Ergen kızlarda polikistik over sendromu: klinik, endokrin ve metabolik bulgular

Yıl 2019, Cilt: 50 Sayı: 4, 194 - 197, 15.12.2019

Bahar Özcabı , Feride Tahmiscioğlu Bucak Esma Şengenç Evrim Sunamak İbrahim Adaletli , Sebuh Kuruğoğlu Oya Ercan Olcay Evliyaoğlu

https://doi.org/10.16948/zktipb.499708

Öz

Amaç:
Polikistik over sendromu tanısı alan ergen kızların başvurudaki klinik, metabolik
ve endokrin bulgularını değerlendirmeyi amaçladık.

Gereç-Yöntemler: Ocak 2008-Aralık 2012 tarihleri arasında Rotterdam tanı ölçütlerine göre tanılandırılan
53 olgunun yakınmaları, adet düzenleri, fizik bakı bulguları (antropometrik
ölçümler, Ferriman Gallwey skoru, akantozis nigrikans varlığı), bazal/uyarılmış
adrenal androjen, açlık glukoz/insülin değerleri, kan yağ ve lipoprotein
düzeyleri, pelvik ultrasonografi bulguları kaydedildi. Yaşa göre vücut kitle
indeksi (VKİ) %95 ve üzeri olgular şişman olarak tanımlandı. Oligo/amenore,
hiperandrojenizm ve ultrasonografide polikistik over bulgularının hepsinin bulunduğu
hastalar klasik grup olarak adlandırıldı. Kan trigliserit düzeyi yaşa göre %97
değerinden fazla ise yüksek olarak nitelendirildi; HOMA-IR değeri ≥ 3,82 olgularda
insülin direnci var kabul edildi.

Bulgular:
Ortalama başvuru yaşı 15±1,5 yıldı. En sık yakınma adet düzensizliğiydi
(%49,1). Adet düzeni ayrıntılı sorgulandığındaysa olguların %60,4’ünde oligo/amenore
olduğu görüldü. Olguların  %43,4’ü
şişmandı. Akantozis nigrikans (%37,7) olan olgularda şişmanlık daha sıktı
(p=0.010). Hirsutizm %41,5 olguda orta-ağır (Ferriman Gallwey skoru≥16) olarak
belirlendi: orta-ağır olgularda oligo/amenore daha sıktı (p=0,007).
İnsülin direnci %39,6 olguda (%81 obez) vardı ve akantozis nigrikans
saptananlarda daha sıktı (p=0,001). Trigliserit
yüksekliği 49 olgudan 7’sinde saptandı; bu olguların hepsinde insülin direnci de
mevcuttu (p=0,033). Serum trigliserit düzeyi ile HOMA-IR değeri arasında
korelasyon saptandı (r:0,415). Polikistik over bulgusu olguların % 96,2’sinde
belirlendi. Klasik grupta diğer gruba göre oligo/amenore, hirsutizm, akantozis
nigrikans, trigliserit yüksekliği anlamlı (p<0.005), total testosteron
düzeyi anlamlılığa yakın yüksekti (p=0.056).

Sonuç: Polikistik
over sendromu tanısında adet düzeni ayrıntılı olarak sorgulanmalıdır. Akantozis
nigrikans saptanan olgular insülin direnci açısından irdelenmeli, insülin
direnci varlığında trigliserit yüksekliği araştırılmalıdır.

Anahtar Kelimeler

akantozis nigrikans, hiperandrojenizm, hirsutizm, insülin direnci, polikistik over sendromu

Polycystic ovary syndrome in adolescent girls: Clinical, endocrinological and metabolic findings

Öz

Aim:
We aimed to evaluate the clinical, metabolic, and endocrinological findings of
adolescent girls with polycystic ovary syndrome.

Material-Methods: The data
about menstrual patterns, physical examination (anthropometric measurements,
Ferriman Gallwey score, acanthosis nigricans), basal/stimulated adrenal
androgens, fasting glucose/insulin, lipid/lipoprotein levels, and
ultrasonography findings were
obtained from the medical records of
53 cases diagnosed according to Rotterdam criteria between January
2008-December 2012. Patients with body mass index (BMI) percentile ≥95%
according to age were defined as obese. Patients meeting all of the 3 criteria
(menstrual irregularity, hyperandrogenism and polycystic ovaries on ultrasound)
were defined as the classical group and the rest as the other group. Blood triglyceride
level more than %97 percentile level according to age is considered high;
insulin resistance was considered to be present in patients with HOMA-IR ≥3.82.

Results:
The mean age was 15±1.5 years. The most common complaint was menstrual irregularity(49,1%);
oligo/amenorrhea was present in 60.4% of cases when questioned in detail.
Acanthosis nigricans was more frequent in obese cases (p=0.010). Moderate-severe
hirsutism (Ferriman Gallwey score ≥16) was present in 41.5% of patients in whom
oligo/amenorrhea was more frequent (p=0.007). Insulin resistance was detected in 39.6% of the patients
(81% obese) and more frequent in patients with acanthosis nigricans (p=0.001). Hypertriglyceridemia
was determined in seven of 49 cases in which insulin resistance was
significantly more frequent (p=0.033). A positive correlation was detected
between triglyceride and HOMA-IR levels (r:0,415). Polycystic ovary on ultrasound was detected in 96.2% of patients. In
classical group; oligo/amenorrhea, hirsutism, acanthosis nigricans, and
hypertriglyceridemia were more frequent than the other group   (p<0.005).
Total testosterone level was higher in the classical group but the difference
was not significant (p=0.056).

Conclusion: The menstrual cycle of patients
with polycystic ovary syndrome should be questioned in detail. In patients with
acanthosis nigricans, insulin resistance must be considered and in the presence
of insulin resistance hypertriglyceridemia should be investigated.

Anahtar Kelimeler

acanthosis nigricans, hirsutism, hyperandrogenism, insulin resistance, polycystic ovary syndrome

Kaynakça

• 1) Fauser BC, Tarlatzis BC, Rebar RW et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012; 97(1), 28-38.
• 2) Witchel SF. Hirsutism and polycystic ovary syndrome In: Lifshitz F, editor. Pediatric Endocrinology. New York: Informa Healthcare USA Inc, 2007. P.325-48.
• 3)Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004; 81(1), 19-25.
• 4) Sultan C, Paris F. Clinical expression of polycystic ovary syndrome in adolescent girls. Fertil Steril. 2006; 86 Suppl 1:S6.
• 5) Witchel SF, Oberfield S, Rosenfield RL et al. The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr. 2015; 83(6), 376-389.
• 6) Rosenfield RL, Cooke DW, Radovick S. Puberty and its disorders in the female. In: Sperling MA editor. Pediatric Endocrinology. Philadelphia: Saunders Elsevier. 2008;530-609.
• 7) Evliyaoğlu O. Polikistik over sendromu ve hirsutizm. Türk Ped Arş. 2011; 46(11).
• 8) Rosenfield RL. The diagnosis of polycystic ovary syndrome in adolescents. Pediatrics. 2015; 136(6):1154-65
• 9) Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, Baş F. Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol. 2015;7(4):280-93.
• 10) Evliyaoglu O, Alikaşifoğlu M, Büyükgebiz A, Ercan O. Adolesan dönemi endokrin sorunları. In: Cinaz P, Darendeliler F, Akıncı A, Özkan B, Dündar B, Abacı A, Akçay T, editors. Çocuk Endokrinolojisi. İstanbul: Nobel Tıp Kitabevleri; 2014.p.179-202.
• 11) Kumar S, Kelly A.S. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. In: Mayo Clin Proc. Elsevier. 2017; 92(2):251-265.
• 12) Craig ME, Jefferies C, Dabelea D et al. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014; 15(Suppl 20), 4-17.
• 13) Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Ped Endo. 2010; 2(3), 100-106.
• 14) Daniels, SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008; 122(1), 198-208
• 15) Bhattacharya SM, Ghosh M. Insulin resistance and adolescent girls with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2010;23(3):158-6
• 16) Rocha MP, Marcondes JA, Barcellos CR et al. Dyslipidemia in women with polycystic ovary syndrome: incidence, pattern and predictors. Gynecol Endocrinol. 2011; 27(10), 814-819.