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Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com

Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com

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    Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com Presentation Transcript

    • PCOS Described in 1935 by Stein-Leventhal
    • Incidence
      • Described as the most common endocrine
      • disorder among women of reproductive
      • age.
      • Franks, N Engl J Med, 1995; 333
    • Laboratory Diagnosis for PCOS Glueck, Metabolism, Vol 48, No 12, 1999
      • BMI >27 (88%)
      • Testosterone >83 ng/dL (16%)
      • Androstenedione >250ng/dL (29%)
      • LH/FSH ratio >1.5 (amenorrheic state) (61%)
      • Fasting serum insulin >20 uU/mL (60%)
      • Fasting blood glucose >125 mg/dL (4%)
      • HbA1c>6.4% (6%)
    • Difficult Diagnosis
      • Patients with polycystic ovary syndrome saw a mean of 5 medical practitioners before being correctly diagnosed.
      • Ob/Gyn News, 7/1/02
    • Frequency of Signs and Symptoms
      • Hirsuitism 60-90%
      • Oligomenorrhea 50-90%
      • Infertility 55-75%
      • Polycystic ovaries on US 50-75%
      • Obesity 40-60%
      • Amenorrhea 25-50%
      • Acne 25%
      • Dysfunctional uterine bleeding 30%
      • Normal menstrual pattern 22%
      • Virilization 0-28%
      • Southern Medical Journal; Feb 2001; vol 94, no 2
    • Calculated LDL by Age J Clin Epidemiol; 1998; Vol 51, No 5
    • Total Cholesterol by Age J Clin Epidemiol; 1998; Vol 51, No 5
    • HDL-T by Age J Clin Epidemiol; 1998; Vol 51, No 5
    • Evidence for an association between PCOS patients and premature carotid atherosclerosis (intima-media thickness vs. age) Arterioscler Thromb Vasc Biol 20:2414-2421; 2000
    • Hyperinsulinemia and Hyperandrogenism
      • Insulin causes a direct stimulation of ovarian androgen secretion, possibly through stimulatory effects on the 17x-hydroxylase/17-20 lyase and on 3b-hydroxysteroid dehydrogenase enzymes
      • Insulin decreases levels of SHBG, with concomitant elevation of free androgen tissue availability
      • Insulin decreases IGFBP-1 production, both in the liver and in the ovary
      • Insulin uregulates ovarian IGF receptor type 1 with amplification of IGF-1, IGF-II and insulin actions in the ovary
      • Insulin increases the LH ovary receptor number and sensitizes LH secreting pituitary cells to GnRH stimulation
      • Insulin promotes ovarian growth and cyst formations
      • Insulin can cause a direct stimulation of adrenal androgen secretion, possibly through stimulatory effects on the 17x-hydroxylase/17-20 lyase enzyme
      • Insulin may increase the 17x-hydroxylase/17-20 lyase adrenal enzyme response to ACTH
    • Prevalence of coronary artery disease (CAD), non-insulin diabetes mellitus (NIDDM), and hypertension (HTN) in PCOS patients and controls Human Reproduction, vol 15, no 4; pp 785-789; 2000
      • PCOS Controls P-value
      • n=28 n=752
      • Number % Number %
      • ------------------------------------------------------------------------
      • CAD 6 21 38 5 P<0.001
      • NIDDM 9 32 60 8 P<0.001
      • HTN 14 50 290 39 NS
    • Percent changes after 8 weeks on Metformin therapy Metabolism, vol 43, no 5; 1994
    • Insulin response to 40% vs 60% CHO diet J Clin Endocrin & Metab; 85:3085; 2000 p<0.01
    • Triglyceride (mmol/L) response to 40% vs. 60% CHO diet J Clin Endocrinol & Metab; 85:3085, 2000 p<0.001
    • Changes in body weight (kg) with diet, aerobic exercise, and strength training Arch Intern Med, vol 158, Dec7/21, 1998
    • Summary
      • Issues of premature diabetes mellitus and/or cardiovascular disease and the prevalence of PCOS suggest that PCOS is a major public health issue.
      • Am J Ob/Gyn; 1/02