Relationships of DHEA-S Levels With Fertility, Pregnancy, Ovarian Reserve and Endothelial Functions
Abstract
Dihidroepiandrostenedion (DHEA) primer olarak adrenal bezden, sekrete edilen 19 karbonlu bir adrenal androjendir. DHEA-S seviyesi yaşamın ilk yılında hızla düşme eğilimindedir, minimum seviyelere indikten sonra bunu beş yıl kadar sürdürür. 6-7 yaşından sonra önemli artış göstererek kadında 24, erkekte 30 yaşında maksimum seviyelerine ulaşır. Daha sonra da hızla düşme eğilimindedir, ancak bu düşüş 50-60 yaşından sonra daha ılımlıdır.Çalışmamızda 2004-2005 yılları ve sonrasında DHEA-S düzeyine bakılan 20-35 yaş arası kadınlar alındı. Gelen hasta sayısı 96 idi.Gelen hastaların DHEA-S düzeyine bakıldı ve kan basınçları ölçüldü. Bu arada kaç doğum yaptığı, abortus öyküsü olup olmadığı, menarş yaşı, adet düzeni sorgulandı. Gelen hastaların 45'inin boy, kilo, kan basıncı ölçümleri ile ultrasonografik flow-mediated dilation (FMD) ölçümleri kardiyoloji polikliniğinde gerçekleştirildi.Yine 2004-2005 senelerinde DHEA-S bakılmış 40-50 yaş arası 28 kadın hastanın adet görüp görmedikleri , menopoz belirtilerinin olup olmadığı sorgulandı.Grupların karşılaştırılmasında unpaired t testi, değişkenler arasındaki korelasyonun analizinde Pearson korelasyon analizi kullanıldı ve p < 0.05 olması durumu istatistiksel farklılık olarak kabul edildi.65 hastanın DHEA-S düzeyi düşerken, 31 hastanınki artış gösteriyordu. DHEA-S'da ortalama değişim 26,4 ± 90.4 ?? g/dl düşüştü. DHEA-S'daki yıllık değişim 8,6±28,1 g/dl düşüş mevcuttu. DHEA-S'sı azalanların ilk DHEA-S değerleri, DHEA-S'sı artanlara göre anlamlı yüksek izlendi .Gebelik geçiren kadınlardaki DHEA-S düşüşü çocuk doğurmayanlara göre istatiksel olarak anlamlıydı. Ancak abortus geçirenler çıkarıldığında fark ortadan kalkmaktaydı. DHEA-S'si düşenler arasında abortus yapmadan doğum öyküsü olanlarda DHEA-S düşüş miktarı gebe olmayanlara göre anlamlı derecede azdı. DHEA-S'si düşenlerde, gebelik sayısı ile düşüş miktarı negatif korele bulundu.Abortus geçiren 5 hastada ilk bakılan DHEA-S düzeyi abortus geçirmeyenlere göre daha yüksek olmakla birlikte fark istatistiksel olarak anlamlı değildi. Ancak DHEA-S'deki yıllık değişim , DHEA-S'deki düşüş miktarı anlamlı derecede yüksek bulundu. Abortus sayısı ile DHEA-S'deki düşüş miktarı ve yıllık düşüş miktarı ile koreleydi DHEA-S'si artanlarda, kilo, DHEA-S düzeyinin ilk ve son ölçümlerinin yanı sıra, DHEA-S düzeyinde artış yüzdesiyle ve senelik artış yüzdesiyle ters korele bulundu . DHEA-S'i artanlarda boy, DHEA-S'deki yüzdelik artış ve yıllık yüzdelik artışla ters korele bulundu. Boy, menarş yaşı ile pozitif koreleydi. Aynı grupta, BMI, DHEA-S'deki artış yüzdesi ve yıllık artış yüzdesi ile doğru koreleydi.FMD ölçümlerinde, sistolik ve diastolik KB ölçümleri dahil herhangi bir veri ile korelasyonu yoktu. DHEA-S'si azalanlarda, sistolik kan basıncı ile DHEA-S deki düşüş miktarı ve yıllık düşüş miktarı koreleydi .DHEA-S ile menopoz arasında bir ilişki kurulamamıştır.Sonuç olarak çalışmamızda DHEA-S'nin zirve düzeyine erişme yaşı farklılıklar göstermiştir. DHEA-S düzeyi yavaş artanlar daha uzun boylu idiler. Abortus DHEA-S düzeylerinde düşmeye neden olurken, canlı doğum DHEA-S düşüşünü azaltmaktadır. Endojen DHEA-S, obezite karşıtı etkiye sahip olabilir. DHEA-S düzeyinde düşme, sistolik kan basıncını arttırabilir. Hasta grubumuzda DHEA-S düzeyi over rezervinin bir göstergesi değildir.Anahtar Kelimeler: Dehidroepiandrostedion, Hipertansiyon, Yaşlanma, Menopoz, Gebelik
Dhydroepiandrostenedione (DHEA) is the major adrenal androgen. It?s levels are high at birth and rapidly drop in first months of life. It remains low in first five years then steadily increase after age 6-7. It reaches its peak levels at age 24 in women and at age 30 in men. It then begins to decrease rapidly, the rate of decrease diminishes through fifth and sixth decades.In our study, 96 women aged 20 to 35 were recruited by phone calls among patients whose DHEA-S level had been measured in 2004 and 2005 in Yuzuncu Yil Univertiy Faculty of Medicine. Participants were interviewed about the age of menarche, history of pregnancy, live birth, abortus and menstrual habitus. Forty-five of them accepted flow mediated dilation (FMD) measurement by ultrasonography.Another group of 28 women aged 40 to 50 were interviewed through phone calls and asked about their menstrual status and signs of menopause.For statistical analysis, unpaired t test was used to compare groups and Pearson correlation analysis was used for correlation analysis. P<0,05 is regarded as statistically significant.DHEA-S levels were decreased in sixty-one patients and increased in 31 patients. Mean DHEA-S levels decreased 26,4 ± 90.4 g/dl during the period and 8,6±28,1 g/dl annually. Initial DHEA-S levels of whose DHEA-S levels decrease were significantly higher compared to whose DHEA-S levels increased.Women with history of pregnancy had significantly higher DHEA-S drops compared to these never conceived. However, after exclusion of women who had aborted, DHEA-S decrease became similar. Moreover, number of pregnancies was negatively correlated with DHEA-S decrease in these patients whose DHEA-S levels decreased.Women who had aborted had higher initial DHEA-S levels but the difference was not significant. Annual and total decrease of DHEA-S was significantly higher in these women. Number of aborts was also correlated positively with the amount of DHEA-S decrease.In these with increasing DHEA-S levels, body weight negatively correlated with DHEA-S initial and last values and percentage of total and annual increase. In the same group, body height was also negatively correlated with DHEA-S initial and last values and percentage of total and annual increase. BMI was correlated positively with these. Body height was positively correlated with age of menarche.FMD measurements did not correlate with any of the parameters including systolic and diastolic blood pressures. In these with decreasing DHEA-S levels, systolic blood pressure is positively correlated with the total and annual decrease of DHEA-S.DHEA-S level is not correlated with menopause.In conclusion, DHEA-S levels may peak at different ages and some may reach the peak later and some begin to decrease earlier. Adult height seems to be higher in whose DHEA-S levels increase slower. Abortus may accelarate DHEA-S decrease, whereas live birth may decelerate DHEA-S drop. Endogenous DHEA-S may have some anti-obesity effects. DHEA-S decrease may increase systolic blood pressure. DHEA-S levels was not a marker of ovarian reserve in our study population.Key words: Dehydroepiandrostenedione, Hypertension, Aging, Menopause, Pregnancy.
Dhydroepiandrostenedione (DHEA) is the major adrenal androgen. It?s levels are high at birth and rapidly drop in first months of life. It remains low in first five years then steadily increase after age 6-7. It reaches its peak levels at age 24 in women and at age 30 in men. It then begins to decrease rapidly, the rate of decrease diminishes through fifth and sixth decades.In our study, 96 women aged 20 to 35 were recruited by phone calls among patients whose DHEA-S level had been measured in 2004 and 2005 in Yuzuncu Yil Univertiy Faculty of Medicine. Participants were interviewed about the age of menarche, history of pregnancy, live birth, abortus and menstrual habitus. Forty-five of them accepted flow mediated dilation (FMD) measurement by ultrasonography.Another group of 28 women aged 40 to 50 were interviewed through phone calls and asked about their menstrual status and signs of menopause.For statistical analysis, unpaired t test was used to compare groups and Pearson correlation analysis was used for correlation analysis. P<0,05 is regarded as statistically significant.DHEA-S levels were decreased in sixty-one patients and increased in 31 patients. Mean DHEA-S levels decreased 26,4 ± 90.4 g/dl during the period and 8,6±28,1 g/dl annually. Initial DHEA-S levels of whose DHEA-S levels decrease were significantly higher compared to whose DHEA-S levels increased.Women with history of pregnancy had significantly higher DHEA-S drops compared to these never conceived. However, after exclusion of women who had aborted, DHEA-S decrease became similar. Moreover, number of pregnancies was negatively correlated with DHEA-S decrease in these patients whose DHEA-S levels decreased.Women who had aborted had higher initial DHEA-S levels but the difference was not significant. Annual and total decrease of DHEA-S was significantly higher in these women. Number of aborts was also correlated positively with the amount of DHEA-S decrease.In these with increasing DHEA-S levels, body weight negatively correlated with DHEA-S initial and last values and percentage of total and annual increase. In the same group, body height was also negatively correlated with DHEA-S initial and last values and percentage of total and annual increase. BMI was correlated positively with these. Body height was positively correlated with age of menarche.FMD measurements did not correlate with any of the parameters including systolic and diastolic blood pressures. In these with decreasing DHEA-S levels, systolic blood pressure is positively correlated with the total and annual decrease of DHEA-S.DHEA-S level is not correlated with menopause.In conclusion, DHEA-S levels may peak at different ages and some may reach the peak later and some begin to decrease earlier. Adult height seems to be higher in whose DHEA-S levels increase slower. Abortus may accelarate DHEA-S decrease, whereas live birth may decelerate DHEA-S drop. Endogenous DHEA-S may have some anti-obesity effects. DHEA-S decrease may increase systolic blood pressure. DHEA-S levels was not a marker of ovarian reserve in our study population.Key words: Dehydroepiandrostenedione, Hypertension, Aging, Menopause, Pregnancy.
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Endokrinoloji ve Metabolizma Hastalıkları, Endocrinology and Metabolic Diseases
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105