American Journal of Medicine and Medical Sciences 2015, 5(3): 135-139

DOI: 10.5923/j.ajmms.20150503.05

Role of Prolactin in Iraqi Obese Women with

Polycystic Ovary Syndrome
Jasmine S. Hasan1,*, Alia H. Ali1, Muhammad-Baqir M-R. Fakhrildin2

1
College of science for Women, Baghdad University, Baghdad, Iraq
2
High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, AL-Nahrain University, Baghdad, Iraq

Abstract Prolactin is a polypeptide hormone which produces by the pituitary gland during pregnancy and lactation. In
some cases, it is slightly elevated in polycystic ovary syndrome (PCOS). This study was aimed to find the relationship
between prolactin (PRL) level and BMI in women with polycystic ovary syndrome. The present study was carried out on (51)
PCOS women and (10) healthy women as controls at High Institute for Infertility Diagnosis and Assisted Reproductive
Technologies/AL-Nahrain University, from February to August, 2014. Prolactin and OGTT were performed for all women.
Descriptive data including age and BMI were recorded for all subjects. Significant increment (P<0.05) in the BMI value was
observed for PCOS subgroup with insulin resistance and for PCOS women with age (25.63±0.676 years). Significant
increment (P<0.05) of serum PRL level was observed for obese PCOS women with insulin resistance as compared with
controls. Also, highly significant increment (P<0.05) of PRL level was assessed in PCOS age group (A) with mean age
(18.91±0.285) and (B) with mean age (25.63±0.676) as compared with controls. OGTT observed in obese women and in
PCOS women with age mean (25.63±0.676) were significantly increased (P<0.05) as compared with controls. In conclusion,
PRL level was associated with obesity and insulin resistance in PCOS patients.
Keywords Prolactin, Obese Women, Polycystic Ovary Syndrome

resistance and upper body obesity which in turn aggravates

1. Introduction insulin resistance and hyperandrogenism of women with
PCOS and modulate β–cell function [7]. PCOS case similar
Prolactin (PRL) is a polypeptide hormone produced by the to hyperprolactinemic are both common causes of secondary
pituitary gland and plays an important role in the amenorrhea in women. The correlation between PCOS and
differentiation of normal mammary epithelium. It's hyperprolactinemia so far has been reported still with
contained 200 amino acids and prepares the physiology for argumentative results. It appears that PCOS is very dominant
lactation and maternal care in women [1]. The elevation in with hyperprolactinemia, though there are variant reasons of
PRL levels is normal during pregnancy and breastfeeding. altered regulation of gonadotropin secretion and suggests
Furthermore, PRL can abnormally increase because of a that these conditions have independent origins [3]. Therefore,
disease or the use of certain medications [2]. For unclear the aim of this study is to find the relationship between
reasons, some of the PCOS women may have a slightly prolactin level and obesity in PCOS women.
increment in prolactin levels [3].
Polycystic ovary syndrome (PCOS) is a common
endocrine disorder in women of reproductive age, which 2. Materials and Methods
affects 5-10% of women [4]. About 50% of PCOS patients This study was carried out at the laboratory of Hormonal
are obese or they have a greater risk of overweight, obesity, and Biochemical assays of High Institute for Infertility
and central obesity [5]. Obesity is a common finding in Diagnosis and Assisted Reproductive Technologies /
PCOS and aggravates many of its reproductive and AL-Nahrain University from February to August, 2014.
metabolic features. The correlation between PCOS and From a total of 61 women with age range 17-49 were studied,
obesity is complex and not well understood, which involves 51 women were suffering from PCOS, and 10 healthy
the interaction of genetic and environmental factors [6]. women were considered as controls to compare with PCOS's
Women with high PCOS have 76.5% prevalence of insulin women.
Blood samples (2.5 mL) were collected from each fasting
* Corresponding author:
[email protected] (Jasmine S. Hasan)
woman in the morning, and 75 gm of glucose loaded in
Published online at http://journal.sapub.org/ajmms 400-500 mL of water and given to the subjects. The
Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved collected blood was transferred to gel and clot activator tube
136 Jasmine S. Hasan et al.: Role of Prolactin in Iraqi Obese Women with Polycystic Ovary Syndrome

and incubated for 10 minute in the incubator at 37C to considered statistically significant at the level (P<0.05).
coagulate, and serum separated by centrifuge and freezing in
-4C. Prolactin assay was performed to all subjects using
mini Vidas kit (Biomerieux, France). The normal value of 3. Results
prolactin range 5-35 ng/mL. OGTT test was performed after Table (1) demonstrated a comparison among three groups
30, 60, and 90 minute after glucose loading. GTT was according to OGTT, including; PCOS with insulin resistance
performed using glucose MR kit of Linear (Spain). The (IR), PCOS without insulin resistance (NIR) and control
normal value of OGTT is <140 mg/dl, OGTT between group. No significant differences (P>0.05) were observed in
140-199mg/dl refer to impaired glucose tolerance, and its the age among these three groups. There was significant
considered diabetic if OGTT ≥ 200 mg/dl [8]. Body mass increment (P<0.05) for BMI of PCOS-IR subgroup than both
index (BMI) was measured for all subjects by dividing PCOS-NIR and control group. Also, there was no significant
weight in kilogram on height in meter square. BMI value difference (P>0.05) in BMI between PCOS-NIR subgroup
indicates for body weight, subjects with BMI 18.5-24.9 and control group. The level of serum PRL was significantly
Kg/m2considered normal weight, with BMI 25-29.9 Kg/m2 increased (P<0.05) in PCOS-IR when compared with
considered overweight, and with BMI ≥ 30 Kg/m2considered healthy controls women. While non-significant differences
obese. The duration of infertility recorded for all infertile (P>0.05) were observed between PCOS-NIR and both
PCOS patients. PCOS-IR and controls. According to GTT, PCOS women
Statistical analysis was performed to all data using were divided into PCOS-IR and PCOS-NIR as shown in the
Statistical Package for Social Science (SPSS); version 20. same table, significant increment (P<0.05) was recorded in
The differences among more than two groups were assessed the level of fasting blood glucose for PCOS-IR than control
by using ANOVA table- Duncan test with means and group, but not significant (P>0.05) with PCOS-NIR women.
standard error of means. The confidence level has been Moreover significant elevation (P<0.05) in BS levels were
chosen as 95% and P-value <0.05 was considered as recorded of reading one (R1BS after 30 minute), reading two
significant. The Pearson correlation coefficient was (R2BS after 60 minute), and reading three (R3BS after 90
estimated between PRL and BMI. The correlation value was minute) in PCOS-IR than both PCOS-NIR and controls.
Table (1). Comparison among PCOS subgroups according to OGTT and healthy control women

Control (n=10) PCOS IR(n=32) PCOS NIR (n=19)

Parameters 16.40% 52.45 % 31.15%
Mean ± S.E Mean ± S.E Mean ± S.E
Age (Years) 33.10±3.139 a 27.75±1.173 a 29.84±2.059 a
BMI (Kg/m2) 26.99±1.746 b 31.81±1.226 a 27.00±0.952 b
PRL (ng/mL) 5.05±1.650 b 16.95±1.665 a 12.46±2.839 ab
FBS (0 time) (mg/dL) 82.48±1.768 b 100.63±5.506 a 87.57±1.868 ab
R1BS(30min)(mg/dL) 136.20±2.928 b 174.87±7.807 a 123.19±3.299 b
R2BS(60min)(mg/dL) 125.38±5.438 b 183.46±10.156 a 108.12±5.263 b
R3BS(90min)(mg/dL) 115.68±5.407 b 161.62±10.118 a 102.22±4.330 b
Different letters mean significant (P<0.05)

PCOS=polycystic ovary syndrome, BMI=Body mass index, FBS= fasting blood sugar, R1BS=Reading 1 blood sugar, R2BS=
Reading 2 blood sugar, R3BS= Reading 3 blood sugar PRL=Prolactin

Table (2). Comparison in parameters among PCOS BMI groups and healthy controls

Control (n=10) PCOS Normal weight PCOS Overweight PCOS Obese

Parameters 16.40% (n=13) 21.31% (n=16) 26.23% (n=22) 36.06%
Mean ± S.E Mean ± S.E Mean ± S.E Mean ± S.E
Age (Years) 33.10±3.139 a 28.46±2.712 a 30.06±1.764 a 27.45±1.403 a
BMI (Kg/m2) 26.99±1.746 b 23.38±0.275 c 27.30±0.304 b 35.92±1.126 a
PRL (ng/mL) 5.05±1.650 b 13.85±2.278 ab 12.56±2.786 ab 18.92±2.322 a
FBS (0 time) (mg/dL) 82.48±1.768 b 90.57±4.174 ab 87.71±2.529 ab 104.70±7.487 a
R1BS(30min)(mg/dL) 136.20±2.928 b 140.69±9.282 ab 147.04±7.367 ab 170.67±11.443 a
R2BS (60min)(mg/dL) 125.38±5.438 b 125.29±10.978 b 151.89±11.763 ab 175.73±15.173 a
R3BS (90min)(mg/dL) 115.68±5.407 b 119.27±9.186 ab 131.22±10.273 ab 157.45±14.567 a
Different letters mean significant (P<0.05)

PCOS=polycystic ovary syndrome, BMI=Body mass index, FBS= fasting blood sugar, R1BS=Reading 1 blood sugar,
R2BS= Reading 2 blood sugar, R3BS= Reading 3 blood sugar PRL=Prolactin
 American Journal of Medicine and Medical Sciences 2015, 5(3): 135-139 137

As demonstrated in the table (2), a comparison among Moreover, significant positive correlation (r=0.364*; P<0.05)
PCOS women with normal Weight (BMI 23.38 kg/m2), as was assessed between prolactin level and BMI.
contrast PCOS women with overweight (BMI 27.30 kg/m2), According to age group, table (3) illustrates a comparison
PCOS obese subgroup (BMI 35.92kg/m2), and control group. among PCOS subgroups and control group. PCOS age group
However, no significant differences (P>0.05) were observed included; subgroup (A) with age ≤20 years, subgroup (B)
in the age among the four groups. Highly significant with age range from 21-30 years, subgroup (C) with age
differences (P<0.05) were observed in BMI of obese PCOS range from 31-40 years, and subgroup (D) with age >40
than normal weight PCOS, overweight PCOS and control years, and compare to control group with age range from
group. Also, there was higher significant (P<0.05) level in 18-49 years. Furthermore, significant differences (P<0.05)
BMI value for overweight PCOS group than normal weight were assessed in the age among PCOS age group and control,
PCOS group. Normal weight PCOS was had the lower value but no significant difference (P>0.05) in the age was
of BMI than the control group, but there was no significant observed between PCOS subgroup (C) and control. BMI
difference (P>0.05) in BMI between overweight PCOS and values illustrated non-significant differences (P>0.05)
control group. On the other hand, PRL level was elevated among PCOS age group and control group. In contrast,
significantly (P<0.05) in obese PCOS subgroup than significant differences (P<0.05) were observed in levels of
controls, while the differences in prolactin level were not prolactin with elevation for PCOS subgroup (A) and (B) in
significant (P>0.05) among normal weight, overweight and comparison to control group. Also, no significant differences
obese PCOS subgroups, as well as, among normal weight, (P>0.05) were observed in prolactin levels between PCOS
overweight and healthy controls. From the same table, a subgroups (C) and (D) in one hand with PCOS subgroups (A)
comparison in GTT among PCOS subgroups and controls and (B), and control group.
shows significant increased (P<0.05) in FBS, R1BS, and As for GTT, non-significant differences (P>0.05) were
R3BS levels of obese PCOS than the control group. In observed in FBS, and R2BS levels among PCOS age group
contrast, there were non-significant differences (P>0.05) in and controls. In contrast, significant increment (P<0.05) in
levels of FBS, R1BS, and R3BS among normal weight R1BS level was assessed in PCOS subgroup (B) when
PCOS, overweight PCOS, and control groups. Also, there compared with PCOS subgroup (D) and control group.
were non-significant differences (P>0.05) in levels of FBS, Moreover, the non-significant difference (P>0.05) in R1BS
R1BS, and R3BS among normal weight PCOS, overweight level was noticed between PCOS subgroup (D) and control
PCOS, and obese PCOS group. Significant increment group. Also, non-significant difference (P>0.05) in R1BS
(P<0.05) was observed in R2BS levels in obese PCOS when level was assessed between PCOS subgroups (A) and (C) in
compared with the control group. Also, there was significant one hand and with subgroups (B) and (D), and control group
elevation (P<0.05) in R2BS level of obese PCOS as in other hand. Additionally, significant elevation (P<0.05) in
compared to normal weight PCOS group. No significant R3BS level was observed in PCOS subgroup (B) as
differences (P>0.05) were observed in R2BS among normal compared to control group. While no significant differences
weight PCOS, overweight PCOS, and control group. (P>0.05) were assessed among PCOS subgroups (A) and (C),
Additionally, there was no significant difference (P>0.05) and (D) in one hand, and with subgroups (B), and control
between obese PCOS and overweight PCOS subgroups. group in the other hand.
Table (3). Comparison in parameters among PCOS age group and healthy controls

Control (A)(≤20 years) (B)(21-30 years) (C)(31-40 years) (D)(>40 years)

(18-49 years) (n=10) (n=11) (n=19) (n=17) (n=4)
Parameters 16.40% 18.03% 31.15% 27.86% 6.56%

Mean± S.E Mean± S.E Mean± S.E Mean± S.E Mean± S.E

Age (Years) 33.10±3.139 b 18.91± 0.285d 25.63± 0.676c 35.00± 0.776b 41.25± 0.250a
2
BMI (Kg/m ) 26.99±1.746 a 29.54±2.299 a 31.81±1.667 a 29.17±1.093 a 26.42±2.758 a

PRL (ng/mL) 5.05±1.650 b 19.78±3.145 a 18.27±1.854 a 9.12±1.969ab 14.93±10.43 ab

FBS (0 time) (mg/dL) 82.48±1.768 a 88.22±3.210 a 105.66±9.001 a 91.42±2.096 a 88.00±4.183 a

R1BS(30min) (mg/dL) 136.20±2.928 b 139.30±6.325 ab 176.63±12.785 a 148.61±8.611 ab 130.48±8.527 b

R2BS(60 min)(mg/dL) 125.38±5.438 a 135.31±10.423 a 177.69±16.817 a 148.53±13.198 a 133.83±23.881 a

R3BS(90 min)(mg/dL) 115.68±5.407 b 122.45±10.504ab 166.56±16.298 a 125.02±8.574 ab 119.23±19.887ab

Different letters mean significant (P<0.05)

PCOS=polycystic ovary syndrome, BMI=Body mass index, FBS= fasting blood sugar, R1BS=Reading 1 blood sugar, R2BS= Reading 2 blood sugar,
R3BS= Reading 3 blood sugar PRL=Prolactin
138 Jasmine S. Hasan et al.: Role of Prolactin in Iraqi Obese Women with Polycystic Ovary Syndrome

4. Discussion to disruption of central nervous system (CNS) dopaminergic

tone [20]. Also, Hernandz et al., [21] concluded that a
In present study, 52.45 % of females with PCOS had IR hypothalamic deficiency of dopamine (DA) could explain
according to higher OGTT (OGTT>140 mg/dl), and 31.15% the mild elevation in PRL level frequently present in women
of females with PCOS had not IR according to lower OGTT with PCOS, which is further supported by the finding of a
(OGTT<140 mg/dl) (Table 1). This result coincided with low DA hypothalamic tone with increased prolactin
Legro et al. [9] and Recha et al. [10]. As well, they were bioactivity in obese, hyperinsulinemic women with PCOS
obese or overweight which agrees with Hoeger, [11] and which was agrees with this study [21]. Another study was
Gomathi et al. [12]. Additionally, when PCOS women done by Tuzcu et al. [22] on 60 hyperprolactinemic women
divided into subgroups according to BMI values (Table 2), and 12 healthy as control, and they found basal insulin level
higher prevalence of PCOS women (36.06%) of females of hyperprolactinemic patients were higher than the control
were observed obese, about 26.23% of females with PCOS group, and they concluded that hyperprolactinemic patients
were overweight, and about 21.31% of subjects with PCOS were more insulin resistant than control subjects this
were normal weight that means PCOS case frequently higher conclusion agrees with the present study which illustrated
in overweight and obese women, and the obesity play an higher glucose levels (OGTT>140mg/dl) (IR marker) were
important role in pathophysiology of this syndrome [13]. observed in obese and overweight patients and those patients
Several studies suggested that obese PCOS women had had higher mild levels of prolactin [22]. Recently, Tuzcu et
higher resistin level. The serum resistin level may increase in al. [22] demonstrated that prolactin induces glucose
overweight and obese women in comparison with intolerance, hyperinsulinemia and insulin resistance in
normal-weight women, irrespective of having PCOS [14]. In several animal species, and they concluded that
other study done by Seow et al. [15] concluded that resistin hyperprolactinemia in women was associated with insulin
mRNA levels were two-fold higher in adipocytes from resistance state [23].
women with PCOS than in those from normal controls.
In this study, PCOS women with IR had higher levels of
OGTT in comparison with PCOS NIR (non-insulin 5. Conclusions
resistance) and control group; obese PCOS subgroup; and
Higher prolactin level was associated with multiple
according to age group, PCOS patient subgroup (B) (age
disorders. It has a relation with obesity and insulin resistance
mean 25.63 years) had higher OGTT with BMI >30 kg/m2.
in cases of PCOS. Moreover, prolactin plays a role in obesity
This situation is may due to the relation of resistin with
condition for PCOS women. In spite of elevation level of
obesity and insulin resistance which was agreement with
serum prolactin in hyperinsulinemic and obese PCOS
Steppan et al. which they mentioned that resistin hormone
women when compared with healthy fertile women but still
leading to insulin resistance, while serum resistin level
prolactin level within normal range. Further biochemical and
increase in the presence of obesity in mice, an anti-diabetic
molecular studies are recommended to investigate the
agent rosiglitazone decreased levels and that administration
correlation between appetite and level of serum prolactin in
of recombinant resistin to mice caused impairment in
healthy and PCOS women.
glucose tolerance and insulin effect [16]. Also, Rekha et al.
[10], concluded that IR was common in PCOS women and
was practically more common in obese PCOS subgroup, and
this conclusion in line with the present study. Thus, no
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