EVALUATION OF SERUM PROSTATE
SPECIFIC ANTIGEN AND LEPTIN
LEVELS IN PATIENTS WITH
POLYCYSTIC OVARY SYNDROME
Protocol of Thesis
Submitted for partial fulfillment of Master degree
in Obstetrics and Gynecology
Rehab Mohammed El Shahat El Sadak Ghreb
M.B., B.Ch. (Zagazig Universtiy-2003)
Resident of Obstetric and Gynecology
In Zagazig Hospital
Under Supervision of
Prof. Mohamed Ashraf Mohamed Farouk Kortam
Professor of Obstetrics & Gynecology
Faculty of Medicine – Ain Shams University
Dr. Tarek Aly Raafat
Lecturer of Obstetrics & Gynecology
Faculty of Medicine – Ain Shams University
Dr.Nermine Helmy Mahmoud
Lecturer of Clinical Pathology
Faculty of Medicine – Ain Shams University
Faculty of Medicine
Ain Shams University
Polycystic ovary syndrome (PCOS) is one of the most common
endocrinological disorders among reproductive-age women. The prevalence
of PCOS varies between 4% and 11% of all women (Ehrmann., 2005).
Polycystic ovary syndrome is clinically characterized by chronic
anovulation, menstrual irregularities, infertility and obesity in combination
with some evidence of androgen excess such as hirsutism, acne and
increased serum androgen concentrations (Azziz., 2003).
The fundamental pathophysiologic defect still remains unknown.
PCOS appears to be a heterogeneous disorder in which ovarian, and possibly
adrenal androgen excess is present along with varying degrees of
gonadotropic and metabolic abnormalities (Legro., 2003).
Additionally insulin resistance, hyperinsulinism, type II Diabetes
Mellitus, endometrial carcinoma, dyslipidemia and psychosocial dysfunction
are presented as other clinical consequences associated with PCOS (Azziz.,
It should be noted that the universal and pervasive pathology in PCOS
is androgen excess that is responsible for signs and symptoms of
hyperandrogenism such as hirsutism, acne, alopecia, and ovulatory
dysfunction (Obiezu et al., 2001).
Androgen suppression following the diagnosis of hyperandrogenism
continues to be the mainstay of treatment of PCOS in patients not desiring
immediate fertility (Birol Vural et al., 2007).
Prostate-specific antigen (PSA) is determined to be a 33-kDa serine
protease that is primarily a product of prostatic tissue and secreted into the
seminal plasma. PSA is used as a highly specific and valuable marker of
prostatic adenocarcinoma regarding the screening, diagnosis and monitoring
of the disease (Escobar-Morale et al., 1998).
Recent development of ultrasensitive assays demonstrated PSA in a
wide variety of female tissues and fluids such as the ovary, breast, amniotic
fluid and milk which provided worthy implications especially in diagnosis
and clinical follow-up of breast cancer cases (Burelli et al., 2006).
The gene expression and protein production of PSA in extraprostatic
tissues seem to be upregulated by steroid hormones such as androgens,
progestins, and glucocorticoids as demonstrated by cell culture studies and
research on breast cancer (Diamandis et al., 1999).
Androgenic therapies established for female to male transsexuals led
to elevated levels of serum PSA comparable with the results of increased
urinary PSA levels secondary to long-term testosterone treatments used in
the same group of patients (Obiezu et al., 2000).
All those data concluded that there is a link between increased
androgen levels and PSA values measured in serum or urine. Depending on
the gathered data, PSA may be a useful clinical marker of hyperandrogenism
in females of PCOS. Although the precise role of PSA in hirsute PCOS
patients still remains to be undetermined, it is likely that androgens may be
involved in the production of PSA (Katsaros et al., 1998).
PSA may prove as a new promising marker of androgen excess
Leptin (or OB protein) is a pleiotropic molecule secreted by white
adipocytes that play a role in the regulation of body weight fluid intake
(Saleh et al.,2004).
It is a peptide hormone encoded by the obesity (OB) gene. It
suppresses the appetite and increases the metabolic rate. The molecule is
known to be correlated to fat mass and responds to changes in caloric intake
(Juan et al., 2008).
Recently it has been proposed to be involved in the control of the
reproductive function. Leptin may be an important signal indicating the
adequacy of nutritional status for reproductive function (Telli MH et
In general, however, obesity is a leptin-resistant state in humans such
that higher leptin concentrations are found in more obese women and an
observation which appears to account for the high leptin concentration in
women with PCOS. Recent invitro observation indicates that the leptin may
have direct intra ovarian action (Srivastava el al., 2007).
Leptin receptors are expressed in human ovaries, and leptin has been
shown to inhibit LH as well as Insulin like Growth Factor (IGF-1) with
stimulation of estradiol production in granulosa- theca cells (Dorte
Glintborg, et al., 2006).
Aim of the work
The aim of this work is to evaluate serum levels of prostate- specific
antigen and leptin in women with polycystic ovary syndrome.
PATIENTS AND METHODS
The study will be conducted at Ain Shams University Maternity
Hospital. It will include 80 women from those attending the infertility out
The participants in the study will be divided into two groups:
• Study group: including ( 50 ) patients with the diagnosis of PCOS .
• Control group:including ( 30 ) infertile and regularly menstruating
PCOS will be diagnosed by the presence of two out of the following
three criteria : i- Ultrasonographic finding of at least eight small subcapsular
follicles (2 to 10 mm in diameter) and usually peripherally arrayed around an
enlarged hyperechogenic ovarian stroma. Typically, the multiple follicles
resemble a pear necklace on ultrasound examination (Jonard et al., 2003).
ii-Chronic oligo-ovulation or anovulation (usually manifested as
oligomenorrhea or amenorrhea) after excluding secondary causes iii-Clinical
or biochemical evidence of hyperandrogenism (Lanham., 2006 ).
Exclusion criteria will include:
1. Receiving any medical treatment for PCOS.
2. Has abnormal liver function, thyroid function, hyperprolactinemia.
3. Has non classic adrenal hyperplasia.
4. Has chronic hypertension.
5. Receiving any hormonal preparations.
An informed written consent .will be taken from the women to
participate in the study then :
- A full history and clinical examination will be carried out for every
woman during the follicular phase of the cycle.
- Blood sample will be obtained from participants by venipuncture and
collected into serum separator tube . where will be allowed to clot then
centrifuged for 5minutes at approximately 1000 x g RPM(Run Per
Minute) to separate the serum which will be stored at -20 C until further
assay of prostate-specific antigen (PSA) and Leptin using commercial
All the collected data will be tabulated and statistically analyzed by using
Statistical Package for Social Static 15 (SPSS 15) .Case and control will be
compared as regard levels of leptin and prostate-specific antigen (PSA) by
using student T test .
Conclusion & Recommendations .
Arabic Summary .
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