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Obez ve Obez Olmayan Polikistik Over Sendromlu Adolesanların Klinik ve Laboratuvar Özelliklerinin Karşılaştırılması

Year 2022, , 75 - 81, 01.01.2022
https://doi.org/10.53394/akd.1037762

Abstract

ÖZ
Amaç: Bu çalışmanın amacı, obez ve obez olmayan Polikistik Over Sendromu tanılı kız çocuklarındaki klinik ve laboratuvar bulgularının değerlendirilmesidir.
Yöntem: Çalışmaya yaşları 13-18 arasında değişen 54 Polikistik Over Sendromu tanılı adolesan olgu dahil edildi. Obez ve obez olmayan Polikistik Over Sendromu tanılı olguların klinik, demografik, laboratuvar ve pelvik ultrasonografi bulguları karşılaştırıldı.
Bulgular: Obez ve obez olmayan gruplar karşılaştırıldığında serum; folikül stimule edici hormon (FSH), lüteinleştirici hormon (LH), serbest testosteron, dehidroepiandrosteron sülfat, 17-OH progesteron, androstenedion, açlık kan şekeri, düşük dansiteli lipoprotein düzeyleri ve pelvik ultrasonografi iki grupta benzer bulundu. Obez olgularda, açlık insülin düzeyi, HOMA-IR skoru, trigliserid düzeyi anlamlı olarak daha yüksek iken, yüksek dansiteli lipoprotein ise düşük saptandı. Androjen düzeyleri ile bel çevresi, kol çevresi, derialtı yağ kalınlığı, vücut yağ oranı ve over volümleri arasında ilişki saptanmaz iken LH/FSH oranı ile serbest testosteron, 17-OH progesteron ve androstenedion düzeyleri arasında pozitif korelasyon saptandı.
Sonuç: Adolesan dönemde Polikistik Over Sendromu tanısı konulduğunda mutlaka metabolik sendrom açısından değerlendirme yapılmalıdır. Metabolik sendrom riski saptanan olgularda bu dönemde dengeli diyet ve düzenli egzersiz alışkanlığı edinmek erişkinlik döneminde eşlik edebilecek komorbid hastalıklar sıklığının azaltılmasında anahtar rol oynamaktadır.
Anahtar Sözcükler: Polikistik over sendromu, Adolesan, Obezite, Hirsutizm

References

  • 1. Ibáñez L, Oberfield S.E, Witchel S, Auchus R.J, Chang R.J, Codner E, Dabadghao P, Darendeliler F, Elbarbary N.S, Gambineri A, Garcia Rudaz C, Hoeger K.M, López-Bermejo A, Ong K, Peña A.S, Reinehr T, Santoro N, Tena-Sempere M, Tao R, Yildiz B.O, Alkhayyat H, Deeb A, Joel D, Horikawa R, de Zegher F, Lee P.A. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Pediatr 2017; 88:371-395.
  • 2. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yıldız BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89:2745-2749.
  • 3. Christensen SB, Black MH, Smith N, Martinez MM, Jacobsen SJ, Porter AH, Koebnick C. Prevalence of polycystic ovary syndrome in adolescents. Fertil Steril 2013; 100(2):470–477.
  • 4. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352:1223-1236.
  • 5. Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91:48-53.
  • 6. Moghetti P, Tosi F, Bonin C, Di Sarra D, Fiers T, Kaufman JM, Giagulli VA, Signori C, Zambotti F, Dall’Alda M, Spiazzi G, Zanolin ME, Bonora E. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:628-637.
  • 7. Wu S, Divall S, Wondisford F, Wolfe A. Reproductive tissues maintain insulin sensitivity in diet-induced obesity. Diabetes 2011; 61:114-123.
  • 8. Rosenfield RL. Clinical practice. Hirsutism. N Eng J Med 2005; 353:2578-2588.
  • 9. Martin K, Chang J, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swigloet BA. Evaluation and treatment of hirsutism in premenopausal women: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93:1105-1120.
  • 10. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis Model Assessment Is More Reliable Than the Fasting Glucose/Insulin Ratio and Quantitative Insulin Sensitivity Check Index for Assessing Insulin Resistance Among Obese Children and Adolescents. Pediatrics 2005; 115:e500-e503.
  • 11. Littlejohn EE, Weiss RE, Deplewski D, Edidin DV, Rosenfield R. Intractable early childhood obesity as the initial sign of insulin resistant hyperinsulinism and precursor of polycystic ovary syndrome. J Pediatr Endocrinol Metab 2007; 20:41-51.
  • 12. Vatopouloua A, Tziomalos K. Management of obesity in adolescents with polycystic ovary syndrome. Expert Opin Pharmacother 2020; 21(2):207-211.
  • 13. Coviello AD, Legro RS, Dunaif A. Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab 2006; 91:492-497.
  • 14. Alemzadeh R, Kichler J, Calhoun M. Spectrum of metabolic dysfunction in relationship with hyperandrogenemia in obese adolescent girls with polycystic ovary syndrome. Eur J Endocrinol 2010; 162:1093-1099.
  • 15. Goss AM, Chandler Laney PC, Ovalle F, Lee Goree L, Azziz R, Desmond RA, G. Bates GW, Goweret BA. Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS. Metabolism 2014; 63:1257-1264.
  • 16. Ezeh U, Pall M, Mathur R, Azziz R. Association of fat to lean mass ratio with metabolic dysfunction in women with polycystic ovary syndrome. Hum Reprod 2014; 29:1508-1517. https://doi.org/10.1093/humrep/deu096
  • 17. Roe AH, Prochaska E, Smith M, Sammel M, Dokras A. Using the androgen excess-PCOS society criteria to diagnose polycystic ovary syndrome and the risk of metabolic syndrome in adolescents. J Pediatr 2013; 162:937-941.
  • 18. Geronikolou SA, Bacopoulou F, Cokkinos D. Bioimpedance measurements in adolescents with polycystic ovary syndrome: a pilot study. Adv Exp Med Biol 2017; 987:291-299.
  • 19. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycyctic ovary syndrome. Fertil Steril 2004; 81:19-25.
  • 20. Codner E, Villarroel C, Eyzaguirre FC, Lopez P, Merino PM, Perez-Bravo F, German Iniguez G, Cassorla F. Polycystic ovarian morphology in postmenarchal adolescents. Fertil Steril 2011; 95:702-706.
  • 21. Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study. J Pediatr 1997; 130:30-39.
  • 22. Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril 2005; 83:1717-1723.
  • 23. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19:41-47.
  • 24. Caldwell ASL, Edwards MC, Desai R, Jimeneza M, Gilchristb RB, Handelsmana DJ, Walterset KA. Neuroendocrine androgen action is a key extraovarian mediator in the development of polycystic ovary syndrome. Proc Natl Acad Sci USA. 2017; 114:3334-3343.
  • 25. Dabadghao P. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Endocrinol Metab 2019; 33(3):101272.
  • 26. Nestler JE, Jakubowicz DJ, De Vargas AF, Brik C, Quintero N, Medina F. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab 1998; 83:2001-2005.
  • 27. Cho LW, Jayagopal V, Kilpatrick ES, Holding S, Atkin SL. The LH/FSH ratio has little use in diagnosing polycystic ovarian syndrome. Ann Clin Biochem 2006; 43:217-219.
  • 28. Escobar Morreale HF, Asuncio´n M, Calvo RM, Sancho J, San Milla´n JL. Receiver operating characteristic analysis of the performance of basal serum hormone profiles for the diagnosis of polycystic ovary syndrome in epidemiological studies. Eur J Endocrinol 2001; 145:619-624.
  • 29. Barth JH, Field HP, Yasmin E, Balen AH. Defining hyperandrogenism in polycystic ovary syndrome: measurement of testosterone and androstenedione by liquid chromatography–tandem mass spectrometry and analysis by receiver operator characteristic plots. Eur J Endocrinol 2010; 162:611-615.
  • 30. Fruzzetti F, Perini D, Lazzarini V, Parrini D, Genazzani AR. Adolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels. Fertil Steril 2009; 92:626-634.
  • 31. Rossi B, Sukalich S, Droz J, Griffin A, Cook S, Blumkin A, Guzick DS, Hoegeret KM. Prevalence of metabolic syndrome and related characteristics in obese adolescents with and without polycystic ovary syndrome. J Clin Endocrinol Metab 2008; 93:4780-4786.
  • 32. Diamanti Kandarakis E. PCOS in adolescents. Best Pract Res Clin Obstet Gynaecol 2010; 24:173-183.
  • 33. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S. The metabolic syndrome in children and adolescents. Lancet 2007; 369(9579):2059.
  • 34. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010; 16:347-363.

Comparison of The Clinical and Laboratory Characteristics of Obese and Non-Obese Adolescents with Polycystic Ovary Syndrome

Year 2022, , 75 - 81, 01.01.2022
https://doi.org/10.53394/akd.1037762

Abstract

ABSTRACT
Objective: The present study aimed to evaluate the clinical and laboratory findings in obese and non-obese girls diagnosed with Polycystic Ovary Syndrome.
Methods: The total sample size was obese and non-obese 54 adolescents diagnosed with Polycystic Ovary Syndrome aged between 13-18 years. Demographic, clinic, laboratory, and pelvic ultrasonography findings of both groups were compared.
Results: Both obese and non-obese adolescents with PCOS features have shown similarities in the levels of serum Follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone, dehydroepiandrosterone sulfate, 17-OH progesterone, androstenedione, fasting blood glucose, low-density lipoprotein levels and pelvic ultrasonography. Fasting insulin level, HOMA-IR score, and triglyceride level were significantly higher in obese patients, though high-density lipoprotein was found to be low. There was no correlation between androgen levels and waist circumference, arm circumference, subcutaneous fat thickness, body fat ratio, and ovarian volume. A positive correlation was found between LH / FSH ratio and free testosterone, 17-OH progesterone and androstenedione levels.
Conclusions: Adolescents diagnosed with the Polycystic Ovary Syndrome should be evaluated in terms of metabolic syndrome. In cases with metabolic syndrome risk, healthy balanced diet accompanied by regular exercise play an important role in reducing the frequency of comorbid diseases that can occur in adulthood.
Key Words: Polycystic ovary syndrome, Adolescent, Obesity, Hirsutism.

References

  • 1. Ibáñez L, Oberfield S.E, Witchel S, Auchus R.J, Chang R.J, Codner E, Dabadghao P, Darendeliler F, Elbarbary N.S, Gambineri A, Garcia Rudaz C, Hoeger K.M, López-Bermejo A, Ong K, Peña A.S, Reinehr T, Santoro N, Tena-Sempere M, Tao R, Yildiz B.O, Alkhayyat H, Deeb A, Joel D, Horikawa R, de Zegher F, Lee P.A. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Pediatr 2017; 88:371-395.
  • 2. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yıldız BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89:2745-2749.
  • 3. Christensen SB, Black MH, Smith N, Martinez MM, Jacobsen SJ, Porter AH, Koebnick C. Prevalence of polycystic ovary syndrome in adolescents. Fertil Steril 2013; 100(2):470–477.
  • 4. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352:1223-1236.
  • 5. Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91:48-53.
  • 6. Moghetti P, Tosi F, Bonin C, Di Sarra D, Fiers T, Kaufman JM, Giagulli VA, Signori C, Zambotti F, Dall’Alda M, Spiazzi G, Zanolin ME, Bonora E. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:628-637.
  • 7. Wu S, Divall S, Wondisford F, Wolfe A. Reproductive tissues maintain insulin sensitivity in diet-induced obesity. Diabetes 2011; 61:114-123.
  • 8. Rosenfield RL. Clinical practice. Hirsutism. N Eng J Med 2005; 353:2578-2588.
  • 9. Martin K, Chang J, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swigloet BA. Evaluation and treatment of hirsutism in premenopausal women: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93:1105-1120.
  • 10. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis Model Assessment Is More Reliable Than the Fasting Glucose/Insulin Ratio and Quantitative Insulin Sensitivity Check Index for Assessing Insulin Resistance Among Obese Children and Adolescents. Pediatrics 2005; 115:e500-e503.
  • 11. Littlejohn EE, Weiss RE, Deplewski D, Edidin DV, Rosenfield R. Intractable early childhood obesity as the initial sign of insulin resistant hyperinsulinism and precursor of polycystic ovary syndrome. J Pediatr Endocrinol Metab 2007; 20:41-51.
  • 12. Vatopouloua A, Tziomalos K. Management of obesity in adolescents with polycystic ovary syndrome. Expert Opin Pharmacother 2020; 21(2):207-211.
  • 13. Coviello AD, Legro RS, Dunaif A. Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab 2006; 91:492-497.
  • 14. Alemzadeh R, Kichler J, Calhoun M. Spectrum of metabolic dysfunction in relationship with hyperandrogenemia in obese adolescent girls with polycystic ovary syndrome. Eur J Endocrinol 2010; 162:1093-1099.
  • 15. Goss AM, Chandler Laney PC, Ovalle F, Lee Goree L, Azziz R, Desmond RA, G. Bates GW, Goweret BA. Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS. Metabolism 2014; 63:1257-1264.
  • 16. Ezeh U, Pall M, Mathur R, Azziz R. Association of fat to lean mass ratio with metabolic dysfunction in women with polycystic ovary syndrome. Hum Reprod 2014; 29:1508-1517. https://doi.org/10.1093/humrep/deu096
  • 17. Roe AH, Prochaska E, Smith M, Sammel M, Dokras A. Using the androgen excess-PCOS society criteria to diagnose polycystic ovary syndrome and the risk of metabolic syndrome in adolescents. J Pediatr 2013; 162:937-941.
  • 18. Geronikolou SA, Bacopoulou F, Cokkinos D. Bioimpedance measurements in adolescents with polycystic ovary syndrome: a pilot study. Adv Exp Med Biol 2017; 987:291-299.
  • 19. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycyctic ovary syndrome. Fertil Steril 2004; 81:19-25.
  • 20. Codner E, Villarroel C, Eyzaguirre FC, Lopez P, Merino PM, Perez-Bravo F, German Iniguez G, Cassorla F. Polycystic ovarian morphology in postmenarchal adolescents. Fertil Steril 2011; 95:702-706.
  • 21. Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study. J Pediatr 1997; 130:30-39.
  • 22. Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril 2005; 83:1717-1723.
  • 23. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19:41-47.
  • 24. Caldwell ASL, Edwards MC, Desai R, Jimeneza M, Gilchristb RB, Handelsmana DJ, Walterset KA. Neuroendocrine androgen action is a key extraovarian mediator in the development of polycystic ovary syndrome. Proc Natl Acad Sci USA. 2017; 114:3334-3343.
  • 25. Dabadghao P. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Endocrinol Metab 2019; 33(3):101272.
  • 26. Nestler JE, Jakubowicz DJ, De Vargas AF, Brik C, Quintero N, Medina F. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab 1998; 83:2001-2005.
  • 27. Cho LW, Jayagopal V, Kilpatrick ES, Holding S, Atkin SL. The LH/FSH ratio has little use in diagnosing polycystic ovarian syndrome. Ann Clin Biochem 2006; 43:217-219.
  • 28. Escobar Morreale HF, Asuncio´n M, Calvo RM, Sancho J, San Milla´n JL. Receiver operating characteristic analysis of the performance of basal serum hormone profiles for the diagnosis of polycystic ovary syndrome in epidemiological studies. Eur J Endocrinol 2001; 145:619-624.
  • 29. Barth JH, Field HP, Yasmin E, Balen AH. Defining hyperandrogenism in polycystic ovary syndrome: measurement of testosterone and androstenedione by liquid chromatography–tandem mass spectrometry and analysis by receiver operator characteristic plots. Eur J Endocrinol 2010; 162:611-615.
  • 30. Fruzzetti F, Perini D, Lazzarini V, Parrini D, Genazzani AR. Adolescent girls with polycystic ovary syndrome showing different phenotypes have a different metabolic profile associated with increasing androgen levels. Fertil Steril 2009; 92:626-634.
  • 31. Rossi B, Sukalich S, Droz J, Griffin A, Cook S, Blumkin A, Guzick DS, Hoegeret KM. Prevalence of metabolic syndrome and related characteristics in obese adolescents with and without polycystic ovary syndrome. J Clin Endocrinol Metab 2008; 93:4780-4786.
  • 32. Diamanti Kandarakis E. PCOS in adolescents. Best Pract Res Clin Obstet Gynaecol 2010; 24:173-183.
  • 33. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S. The metabolic syndrome in children and adolescents. Lancet 2007; 369(9579):2059.
  • 34. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010; 16:347-363.
There are 34 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Aynur Bedel This is me 0000-0001-6074-7606

Hale Tuhan This is me 0000-0002-7637-9630

Eren İsmailoğlu This is me 0000-0001-9998-6081

Deniz Özalp Kızılay This is me 0000-0003-4529-4404

Sezer Acar This is me 0000-0002-0768-835X

Publication Date January 1, 2022
Submission Date December 24, 2020
Published in Issue Year 2022

Cite

APA Bedel, A., Tuhan, H., İsmailoğlu, E., Özalp Kızılay, D., et al. (2022). Obez ve Obez Olmayan Polikistik Over Sendromlu Adolesanların Klinik ve Laboratuvar Özelliklerinin Karşılaştırılması. Akdeniz Tıp Dergisi, 8(1), 75-81. https://doi.org/10.53394/akd.1037762