General HealthPCOS/PCOD

Analysing components of PCOD profile test

PCOD (polycystic ovary disease) is a hormonal disorder that is common among women of reproductive age. It is a condition that leads to multiple cysts in the ovaries of women. Women with PCOD may experience infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

A PCOD Profile test is done to assess the function and level of various hormones in the body. PCOD triggers diabetes, infertility, acne and excessive hair growth.

The PCOD Profile consists of seven tests that help diagnose PCOD and monitor the treatment. The patient is advised not to consume anything except water for 8 to 12 hours before the test.

The doctor may recommend a PCOD test in case the patient experiences the following symptoms:

  • The presence of multiple ovarian cysts on ultrasonography
  • Irregular menstrual cycle
  • Pelvic pain
  • Abnormal weight gain
  • Excessive body hair growth
  • Acne/darkening of the skin

MedPiper recommended PCOD profile includes the following tests:

  1. Testosterone, Total: It measures the level of Testosterone in the blood. The level of Testosterone is higher for women diagnosed with PCOD.
  2. 17-Alpha-Hydroxyprogesterone (17-OHP): It measures the amount of 17-OHP level in the blood. 17-OHP is a hormone produced by the adrenal glands and sex glands.
  3. Luteinizing Hormone (LH): It measures the level of Luteinizing hormone (LH) in the blood. Elevated LH (Luteinizing Hormone) to FSH (Follicle Stimulating Hormone) ratio is an indication of PCOD.
  4. Follicle-Stimulating Hormone (FSH): It measures the level of follicle-stimulating hormone (FSH) in the blood. Elevated LH (Luteinizing Hormone) to FSH (Follicle Stimulating Hormone) ratio is indicative of PCOD.
  5. Prolactin: This test is done to rule out elevated prolactin.
  6. Thyroid-Stimulating Hormone (TSH), Serum: This test is done to rule out any thyroid disorder.
  7. Glucose, Fasting: It is recommended for the diagnosis of diabetes. It measures the sugar levels in the blood in the absence of food.

Fasting blood sugar (FBS)

A fasting blood glucose test is done to determine how well the body is able to manage the blood sugar levels in the absence of food. When the patient does not consume food for several hours, the body releases glucose into the blood via the liver, and post that the insulin level in the body shall help stabilise the blood glucose levels.

Reference ranges for Fasting Blood Sugar Test

  • 70-110 mg/dl = Normal
  • Between 111-125 mg/dl = Impaired fasting glucose (i.e., prediabetes/increased risk of diabetes)
  • Greater than 126 mg/dl on two or more samples = Diabetes
  • Under 55 mg/dl = Hypoglycemia

Name of the method– Orthotoluidine method

Specimen collection– The patient should fast for 8-12hours prior to specimen collection.

Fasting sample– Collect 1 – 2 ml of blood in a fluoride vial.

Test Principle

Glucose reacts with orthotoluidine in a hot acidic medium to form green colour, the intensity of colour produced is measured by using a photometer (620-640nm). The intensity of colored light is proportional to the amount or concentration of glucose present in the serum sample.

Glycosylated haemoglobin (hba1c)

This happens when glucose in the body attaches to red blood cells. Since our body cannot use sugar properly, much of it attaches to our blood cells and accumulates in our blood. Red blood cells are active for about 2-3 months, so readings are done quarterly. High HbA1c means that there is too much sugar in the blood. This means that we are more likely to develop diabetic complications such as serious eye and feet problems. HbA1c is the average blood glucose level over the past 2-3 months. For diabetes, the ideal HbA1c level is below 48 mmol/mol 6.5%. If you are at risk of developing type 2 diabetes, our HbA1c target should be less than 42 mmol/mol.

HbA1c is recommended as an alternative to fasting blood glucose in the diagnosis of diabetes. In addition to being a reliable measure of chronic hyperglycemia, HbA1c correlates well with the risk of long-term diabetic complications. Elevated HbA1c levels are considered an independent risk factor for coronary artery disease and stroke, with or without diabetes. The valuable information provided by a single HbA1c test makes it a reliable biomarker for the diagnosis and prognosis of diabetes.

Uses

  • Evaluate long-term management of blood glucose levels in diabetics
  • Diagnosis of diabetes
  • Identifying patients at high risk of diabetes (prediabetes)

Insulin fasting

Insulin is a protein hormone produced by the beta cells of the Langerhans in the pancreas.

Beta cells in the islets of Langerhans release insulin in two phases: In the first phase, insulin release is rapidly triggered in response to increased blood glucose levels.

In the second phase, it is a continuous process in which the slow release of newly formed vesicles is triggered independently of sugar.

Reference range of serum insulin (fasting):

2-25 uIU/ml i.e, 12-150 pmol/l

Estimation of serum insulin in vitro

Method: Elisa kit

Sample: Venous blood is required (8-12 hours fasting is required prior to the sample collection).

Test principle:

Insulin Elisa Test is a quantitative solid-phase enzyme-linked immunosorbent assay for in vitro measurement of insulin human serum. It includes specific antibodies, enzymes-conjugated with different epitope recognition in excess and native antigen. In this procedure, immobilisation occurs at the microplate well surface via the interaction of streptavidin coated on the well. A biotinylated monoclonal insulin antibody is added exogenously. After completion of all test steps, the ELISA reader interprets the test results at 450 nm wavelength.

Clinical Interpretation of Insulin

The major clinical application of insulin estimation is the evaluation of patients with fasting hypoglycemia or having diabetes mellitus requiring insulin treatment.

High insulin level in blood or insulin resistance depicts polycystic ovary disorder and an underlying physiological driver because the pancreas produces high insulin which causes inflammation and weight gain that leads to type 2 diabetes and heart disease, thus fasting insulin test is required to detect the presence of an insulin-producing tumours in the pancreas.

Hence insulin resistance clinically correlates with PCOS, which is a key feature of both obese and lean PCOS which affects the ovaries and ovulation in women.

It is also used to diagnose insulinoma, in this condition, the following parameters occur – glucose level <40 mg/dl, high insulin level, high proinsulin level, and c-peptide during fasting.

Insulin fasting test is recommended when a patient experiences the following symptoms:

  • Obesity
  • Irregular periods
  • Excessive hair growth on the upper lip – a characteristic feature of PCOD
  • Excessive sweating
  • Palpitations
  • Fainting
  • Dizziness
  • Skin tags
  • Dark velvety skin patches are called acanthosis nigricans.

Author

Yash Batra

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