Polycystic ovary syndrome and hirsutism

Abstract

Polycystic ovary syndrome is a multi factorial heterogenous disorder characterized by chronic anovulation and hyperandrogenism Diagnosis is based on clinical or laboratory evidence of nbsp; hyperandrogenism nbsp; For diagnosis at least two of the three Rotterdam criteria oligo anovulation clinical or biochemical signs of hyperandrogenism polycystic ovaries nbsp; should be ensured Clinical symptoms usually begin around menarche nbsp; Oligomenorrhea amenorrhea hirsutism acne alopecia can be associated with central obesity İnsulin resistance hyperandrogenism LH excess and sonographic appearance of polycystic ovaries are the laboratory findings nbsp; Functional ovarian and adrenal hyperandrogenism can be demonstrated in the majority of the patients Although pathogenesis is multifactorial insulin resistance seems to play a central role nbsp; İrrespective of obesity there is insulin resistance in 50 70 of the patients Adolescents presenting with hirsutism menstrual irregularities and central obesity should be evaluated for differential diagnosis of nbsp; hyperandrogenism and the etiology be determined Treatment depends on the clinical signs and the source of hyperandrogenism nbsp; nbsp; In the patients with menstrual disorders and or functional ovarian hyperandrogenism oral contraceptives are the first line drugs nbsp; Antiandrogens are prefered in patients with hirsutism and functional hyperandrogenism nbsp; If insulin resistance is the heading symptom insulin sensitizers can be used Hirsutism is defined as excessive terminal hair growth at androgen dependent sites and is the most frequent symptom of hyperandrogenism Treatment consists of nbsp; androgen decreasing drugs related to the etiology of androgen excess and locally epilation of the hair In patients presenting with polycystic ovary syndrome and hirsutism initially the etiology of hyperandrogenism should be identified and treatment planned appropriate to the reason Turk Arch Ped nbsp; 2011; 46 Suppl: 97 102

Keywords

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Polikistik over sendromu ve hirsutizm

Öz

Polikistik over sendromu kronik anovulasyon ve hiperandrojenizm ile kendini gösteren birçok etmenin birlikte oluşturduğu heterojen bir bozukluktur Tanısı hiperandrojenizmin klinik ve laboratuvar bulgularının gösterilmesine ve hiperandrojenizme neden olabilecek diğer bozuklukların dışlanmasına dayanır nbsp; Rotterdam kriterlerinden oligo anovulasyon hiperandrojenizm klinik ve veya biyokimyasal bulguları ve ultrasonografide polikistik overlerin görülmesi en az ikisinin bulunması ile tanı konulur Klinik bulgular menarş yaşı civarında ortaya çıkar Oligomenore amenore hirsutizm akne ve alopesi gibi kronik anovulasyon ve hiperandrojenizm bulguları yanı sıra olgularda santral obezite de bulunabilir İnsulin direnci hiperandrojenizm LH fazlalığı ve ultrasonografide polikistik over görüntüsü laboratuvar bulgularıdır nbsp; Fonksiyonel ovarian veya adrenal hiperandrojenizm olguların önemli bir kısmında belirlenebilir Patogenezinde tek bir etken rol oynamamak ile birlikte insulin direnci merkezde gibi görünmektedir nbsp; Obeziteden bağımsız olarak olguların 50 70 rsquo;inde insulin direnci bulunmaktadır Pubertede hirsutizm menstürel bozukluklar veya santral obezite ile başvuran bütün olgularda ayırıcı tanıda hiperandrojenizme neden olabilecek bozukluklar araştırılmalı hiperandrojenizm nedeni belirlenmeye çalışılmalıdır Tedavisi bulgulara ve hiperandrojenizmin kaynağına bağlı olarak değişkendir Menstürel bozuklukları ve veya fonksiyonel ovarian hiperandrojenizmi bulunan olgularda doğum kontrol hapları ilk seçenektir nbsp; Antiandrojenler hirsutizmi ve fonksiyonel hiperandrojenizmi olanlarda tercih edilir İnsulin direnci ön planda ise insulin duyarlılığını arttıran ilaçlar kullanılır Hirsutizm androjenik bölgelerde aşırı terminal kıllanma olmasıdır Hiperandrojenizmin en sık klinik bulgusudur Tedavisi nbsp; androjen kaynağına göre androjen nbsp; miktarını düşürücü ilaçlar ile birlikte kılların lokal olarak ortadan kaldırılmasıdır Polikistik over sendromu ve hirsutizm ile başvuran olgularda öncelikle hiperandrojenizmin nedeni bulunmalı ve nedene yönelik tedavi planlanmalıdır Türk Ped Arş 2011; 46 Özel Sayı: 97 102

Anahtar Kelimeler

• Polikistik over sendromu, hirsutizm, hiperandrojenizm

Kaynakça

1. Witchel SF. Hirsutism and polycystic ovary syndrome In: Lifshitz F (ed)- Pediatric Endocrinology New York, Informa Healthcare USA Inc, 2007: 325-48.
2. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89: 2745-9. (Abstract) / (Full Text) / (PDF)
3. Kahsar-Miller MD, Nixon C, Boots LR, Go RC, Azziz R. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil Steril 2001; 75: 53-8. (Abstract) / (Full Text) / (PDF)
4. Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference? Clin Endocrinol (Oxf) 2002; 57: 343-50. (Abstract) / (PDF)
5. Williamson K, Gunn AJ, Johnson N, Milsom SR. The impact of ethnicity on the presentation of polycystic ovarian syndrome. Aust NZJ Obstet Gynaecol 2001; 41: 202-6. (Abstract)
6. 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: 41-7. (Abstract) / (Full Text) / (PDF)
7. Balen A, Michelmore K. What is polycystic ovary syndrome? Are national views important? Hum Reprod 2002; 17: 2219-27. (Abstract) / (Full Text) / (PDF)
8. Saxton DW, Farquhar CM, Rae T, Beard RW, Anderson MC, Wadsworth J. Accuracy of ultrasound measurements of female pelvic organs. Br J Obstet Gynaecol 1990; 97: 695-9. (Abstract) /

9. Laven JS, Imani B, Eijkemans MJ, Fauser BC. New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv 2002; 57: 755-67. (Abstract)
10. Engmann L, Maconochie N, Sladkevicius P, Bekir J, Campbell S, Tan SL. The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology. Hum Reprod 1999; 14: 167-71. (Abstract) / (Full Text) / (PDF)
11. Zawadski JK, Dunaif, A. Diagnostic criteria for polycystic ovary syndrome: towarda a rational approach. In: Dunaif A, Givens, J.R. Haseltime, F.P., Merriam GR (eds) Polycystic ovary syndrome. Boston, Blackwell Scientific Publications 1992: 377-84.
12. Ehrmann DA, Rosenfield RL, Barnes RB, Brigell DF, Sheikh Z. Detection of functional ovarian hyperandrogenism in women with androgen excess. N Engl J Med 1992; 327: 157-62. (Abstract) / (PDF)
13. Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries--a common finding in normal women. Lancet 1988; 1: 870-2. (Abstract) / (PDF)
14. Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf) 1999; 51: 779-86. (Abstract) / (PDF)
15. Franks S. Adult polycystic ovary syndrome begins in childhood. Best Pract Res Clin Endocrinol Metab 2002; 16: 263-72. (Abstract) / (PDF) 1101
16. Polikistik over sendromu
17. Non-klasik konjenital adrenal hiperplazi Androjen tümörler Cushing sendromu
18. Hiperprolaktinemi Hipotiroidi
19. Büyüme hormonu fazlalığı Androjenik ilaçlar
20. Germ hücre tümörleri Obezite İdiyopatik
21. Ibanez L, Valls C, Potau N, Marcos MV, de Zegher F. Polycystic ovary syndrome after precocious pubarche: ontogeny of the low-birthweight effect. Clin Endocrinol (Oxf) 2001; 55: 667-72. (Abstract) / (PDF)
22. Eisner JR, Dumesic DA, Kemnitz JW, Colman RJ, Abbott DH. Increased adiposity in female rhesus monkeys exposed to androgen excess during early gestation. Obes Res 2003; 11: 279-86. (Abstract)
23. Abbott DH, Dumesic DA, Franks S. Developmental origin of polycystic ovary syndrome - a hypothesis. J Endocrinol 2002; 174: 1-5. (Abstract) / (PDF)
24. Escobar-Morreale HF, San Millan JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab 2007; 18: 266-72. (Abstract) / (PDF)
25. Rosenfield RL, Cooke, D.W., Radovick, S. Puberty and it's disorders in the female. In: Sperling MA (ed). Pediatric Endocrinology 3'rd ed-Philadelphia, Saunders Elsevier, 2008:530-609.
26. Khan U. Polycystic ovary syndrome in adolescents. J Pediatr Adolesc Gynecol 2007; 20: 101-4. (Abstract) / (Full Text) / (PDF)
27. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18: 774-800. (Abstract) / (Full Text) / (PDF)
28. Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J Clin Endocrinol Metab 2005; 90: 3236-42. (Abstract) / (Full Text) / (PDF)
29. Mukherjee S, Maitra A. Molecular & genetic factors contributing to insulin resistance in polycystic ovary syndrome. Indian J Med Res 2010; 131: 743-60. (Abstract) / (PDF)
30. Bremer AA, Miller WL. The serine phosphorylation hypothesis of polycystic ovary syndrome: a unifying mechanism for hyperandrogenemia and insulin resistance. Fertil Steril 2008; 89: 1039-48. (Abstract) / (Full Text) / (PDF)
31. Barbieri RL, Makris A, Ryan KJ. Insulin stimulates androgen accumulation in incubations of human ovarian stroma and theca. Obstet Gynecol 1984; 64: 73-80. (Abstract)
32. Sekar N, Lavoie HA, Veldhuis JD. Concerted regulation of steroidogenic acute regulatory gene expression by luteinizing hormone and insulin (or insulin-like growth factor I) in primary cultures of porcine granulosa-luteal cells. Endocrinology 2000; 141: 3983-92. (Abstract) / (Full Text) / (PDF)
33. Ciaraldi TP, Morales AJ, Hickman MG, Odom-Ford R, Yen SS, Olefsky JM. Lack of insulin resistance in fibroblasts from subjects with polycystic ovary syndrome. Metabolism 1998; 47: 940-6. (Abstract) / (PDF)
34. Book CB, Dunaif A. Selective insulin resistance in the polycystic ovary syndrome. J Clin Endocrinol Metab 1999; 84: 3110-6. (Abstract) / (Full Text) / (PDF)
35. Suikkari AM, MacLachlan V, Montalto J, Calderon I, Healy DL, McLachlan RI. Ultrasonographic appearance of polycystic ovaries is associated with exaggerated ovarian androgen and oestradiol responses to gonadotrophin-releasing hormone agonist in women undergoing assisted reproduction treatment. Hum Reprod 1995; 10: 513-9. (Abstract) / (PDF)
36. Ibanez L, Potau N, Marcos MV, de Zegher F. Treatment of hirsutism, hyperandrogenism, oligomenorrhea, dyslipidemia, and hyperinsulinism in nonobese, adolescent girls: effect of flutamide. J Clin Endocrinol Metab 2000; 85: 3251-55. (Abstract) / (Full Text) / (PDF)
37. Deplewski D, Rosenfield RL. Role of hormones in pilosebaceous unit development. Endocr Rev 2000; 21: 363-92. (Abstract) / (Full Text) / (PDF)
38. Azziz R, Carmina E, Sawaya ME. Idiopathic hirsutism. Endocr Rev 2000; 21: 347-62. (Abstract) / (Full Text) / (PDF)
39. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981; 140: 815-30. (Abstract)
40. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998; 83: 3078-82. (Abstract) / (Full Text) / (PDF)
41. Clark BJ, Wells J, King SR, Stocco DM. The purification, cloning, and expression of a novel luteinizing hormone-induced mitochondrial protein in MA-10 mouse Leydig tumor cells. Characterization of the steroidogenic acute regulatory protein (StAR). J Biol Chem 1994; 269: 28314-22. (Abstract) / (PDF)
42. Danilenko DM, Ring BD, Pierce GF. Growth factors and cytokines in hair follicle development and cycling: recent insights from animal models and the potentials for clinical therapy. Mol Med Today 1996; 2: 460-7. (Abstract)
43. Chen W, Thiboutot D, Zouboulis CC. Cutaneous androgen metabolism: basic research and clinical perspectives. J Invest Dermatol 2002; 119: 992-1007. (Abstract) / (Full Text) / (PDF)
44. Thiboutot D, Bayne E, Thorne J, et al. Immunolocalization of 5alpha-reductase isozymes in acne lesions and normal skin. Arch Dermatol 2000; 136: 1125-9. (Abstract) / (Full Text) / (PDF)