Effect of Polycystic Ovary Syndrome and Hormones Disorder on Enzymes Gammaglutamyl Transferase, Oxaloacetic Transaminase, and Proteins

Polycystic ovary syndrome (PCOS) is complex metabolic disorder of endocrine gland in women of reproductive age. The present work illustrate the effect of (PCOS) and hormone disturbance on serum enzymes activities, iron status parameters and hormone profile in patient women suffering from, PCOS, acute kidney disease (AKD) with PCOS, acute kidney disease and iron deficiency anemia (IDA). A total of 160 women, include 135 patients and 25 of control apparently healthy group, patients were subdivided into four groups,(G1) consisted of 50 patients of PCOS, (G2) of 30 patients of PCOS with AKD, (G3) of 30 patient of AKD and (G4) involve 25 patients of IDA. The specimens were collected from different hospital in Baghdad city. The patients and control were investigated for enzymes, gammglutamyltrasferase (GGT), glutamic oxaloacetic transaminase (GOT) or aspartate transaminase (AST) & glutamicpyruvic transaminase (GPT) or alanine transaminase (ALT) lactate dehydrogenase (LDH), total serum proteins (TSP), albumin, globulin, total cholesterol (TC), triglyceride (TG), urea, creatinine and uric acid. Also iron status parameters (serum iron, transferrin saturation percent (TS%), transferrin concentration, and total iron binding capacity (TIBC) and ferritin concentration) were estimated. As well as hormone profile (testosterone (TT), Follicle stimulating hormone (FSH), lutinizing hormone (LH), prolactin (PL), estradiol (E), and progesterone (PRG)) were estimated Results revels highly significant increases for AST or GOT, ALT or GPT, and GGT activities P˂0.001, and a change in LDH of G1 and G2 patients were highly increased P˂0.001 as compared with normal. Remarkable rising was detected in TSP of (G1) patient while there is significant decrease in proteins level of (G2) patients in comparison with normal. Patients of (G3) show significant difference in GGT, LDH and protein. There is significant change in LDH and albumin in (G4), and no change in AST, ALT, GGT, and proteins as compared with normal. Triglyceride (TG), total cholesterol (TC), creatinine show very highly significant change for patients of (G1, G2, G3&G4). Patients women with PCOS show no remarkable change in uric acid and urea and a change in creatinine concentration. Serum iron parameters were changed significantly in patients of (G1, G2, G3, and G4) in comparison with healthy control groups. Hormones levels were significantly different in PCOS patients as compared with normal individual. In conclusion there were remarkable changes in the activities of AST, ALT, GGT, and LDH. This is the first time for the estimation of a change in LDH activity in women with (PCOS) this could be due to genetic and envirmental factor and gene mutation. Hormone levels and iron status parameter changed remarkably may be due to metabolic disturbance and abnormality in the function of hypothalamic neurotransmitter. [DOI: 10.22401/JNUS.20.2.05] Keyword: Polycystic ovary syndrome, GGT, Iron status, LDH, TG. Introduction Polycystic ovary syndrome (PCOS) is heterogenous complex endocrine disorder characterizedby, hyperinsulinemia, hyperandrogenemia, resistance of insulin, and chronic anovulation. It is increasingly recognized for women of reproductive age between 18-40 years, it affects 5%-18% of all women [1]. The primary pathophsiological defect is unknown, and not fully understood, resistance of insulin, androgen excess and impaired gonadotrppin dynamic and metabolic syndrome play a role in the development of this disease [2]. Levels of the sex hormones progesterone and estrogen are out of balance in condition of PCOS, this can cause problems with women’s menstrual cycle, fertility, leads to growth of ovarian cysts (benign masses on the ovaries). [3], it has multiple components, metabolic, reproductive, and cardiovascular Maysoon M. Najeeb M. Saleem 32 function, with health implications across the life span [3, 4]. Resistance of insulin, elevated ratio of LH to FSH, infertility, adiposity of abdominal, abnormalities vascular, dyslipidemia and disturbances metabolism, of carbohydrate including glucose tolerance impaired and are common in PCOS women. Hyperandrogenemia, excess of androgen favoring the deposition of abdominal fat [5-8]. Abnormality of another hormone in PCOS women is excessive production of LH hormone, which is involved in ovarian stimulation to produce hormones and is released from the pituitary gland in the brain [4,9]. In addition, the released level of hormone Latinizing in the brain by the pituitary gland that is involved in ovarian hormone production is elevated. Others factors contributing possibly in PCOS development include decreased level of chronic inflammation in the body and exposure of fetal to male hormones [2,9,10]. In addition, increased levels of several inflammatory biochemical markers and cardiovascular risk and thrombotic are more prevalent in PCOS patients [11]. Evaluation of endocrine may reveal elevated LH levels and androgens; the ovarian follicles poorly develop commonly this disorder forming multiple cysts. Hypertriglyceridemia, increased levels of lowdensity lipoprotein (LDL) and very-lowdensity lipoprotein cholesterol (VLDL) with decreased high-density lipoprotein cholesterol (HDL) levels also predispose patients in the PCOS to vascular disease [12]. The abnormal typical pattern of biochemical enzymes liver involves of increasing predominantly serum aminotrasferases, with rising of alanine aminotransferase (ALT), relative to aspartate aminotransferase(AST), accompanied by elevated γ-glutamyltransferase (γGT levels. [13,14]. Iron is strong pro-oxidant, and dietary micronutrient, caused increasing catalyzed oxidative stress reactions. A vital role of iron in erythrocyte maturation and production of hemoglobin, these are a cause of iron deficiency anemia which result from iron homeostasis abnormality, it is controlled by complex mechanism erythropoietic activity, hypoxia, iron stores, and inflammation [6,10]. Elevated serum body iron concentration put the patients at increased risk for disease of cardiovascular (CVD) [15]. The content of iron body is regulated tightly by modulating the absorption of iron and from other sources, absence of menstruation, lactation, pregnancy [16]. Ferritin serve as body marker of iron stores in circulation, it is the primary cellular protein for iron storage, and in acute phase reactant, thus may overestimate stores iron in inflammatory state [17]. The transferrin saturation increases in situations when supply iron exceeds demands iron, levels of transferrin are used typically for iron overload diagnosis rather than iron deficiency [18]. The effects of iron sparing of chronic oligomenorrhea might contribute to the increased iron store found in serum individual of PCOS [18]. It was a suggestion that development of glucose tolerance abnormalities caused by iron overload, serum ferritin levels are increased in PCOS, especially when resistance increase [19]. The aim of the present work was to investigate the effect of PCOS and hormone disturbance on the serum enzyme activities AST,ALT GGT,, and LDH, STP, albumin, globulin, TC,TG, urea,, creatinine, uric, hemoglobin, packed cell volume (PCV), and iron status parameters (serum iron, TS%, STIBC, transferrin concentration, and ferritin concentration).Also hormone profile, (TT, PRG, LH, PRL, FSH, and estradiol), all these parameters were evaluated in patients women with PCOS, PCOS with AKD, AKD and patients women with IDA. The estimation of activity of LDH in sera of PCOS patients was done for the first time; there is no data on the effect of this enzyme on PCOS. Patients and Methods A total of 160 women were used in the present study, 135 of whom were patients and 25 of healthy control group they were divided according to pathological case into four groups: The first group (G1) consisted of 50 sera of patients women with PCOS, the age of (M±SD:28.4±4.5)years, they were consecutive patients attending the endocrine gynecological unit and other obtained from different hospital in Baghdad city, central healthy laboratory and Ebn-albaladyhospital, from January 2013 to June 2015. The dysfunction and hyperandrogenism of ovarian patients women Journal of Al-Nahrain University Vol.20 (2), June, 2017, pp.31-41 Science 33 were diagnosed for at least two of the following features; biochemical or clinical sign of androgen excess and assessment of PCOS by ultrasound scan, and blood test for hormone profile levels. Menstrual disturbance, dysmenorrheal, infertility is the chief complaints of patients with PCOS. The subjects in the control group didn’t have any systemic diseases, and they didn't use any medications that might affect their reproductive physiology or iron status. The exclusion criteria were: the using of any medication that interfere with hormonal measurement or metabolic during analysis preceding three months, or a history of used drug causing elevation of liver enzymes or hormone or lipids. A second group (G2) involve 30 patients women with age value of (M±SD:33.1± 5.3) years suffering from PCOS with AKD. The third group (G3) consisted of 30 patients women with AKD with age value of (M±SD:29.7±5.3) and the last group (G4) include 25women with iron deficiency anemia with age value of (M±SD:28.5±3.6) years. All specimens were compared with 25 normal apparently healthy individuals. All patients and normal were collected from different hospitals of Baghdad. Sample Collection: eight ml of venous blood were collected from each normal healthy and patients women after fasting overnight, the specimens were collected in the morning after blood clotting the sera were separated by centrifugation at 3500 rpm for 15 minutes and, the stored sera used for different clinical and biochemical assay. Biochemical Assays: The enzyme activities (AST, ALT, GGT and LDH) were measured by kit method. Other biochemical parameters, protein, albumin, total cholesterol, triglyceride, urea, creatinine an