2018 Uluslarası kanıta dayalı Polikistik Over Sendromu değerlendirme ve yönetim rehberi doğrultusunda uzun dönem risklerin yönetimi

Year 2020, , 453 - 461, 14.05.2020

Derya Kilic , Tolga Güler , Erkan Alataş

https://doi.org/10.31362/patd.641770

Cited By: 1

Abstract

Polikistik
Over Sendromu (PKOS); üreme çağındaki kadınlarda izlenen sık endokrin ve
metabolik bozukluktur. Yüksek prevalansına rağmen farklı fenotipleri, yaş
bağımlı heterojen kliniği ve etnik farklılıkları hem klinisyen hem de hasta
açısından tanıda zorluklara yol açmaktadır. PKOS oluşumunun temel mekanizmaları
halen tam olarak bilinmemektedir. Güncel bilgiler ışığında PKOS’un bir çok
faktörün bir araya gelmesi ile oluşan multifaktoriyel bir sendrom olduğu kabul
edilmektedir. Her ne şekilde olursa olsun gerek insülin rezistansı gerekse de
hiperandrojenemi veya bu ikisinin beraber varlığı hastaları ilerleyen
dönemlerde obezite, dislipidemi, kompensatuvar hiperinsülineminin eşlik ettiği
insülin rezistansı, tip 2 diabetes mellitus, metabolik sendrom ve
kardiyovasküler hastalıklar açısından yüksek risk grubuna almaktadır. PKOS
yaşamın farklı dönemlerinde reprodüktif, metabolik, sistemik veya psikolojik
etkileri ayrı ayrı kliniklerde ön plana çıkabilir. PKOS’ a eşlik eden
hastalıklar çoğunlukla bilinmekle birlikte bu hasta grubunda eşlik eden
hastalıklar açısından optimal tarama, total risk değerlendirmesi ve klinik
yönetimle ilgili algoritmalar hala oldukça tartışmalıdır. Olguların yönetiminde
baskın şikayete yönelik tanı ve tedavi planlaması yapılırken, hastalığın
heterojen özelliği gözardı edilmekte, hastalığın komorbiditeleri ve uzun dönem
riskleri üzerinde çoğunlukla yeterli danışmanlık yapılmamaktadır.  Oysa yaşam süresi boyunca hastalığın
seyrinde belirgin klinik varyasyon izlenmekle beraber kronik süreçte PKOS’a
eşlik eden medikal problemler yükledikleri ek komorbiditelerle hastaların
karşısına yeniden çıkabilmektedir. Bu yayının amacı PKOS tanı ve yönetiminde ‘2018
Uluslarası kanıta dayalı PKOS değerlendirme ve yönetim rehberi (2018 PKOS
Rehberi) doğrultusunda  eşlik eden
hastalıklar ve bu hastalıklara bağlı uzun dönem riskler açısından önerilerin
detaylı olarak irdelenmesidir.

Keywords

polikistik over sendromu, menapoz, obezite, insülin direnci, kardiyovasküler hastalık

The management of long-term risks of Polycystic Ovary Syndrome in accordance to 2018 international guideline for the assessment and management of polycystic ovary syndrome.

Abstract

Polycystic Ovary Syndrome (PCOS); is the
most common endocrine and metabolic disturbance during reproductive period in
women. Although its high prevalence, different phenotypes, heterogeneous clinic
presentations related to age and ethnical differences; result in diagnostic dilemmas
for both the clinicians and the patients. The exact pathophsiology of PCOS is
yet to be defined. PCOS is thought to
be a multi-systemic disease currently. In
any case, both insulin resistance and hyperandrogenemia, and the presence of
both conclude with an increased long-term risk of patients for obesity,
dyslypidemi, insulin resistance with compensatuar hyperinsulinemia, metabolic
syndrome and cardiovascular diseases. Reproductive, metabolic, systemic, or
psychological effects of PCOS may come into prominence separately in different
periods of life. Although the comorbidities of PCOS are mostly known, the
algorithms related to optimal screening, total risk assessment, and clinical
management are still controversial for comorbidities in this patient group.

While the
diagnosis and treatment planning for the complaints, the heterogeneous nature
of the disease is generally ignored, and there is often insufficient
consultation on the comorbidities and long-term risks of the disease. However
there is a marked clinical variation in the course of the disease throughout
life, medical problems associated with PCOS may reappear with additional
comorbidities in the chronic process. The aim of this review is to examine the
recommendations with respect to the 2018 International Evidence Based PCOS
Assessment and Management Guideline (2018 PCOS Guideline) in terms of concomitant
co morbid diseases and long-term risks related to PCOS.

Keywords

polycystic ovary syndrome, menapouse, obesity, insulin resistance, cardiovascular disease

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