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

Öz

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.

Anahtar Kelimeler

• 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

Kaynakça

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