فهرست مطالب zahra mazloom khorasani

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females of reproductive age. Insulin resistance is a frequent metabolic disturbance in PCOS. Vitamin D deficiency is a common problem. Accumulating evidence suggests that vitamin D has a role on insulin sensitivity so may contribute to reduction of hyperandrogenemia. The aim was to determine the effects of vitamin D treatment in metabolic components and ovulation evidence in PCOS. Fifty one untreated PCOS patients were randomly divided into three groups and treated with calcitriol, metformin, or placebo. Before and 3 months after treatment, ovulation evidence was assessed by ovarian trans abdominal sonography. Plasma fasting glucose, insulin, homeostasis model assessment insulin resistance (HOMA-IR), 25-hydroxyvitamin D, parathyroid hormone and androgen levels were measured before and after treatment. A 75gr glucose test was performed before and after treatment and two set of results was compared. Three patients did not continue this study. Only 11 patient (22.9%) had sufficient vitamin D levels (>30 ng/ml). Metformin caused a significant decrease in weight (p=0.027), insulin level (p=0.043), and insulin resistance (p=0.048). Systolic blood pressure and PTH significantly improved after calcitriol (p=0.029, p=0.009 respectively). An improvement in ovulation was detected after calcitriol and seven patients, without evidence of ovulation before treatment, illustrated ovulation after 3 months. Difference with calcitriol in ovulation was significant versus other two methods (p=0.02). Calcitriol treatment in PCOS may be prior to metformin in ovulation induction.

Prevalence of polycystic ovarian syndrome (PCOS) in reproductive age women is about 10 %. There is a lot of morbidity due to this syndrome. Vitamin D deficiency is a common problem in the world and especially in Iran. Because of probable role of activated vitamin D on induction of insulin secretion and reduction in insulin resistance and the effect of hyperinsulinemia on elevation of free androgens; we designed to evaluate the effect of active form of vitamin D on control of PCOS clinical and metabolic complications. This clinical trial study was carried out in Ghaem hospital. 51 untreated PCOS patients randomly were divided into three groups. Treatment with calcitriol (0. 5mg)، metformin (1000 mg) and placebo were started for each group for three month. After three month assessment for improvement in clinical (improvement of ovulation) and metabolic status (fasting blood glucose، glucose tolerance test، insulin resistance and androgen levels) were performed. Only 22. 9% of patients had sufficient vitamin D levels (>30 ng/ml). Treatment with metformin significantly decreased weight (p=0. 027)، insulin level (p=0. 043)، insulin resistance (p=0. 048) and BMI (p=0. 019). Systolic blood pressure and PTH significantly decreased after calcitriol therapy (p=0. 029، 0. 009 respectively). An improvement in ovulation was detected after calcitriol treatment and 7 patients without ovulation demonstrated ovulation features after treatment with calcitriol. Resumption of ovulation was observed in treatment with metformin and placebo but this changes were significantly more evident in calcitriol group (p=0. 02). It seems that treatment with calcitriol may be effective in management of PCOS and it may be better in ovulation induction than metformin therapy.