ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
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Turkish Journal of Reproductive Medicine and Surgery

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Polikistik Ovary Sendromlu Ergen ve Yetişkin Hastalar Arasındaki Klinik, Endokrinolojik ve Biyokimyasal Farkların Değerlendirilmesi
Evaluation of the Clinical, Endocrinological, and Biochemical Differences Between Adolescent and Adult Patients with Polycystic Ovary Syndrome
Received Date : 15 Dec 2020
Accepted Date : 23 Jan 2021
Available Online : 03 Feb 2021
Doi: 10.24074/tjrms.2020-80616 - Makale Dili: TR
TJRMS. 2020;4(1):15-23
ÖZET
Amaç: Polikistik Over Sendromu (PKOS) erken başlangıçlı ve kronik seyreden bir hastalıktır ve etiyopatogenezi tam olarak açıklanamamaktadır. Bu durum teşhis karmaşıklığına neden olur. Bu çalışmanın amacı, erken yaşta doğru PKOS tanısı elde etmek için PKOS'lu adolesan ve erişkin hastaların klinik, biyokimyasal ve endokrinolojik parametrelerini karşılaştırmaktır. Gereç ve Yöntemler: Bu çalışmaya 2003 Rotterdam ASRM / ESHRE kriterlerine göre PKOS tanısı almış 218 hasta dahil edildi. Hastalar 18 yaşından küçük veya 18 yaşından büyük olmalarına göre ergen ve yetişkin olarak iki gruba ayrıldı. Bu çalışma, gözlemsel bir çalışma olarak tasarlanmıştır. Bulgular: 112 ergen ve 106 yetişkinin analizlerinde sadece yaş (p <0.001), jinekolojik yaş (p <0.001) ve hirsutizm varlığı (p = 0.01) istatistiksel olarak anlamlı farklılık gösterdi. Biyokimyasal ve klinik hiperandrojenizm oranları ergenlerde anlamlı olarak daha yüksek bulundu. Analizler, ergenlerde serbest testosteron düzeylerinin anlamlı olarak yüksek (p <0.001) ve toplam kolesterol (p <0.001), LDL (p <0.001) ve HDL düzeylerinin (p = 0.03) anlamlı olarak düşük olduğunu ortaya koydu. Sonuçlar: Bu çalışma PKOS'lu ergen ve yetişkin hastalar arasında bazı farklılıklar olduğunu göstermiştir. Ergen PKOS tanısı ile ilgili devam eden tartışmaları netleştirmek için daha fazla randomize kontrollü çalışmalara ihtiyaç vardır.
ABSTRACT
Objective: Polycystic Ovary Syndrome (PCOS) is a disease with early onset and chronic course, and its etiopathogenesis cannot be exactly clarified. This situation causes a diagnostic complexity. The objective of this study is comparing the clinical, biochemical, and endocrinologic parameters of adolescent and adult patients with PCOS for achieving an accurate diagnosis of PCOS at early ages. Material and Methods: This study included 218 patients that diagnosed as PCOS according to criteria of 2003 Rotterdam ASRM/ESHRE. Patients were separated into two groups as adolescents and adults according to whether they are younger or older than 18 years of age. This study is designed as an observational study. Results: In the analyses of 112 adolescents and 106 adults, only age (p<0.001), gynecological age (p<0.001) and presence of hirsutism (p=0.01) showed statistically significant differences. Biochemical and clinical hyperandrogenism rates were found to be significantly higher in adolescents. Analyses revealed that free testosterone levels were significantly high (p<0.001), and total cholesterol (p<0.001), LDL (p<0.001) and HDL levels (p=0.03) were significantly low in adolescents. Conclusions: This study demonstrated some differences between adolescent and adult patients with PCOS. Further randomized controlled trials are needed to clarify the ongoing discussions about the diagnosis of adolescent PCOS.
SITE.TEXT.RESOURCES
  1. Ehrmann DA. Polycystic ovary syndrome. The New England journal of medicine 2005;352:1223-36.[Crossref] [PubMed] 
  2. Lord J, Wilkin T. Metformin in polycystic ovary syndrome. Current opinion in obstetrics & gynecology 2004;16:481-6.[Crossref] [PubMed] 
  3. Hassan A, Gordon CM. Polycystic ovary syndrome update in adolescence. Current opinion in pediatrics 2007;19:389-97.[Crossref] [PubMed] 
  4. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and sterility 2004;81:19-25.[Crossref] 
  5. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. The Journal of clinical endocrinology and metabolism 1961;21:1440-7.[Crossref] [PubMed] 
  6. Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995;10:2107-11.[Crossref] [PubMed] 
  7. Carmina E. Prevalence of idiopathic hirsutism. European journal of endocrinology / European Federation of Endocrine Societies 1998;139:421-3.[Crossref] [PubMed] 
  8. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. The Journal of clinical endocrinology and metabolism 2006;91:4237-45.[Crossref] [PubMed] 
  9. Baulieu EE. Dehydroepiandrosterone (DHEA): a fountain of youth? The Journal of clinical endocrinology and metabolism 1996;81:3147-51.[Crossref] [PubMed] 
  10. Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. American journal of obstetrics and gynecology 2010;203:201 e1-5.[Crossref] [PubMed] 
  11. Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries--a common finding in normal women. Lancet 1988;1:870-2.[Crossref] 
  12. Clayton RN, Ogden V, Hodgkinson J, Worswick L, Rodin DA, Dyer S et al. How common are polycystic ovaries in normal women and what is their significance for the fertility of the population? Clinical endocrinology 1992;37:127-34.[Crossref] [PubMed] 
  13. Hoeger KM. Role of lifestyle modification in the management of polycystic ovary syndrome. Best practice & research Clinical endocrinology & metabolism 2006;20:293-310.[Crossref] [PubMed] 
  14. Kazerooni T, Dehghan-Kooshkghazi M. Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2003;17:51-6.[Crossref] [PubMed] 
  15. Amato MC, Galluzzo A, Finocchiaro S, Criscimanna A, Giordano C. The evaluation of metabolic parameters and insulin sensitivity for a more robust diagnosis of the polycystic ovary syndrome. Clinical endocrinology 2008;69:52-60.[Crossref] [PubMed] 
  16. Azziz R. Diagnostic criteria for polycystic ovary syndrome: a reappraisal. Fertility and sterility 2005;83:1343-6.[Crossref] [PubMed] 
  17. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-74.[Crossref] [PubMed] 
  18. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. The Journal of clinical endocrinology and metabolism 1998;83:2694-8.[Crossref] [PubMed] 
  19. DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertility and sterility 2005;83:1454-60.[Crossref] [PubMed] 
  20. Skrha J, Haas T, Sindelka G, Prazny M, Widimsky J, Cibula D et al. Comparison of the insulin action parameters from hyperinsulinemic clamps with homeostasis model assessment and QUICKI indexes in subjects with different endocrine disorders. The Journal of clinical endocrinology and metabolism 2004;89:135-41.[Crossref] [PubMed] 
  21. Kim MS, Merke DP. Cardiovascular disease risk in adult women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Seminars in reproductive medicine 2009;27:316-21.[Crossref] [PubMed] [PMC] 
  22. Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity 2002;26:883-96.[Crossref] [PubMed] 
  23. Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertility and sterility 2005;83:1717-23.[Crossref] [PubMed] 
  24. Homburg R, Lambalk CB. Polycystic ovary syndrome in adolescence--a therapeutic conundrum. Hum Reprod 2004;19:1039-42.[Crossref] [PubMed] 
  25. Dunaif A, Xia J, Book CB, Schenker E, Tang Z. Excessive insulin receptor serine phosphorylation in cultured fibroblasts and in skeletal muscle. A potential mechanism for insulin resistance in the polycystic ovary syndrome. The Journal of clinical investigation 1995;96:801-10.[Crossref] [PubMed] 
  26. Kalofoutis C, Piperi C, Zisaki A, Singh J, Harris F, Phoenix D et al. Differences in expression of cardiovascular risk factors among type 2 diabetes mellitus patients of different age. Annals of the New York Academy of Sciences 2006;1084:166-77.[Crossref] [PubMed] 
  27. Lechleitner M. Obesity and the metabolic syndrome in the elderly--a mini-review. Gerontology 2008;54:253-9.[Crossref] [PubMed] 
  28. Gaziano JM, Hennekens CH, O'Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation 1997;96:2520-5.[Crossref] [PubMed] 
  29. Maruyama C, Imamura K, Teramoto T. Assessment of LDL particle size by triglyceride/HDL-cholesterol ratio in non-diabetic, healthy subjects without prominent hyperlipidemia. Journal of atherosclerosis and thrombosis 2003;10:186-91.[Crossref] [PubMed] 
  30. Ibanez L, Potau N, Chacon P, Pascual C, Carrascosa A. Hyperinsulinaemia, dyslipaemia and cardiovascular risk in girls with a history of premature pubarche. Diabetologia 1998;41:1057-63.[Crossref] [PubMed] 
  31. Blake GJ, Ridker PM. Inflammatory bio-markers and cardiovascular risk prediction. Journal of internal medicine 2002;252:283-94.[Crossref] [PubMed] 
  32. Kelly CC, Lyall H, Petrie JR, Gould GW, Connell JM, Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome. The Journal of clinical endocrinology and metabolism 2001;86:2453-5.[Crossref] [PubMed] 
  33. Samy N, Hashim M, Sayed M, Said M. Clinical significance of inflammatory markers in polycystic ovary syndrome: their relationship to insulin resistance and body mass index. Disease markers 2009;26:163-70.[Crossref] [PubMed] [PMC]