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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Farklı Fenotiplere Sahip Polikistik Over Sendromlu Hastaların Klinik ve Laboratuvar Parametreleri Yönünden DeÄŸerlendirilmesi
Characteristics of Different Phenotypes of Polycystic Ovary Syndrome in a Turkish Population: a Prospective Study
Received Date : 21 Dec 2020
Accepted Date : 09 Feb 2021
Available Online : 23 Feb 2021
Doi: 10.24074/tjrms.2020-80730 - Makale Dili: TR
TJRMS. 2021;5(2):47-54
ÖZET
Amaç: Polikistik over sendromu oligo/anovulasyon, klinik veya biyokimyasal hiperandrojenemi, polikistik overlerle karakterize heterojen bir hastalıktır. Bu çalışmada amacımız farklı fenotiplere sahip polikistik over sendromlu (PCOS) hastaların klinik ve laboratuvar parametreleri yönünden değerlendirilmesini sağlayarak hastalığın uygun tanı ve tedavisine katkı sağlamaktır. Gereç ve Yöntemler: Çalışma Ekim 2013–Mayıs 2015 tarihleri arasında Ufuk Üniversitesi Tıp Fakültesi Dr. Rıdvan Ege Hastanesi ve Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum kliniklerinde ortak olarak yürütülmüştür. Çalışmaya PCOS tanısı konulan 760 (%89.1) hasta ve 93 (%10.1) sağlıklı birey dahil edilmiştir. PKOS’lu hastalar dört ana fenotipe ayrılmış olup, bu fenotipler hem kendi aralarında hem de kontrol grubu ile karşılaştırıldılar. Bulgular: PKOS fenotiplerin ülkemizdeki prevalansı 1.fenotip % 45.7, 2.fenotip % 10, 3.fenotip % 17.8 ve 4.fenotip için % 26.6 olarak saptandı. Fenotip 1 klinik ve biyokimyasal olarak en hiperandrojen fenotip olarak tespit edildi. 1. ve 2. fenotiplerde BMI değerleri daha yüksekti dolayısıyla obeziteye diğer fenotiplerden daha yatkındılar. Her 4 fenotipin ortalama sistolik ve diyastolik kan basınçları kontrol grubuna göre anlamlı yüksekti (p<0.05). HOMA indeksi fenotip 1’de en yüksek düzeydi. Metabolik sendrom açısından da fenotip 1 en riskli grubu oluşturmaktaydı (p<0.05). Sonuç: Farklı PKOS fenotipleri arasında klinik, metabolik ve hormonal parametreler yönünden birçok farklılık mevcuttur. Her fenotip için farklı riskler söz konusu olduğundan PKOS tanısı konulurken hastaların hangi fenotipe dahil olduğu uygun şekilde sınıflandırılmalıdır. Bu sayede hastaların karşılaşabilecekleri kısa ve uzun dönemli sağlık riskleri daha iyi hesaplanabilir.
ABSTRACT
Objective: Polycystic ovary syndrome is a heterogeneous disorder characterized by oligo or anovulation, biochemical or clinical manifestations of hyperandrogenemia and polycystic ovaries. The aim of this study was to compare clinical, hormonal, and metabolic variables among polycystic ovary syndrome phenotypes. Material and Methods: This prospective cohort study was conducted in Ufuk University School of Medicine and Zekai Tahir Burak Women Health, Education and Research Hospital between October 2013 and May 2015. During this period, a total of 760 subjects were diagnosed as PCOS and were defined as eligible for the prospective follow-up. Patients with PCOS were further divided into four main phenotypes based on diagnostic features. Additionally, total of 93 subjects were included in the prospective follow-up as for the control group. Clinical and biochemical variables were compared between PCOS phenotypes and the control group. Results: The overall prevalance of phenotypes 1, 2, 3 and 4 in our population were found as % 45.7, % 10, % 17.8 and % 26.6, respectively. Phenotype I was the most hyperandrogenic group in terms of clinical and biochemical features and associated with higher waist-to-hip ratio when compared with other phenotypes. Body mass index (BMI) values were significantly higher in Phenotype 1 and 2 than other phenotypes and controls. Mean systolic and diastolic blood pressure of each phenotype were significantly higher than the control group (p<0.05). Homeostatic Model Assessment Insuline Resistance (HOMA-IR) levels were significantly higher in phenotype 1 than other groups (p<0.05). Metabolic Syndrome prevalance was significantly higher in phenotype 1 when compared with other phenotypes (p<0.05). Conclusion: There are significant differences in terms of clinical, hormonal. metabolic features between different PCOS phenotypes that evaluated according to diagnostic criterias. Since each phenotype reveals different metabolic and cardiovascular risks, subjects that diagnosed with PCOS should be carefully evaluated and classified according to individual phenotype. Following appropriate phenotypical classification of patients that diagnosed with PCOS, short and long term health risks would be better clarified.
REFERANSLAR
  1. Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333(13):853-61. [Crossref] 
  2. Azziz R, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-9. [Crossref] 
  3. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223-36. [Crossref] 
  4. Stein IF. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181-91. [Crossref] 
  5. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25. [Crossref] 
  6. Alberti KG, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-5. [Crossref] 
  7. Welt CK, et al. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: the impact of weight on phenotype and metabolic features. J Clin Endocrinol Metab. 2006;91(12):4842-8. [Crossref] 
  8. Dewailly D, et al. Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metab. 2006;91(10): 3922-7. [Crossref] 
  9. Kahsar-Miller MD, et al. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil Steril. 2001;75(1):53-8. [Crossref] 
  10. Alvarez-Blasco F, et al. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Arch Intern Med. 2006;166(19):2081-6. [Crossref] 
  11. Korhonen S, et al. Relationship of the metabolic syndrome and obesity to polycystic ovary syndrome: a controlled, population-based study. Am J Obstet Gynecol 2001;184(3):289-96. [Crossref] 
  12. Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(1): 162-8. [Crossref] 
  13. Baillargeon JP, Nestler JE. Commentary: polycystic ovary syndrome: a syndrome of ovarian hypersensitivity to insulin? J Clin Endocrinol Metab. 2006;91(1):22-4. [Crossref] 
  14. Gambineri A, et al. Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord. 2002;26(7):883-96. [Crossref] 
  15. Shroff R, et al. Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril. 2007;88(5): 1389-95. [Crossref] 
  16. Guastella E, Longo RA, Carmina E. Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril. 2010;94(6):2197-201. [Crossref] 
  17. Hsu MI, et al. Diagnostic criteria for polycystic ovary syndrome in Taiwanese Chinese women: comparison between Rotterdam 2003 and NIH 1990. Fertil Steril. 2007;88(3):727-9. [Crossref] 
  18. Dilbaz B, et al. Cardiovascular disease risk characteristics of the main polycystic ovary syndrome phenotypes. Endocrine. 2011;39(3): 272-7. [Crossref] 
  19. Chae SJ, et al. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod. 2008;23(8): 1924-31. [Crossref] 
  20. Azziz R, et al. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab. 2005;90(8):4650-8. [Crossref] 
  21. Tsilchorozidou T, Overton C, Conway GS. The pathophysiology of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2004;60(1):1-17. [Crossref] 
  22. Daan NM, et al. Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk? Fertil Steril. 2014;102(5):1444-51. [Crossref] 
  23. Knochenhauer E, et al. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. The Journal of Clinical Endocrinology & Metabolism. 1998;83(9):3078-82. [Crossref] 
  24. Hatch R, et al. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol. 1981;140(7):815-30. [Crossref] 
  25. Guo M, et al. Cardiovascular and metabolic characteristics of infertile Chinese women with PCOS diagnosed according to the Rotterdam consensus criteria. Reprod Biomed Online. 2010;21(4):572-80. [Crossref] 
  26. Wiltgen D, Spritzer PM. Variation in metabolic and cardiovascular risk in women with different polycystic ovary syndrome phenotypes. Fertil Steril. 2010;94(6):2493-6. [Crossref] 
  27. Panidis D, et al. Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod. 2012;27(2): 541-9. [Crossref] 
  28. Wang Y, et al. Different phenotypes of polycystic ovary syndrome by Rotterdam criteria are differently steroidogenic but similarly insulin resistant. Fertil Steril. 2010;93(4):1362-5. [Crossref] 
  29. Banaszewska B, et al. Lipids in polycystic ovary syndrome: role of hyperinsulinemia and effects of metformin. Am J Obstet Gynecol. 2006;194(5):1266-72. [Crossref] 
  30. GÅ‚uszak O, et al. Phenotype and metabolic disorders in polycystic ovary syndrome. ISRN Endocrinol. 2012;2012:569862. [Crossref] 
  31. Barber TM, et al. Metabolic characteristics of women with polycystic ovaries and oligo-amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2007;66(4):513-7. [Crossref]