多囊性卵巢综合征(Polycystic-Ovary-Syndrome)课件

PolycysticOvarySyndrome

DIWEN

M.D.,Ph.D.Professor&ChairmanDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicinePolycysticOvarySyndrome

IntroductionDefinition:polycysticovarysyndrome(PCOS)

isagenericdescriptionforabroadspectrumofclinicalandmorphologicalfindingsinwomenwithanendocrinedysfunction,specificallyabnormalandrogenproductionandmetabolism.IntroductionDefinition:2

IntroductionPCOSwasfirstidentifiedbySteinandLeventhalin1935sothatitcanalsobeknownasStein–LeventhalSyndrome.

IntroductionPCOSwasfirsti3

Etiology&PathopysiologyWhatwethinkweknow.

“Viciouscycle”AbnormalgonadotropinsecretionExcessLHandlow,tonicFSHHypersecretionofandrogensDisruptsfolliclematurationSubstrateforperipheralaromatizationNegativefeedbackonpituitary DecreasedFSHsecreationInsulinresistance,ElevatedinsulinlevelsEtiology&PathopysiologyWhat4

PathologyOvaries:enlargedand/orpolycysticovariesEndometrium:Lackofovulationforanextendedperiodoftimemaycauseexcessivethickeningoftheendometrium(theliningoftheuterus).PathologyOvaries:enlargedan5

PathologyPathology6WhatAretheSymptomsofPCOS?IrregularorLackofMenses:Womenwillhave“spotty”periods(1everycoupleofmonths).Also,insomewomenwithPCOStheysimplyceasehavingamensesatall.WhatAretheSymptomsofPCOS?7SymptomsHirsutism:Excessivebodyhair.InwomenwithPCOSdark,coarsehairwillappearontheface,neck,chest,arms,andinbetweenthelegs.SymptomsHirsutism:8SymptomsWeightProblems:Dependingonthewoman,therecouldbeadecreaseofweightorarapidfluctuationofweightthatsettlesaroundthestomachthatwillleadtomorbidobesity.SymptomsWeightProblems:9SymptomsAcne:BecausewomenwithPCOSareproducingmoremalehormone,thatproducesmoresebum(skinoilsandoldtissue)andcausesblockedporesandmoreacnearoundthejawline,armsandchest.SymptomsAcne:10SymptomsAlopeciaorFemalePatternBaldness:Thisiscausedbytheincreaseofmalehormoneinthewomen'sbody.Thinningorlossofhairisusuallycontainedtotopofthescalp,butinseverecaseslossofhairinfrontoronthehairlinehasbeendocumented.

SymptomsAlopeciaorFemalePa11OtherSymptoms“DirtySkin”orAcanthosisNigricans:Thisconditioncauseslightbrowntoblackroughpatchesaroundtheneckandunderarms.Migraines:Severeheadachesthatcauselightsensitivity,nauseaanddizziness.

OtherSymptoms“DirtySkin”or12DiagnosisBBT(basalbodytemperature)Bultrasound:

multiplesmallovariancystsenlargedovaryEndometriumbiopsy(Curettage)

beforemensesrevealtoproliferativeglands

DeterminationofLH,FSH,E2,P,T,PRL，Ins，(LH:FSH≧3:1)LaparoscopyDiagnosisBBT(basalbodytemp13TreatmentIfpregnancyisdesired——causeovulationanti-estrogens(clomiphene)Gonadotropinsinsulin-loweringagentsanti-androgens(agentsthatlowerandrogenlevels)gonadotropinreleasinghormoneagonists(GnRHa)TreatmentIfpregnancyisdesi14TreatmentIfpregnancyisnotdesiredtoreducetheriskofendometrialcancer(birthcontrolpills)cyclicalprogesterone(MPA,Provera)insulin-loweringagents(metformin,Glucophage)anti-androgens.TreatmentIfpregnancyisnot15LongTermEffects:InfertilityManywomenexperienceinfertilitywhilehavingPCOS.Manywillhavetogotoanfertilitydoctortoconceive.ToconceivewomenwithPCOShavetolearntomonitorovulationbytakingtheirBasalBodyTemperature(BBT)andexaminingcervicalmucus.LongTermEffects:Infertilit16LongTermEffects:HeartDiseaseThereisnewevidencethatfindswomenwithPCOSareatahigherriskformetaboliccardiovasculardisease.Bothdiseasesarecharacterizedbyinsulinresistance,highbloodpressure,andobesity.LongTermEffects:HeartDise17

DIWEN

M.D.,Ph.D.Professor&Chairman