Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com

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Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com

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Polikistik Over Sendromu - PCOS - www.jinekolojivegebelik.com

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

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