Serum kisspeptin levels along reproductive period in women: is it a marker for aging?

OBJECTIVE: To demonstrate the change in serum kisspeptin levels during the reproductive period in healthy women and to investigate the relationship with other reproductive hormones. METHODS: One hundred thirty-one healthy women with normal menstrual history were included and serum kisspeptin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), estradiol (E2), and anti-Müllerian hormone (AMH) levels were determined on cycle day 3. The data were analyzed in 5-year age groups. RESULTS: Serum kisspeptin levels of all women were found to be significantly and negatively correlated with age (r= -0.458). The kisspeptin levels were the highest in the group of women aged between 20 and 24 years compared to other age groups above 25 years (p < .01, p < .001, p < .0005, p < .0005). There was not any significant correlation between serum kisspeptin levels and AMH, FSH, LH, TSH, E2, and body-mass index (BMI), respectively. The Scatter and Violin plots showed that most of the women over 35 years of age had serum kisspeptin levels under the level of 500 pg/ml. The kisspeptin levels of women over 35 years of age clustered closely as opposed to the kisspeptin levels of those below the age of 35, which were scattered. The median serum kisspeptin levels were found to be high in women below the age of 35 (p < .0005). CONCLUSION: In healthy women, serum kisspeptin level is the highest in the group of women aged between 20 and 24 years and declines with age. It tends to be below the level of 500 pg/ml in women over the age of 35.

Serum kisspeptin levels correlated with anti-mullerian hormone levels in women with and without polycystic ovarian syndrome.

MATERIALS AND METHODS: This was a prospective, cross-sectional, comparative study that included 70 women with PCOS and 58 non PCOS controls. PCOS patients were diagnosed according to the Rotterdam criteria. Age, body mass index (BMI), number of menstrual cycles per year, and the Ferriman-Gallwey Score were determined for each woman. Serum levels of kisspeptin, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), estradiol, total testosterone, dehydroepiandrosterone sulfate (DHEA-S), AMH, fasting glucose and insulin were determined. RESULTS: Women with PCOS were younger (p < .001), with higher BMI (p = .027) and glucose values (p < .001); while displaying less number of menstrual cycles per year (p < .001). Although serum kisspeptin levels were similar in both groups, age was negatively (r= -0.33, p = .00018) and serum AMH levels were positively correlated (r = 0.25, p = .0039) with the serum kisspeptin levels in women with the PCOS. After adjusting for age, serum kisspeptin levels were comparable in both groups (p > .05). Serum LH, AMH, DHEA-S and total testosterone glucose, insulin levels and HOMA-IR values were significantly higher in women with PCOS as compared to controls (all p < .05). CONCLUSIONS: Serum kisspeptin levels were similar in women with and without PCOS but positively correlated with AMH serum levels in PCOS women.

Leriche's syndrome and twin pregnancy.

Leriche's syndrome is characterized by chronic obstruction of the abdominal aorta and iliac arteries. A patient with Leriche's syndrome presented with twin pregnancy and severe preeclampsia at 32 weeks' gestation. Cesarean delivery was performed and the patient was admitted to the intensive care unit. Magnetic resonance angiography showed total occlusion of the distal abdominal aorta, common, and external iliac arteries. There were extensive collateral vessels between the lumbar arteries and iliolumbar arteries. The patient was discharged in an improved clinical condition. Leriche's syndrome and pregnancy demonstrating complete aortic, common, and external iliac artery occlusion is very rare in the literature. Despite complete occlusion, viability of the fetus can be achieved with collateral vessels.

Predictive factors for the efficacy of Er:YAG laser treatment of urinary incontinence.

OBJECTIVES: To determine the efficacy and predictive factors for the success of Er:YAG laser treatment in patients with urinary incontinence (UI). METHODS: Eighty-two patients with UI were treated by Er:YAG laser in this cohort study. The patients were evaluated by ICIQ-SF and KHQ-UI before and after the procedure. Improvement was categorized as: none (0-25%), mild (26-50%), moderate (51-75%), or high (76-100%). The duration of the treatment effect was evaluated at follow-up in relation to maximum improvement time (MIT) and total improvement time (TIT). RESULTS: Forty-two patients were determined to have SUI and 40 patients MUI. The mean ISIQ-SF and KHQ-UI scores significantly improved after the procedure (p<0.0001). The SUI patients responded to the laser treatment significantly better (p<0.008). Younger women had significantly better results (p<0.008), while premenopausal women (p<0.032) and women in the early postmenopausal years (p<0.032) also saw a positive response to the Er:YAG laser treatment. Women with a lower BMI had greater improvement (p<0.011). The total laser energy expenditure during the sessions may also be a predictive parameter for the success of Er:YAG laser treatment of UI (p = 0.059). MIT and TIT were significantly longer among the patients in the high-improvement group. CONCLUSION: Er:YAG laser treatment of the symptoms of UI, especially SUI, is more efficacious and of longer duration for younger, premenopausal or early postmenopausal women with normal BMI.