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Neuro endocrine syndromes in gynecology
 

Neuro endocrine syndromes in gynecology

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    Neuro endocrine syndromes in gynecology Neuro endocrine syndromes in gynecology Presentation Transcript

    • Neuro-endocrine syndromes in gynecology
      Lecture by AndriyBerbets
    • Polycystic ovarian syndrome
      PCOS is also known as Stein-Levental syndrome
      Frequency:
      Approximately 1% of female population suffers from PCOS
      30% among patients of gynecological endocrinologist
      75% of infertility with endocrine genesis
    • Polycystic ovarian syndrome
      Structural changes of the ovaries:
      Ovaries are enlarged in size 2-6 times on both sides
      Hyperplasia of stroma and theca cells
      Presence of big amount of follicles with cystic changes and atresia
    • Polycystic ovarian syndrome
      Structural changes of the ovaries:
      The average diameter of the follicle is 5-8 mm
      Follicles form the “necklace” of ovarian
      Ovarian capsule is thick
    • Polycystic ovarian syndrome
      Normal metabolism of androgens in females
      Androgens are synthesized in ovaries in follicles
      Peak of synthesis of androgens in ovaries comes when follicle is 5-8 mm in size
      Ovarian androgens (testosterone, andrestendion) are converted into estrogens (estradiol, estron)
    • Polycystic ovarian syndrome
      The enzyme Cytochrome P450c17 is responsible for conversion of estrogens into androgens
      The synthesis of this enzyme is regulated by follicle-stimulating hormone (FSH) produced by pituitary
    • Polycystic ovarian syndrome
      Pathogenesis
      Develops in puberty age
      Probable reasons are genetic, viral infections, obesity etc
      Hypothalamic gonadotropine-releasing hormone (GRH) is increased
      Consequently, level of luteinizing hormone (LH) increases, FSH decreases
    • Polycystic ovarian syndrome
      High level of LH provokes cystic atresia of follicles
      Low level of FSH causes deficiency of enzyme P450c17
      Androgens are not converted to estrogens enough -> hyperandrogenia and lack of ovarian estrogens
    • Polycystic ovarian syndrome
    • Polycystic ovarian syndrome
      Patients with PCOS have more or less manifesting resistance to insulin (defect of insulin receptors)
      Blood level of glucose increases
      Obesity appears
      Compensatory, levels of insulin and insulin-like growth factor-1 are increased
      That substances cause high synthesis of androgens and estrogens by fat tissue
      Process does not depend from pituitary
    • Polycystic ovarian syndrome
    • Polycystic ovarian syndrome
      Clinical flow
      The average age of menarche is normal but
      Menstrual abnormalities (oligo- and amenorrhea) since the menarche
      No ovulation
      Primary infertility
      Hyperplasia of endometrius (no phases of cycle, “fat estrogens” are present)
    • Polycystic ovarian syndrome
      “Female type” of obesity (circumference of waist/ circumference of hips <0.85)
      Breasts are developed enough but 30% of patients have mastopathia
      Hirsutism
      Changes of glucose profile
    • Polycystic ovarian syndrome
    • Polycystic ovarian syndrome
    • Polycystic ovarian syndrome
      Diagnostics:
      Infertility (primary)
      Obesity + hirsutism
      Oligo- and amenorrhea
      High level of glucose
      Monophasal basal temperature, no ovulation
      Ovaries are enlarged on BOTH sided
      LH is increased, LH/FSH >2,5
    • Polycystic ovarian syndrome
      Ultrasound examination: Normal ovary
    • Polycystic ovarian syndrome
      Polycystic ovary
    • Polycystic ovarian syndrome
      Treatment
      Weight lose (at least 5%)
      Ovulation stimulation: clomiphen
      • blocks hypothalamus estrogen receptors
      • GnRH level raises -> FSH level raises
      • Since 5th to 10th days of menstrual cycle 50 mg/day
      Gestagens (duphaston) 15th 25th days of cycle
    • Polycystic ovarian syndrome
      In case no pregnancy planned – oral hormonal contraceptive pills (OHCP)
      Anti-androgenic treatment: dexamethasone 0.5 mg/day or prednisolone 5 mg /day
      • ACTG level decreases (negative feedback)
      • Androgens from suprarenal glands are lowering
    • Polycystic ovarian syndrome
      Hirsutism treatment: OHCP (Diane-35 which contains androcur)
      • Androcur blocks tissue receptors for androgens
      Hirsutism treatment: spironolactone (verospiron)
      Surgical treatment: ovarian resection (usually laparoscopic)