increased insulin resistance even at low levels of BMI, makes these young girls more vulnerable to develop metabolic complications in future. Therefore we suggest inclusion of ferritin estimation, in the routine workup of PCOS so as to screen the young subjects at high risk of developing metabolic complications and plan appropriate management strategies.