Adolesan polikistik over sendromlu hastalarda metformin tedavisinin hiperandrojenizm ve menstruel fonksiyonlar üzerine etkisi

Amaç: Çalışmamızda insülin direnci olan adolesan polikistik over sendromlu hastalarda 1500 mg/gün metformin tedavisinin hiperandrojenizm ve menstrüel fonksiyonlar üzerine etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmamıza, polikistik over sendromlu 50 adölesan hasta dahil edildi. Tüm hastaların vücut kitle indeksleri (VKI), bel-kalça oranları ve Ferriman-Gallwey skorları hesaplandı. Erken foliküler fazda hormonal ve ultrasonografik değerlendirmeler yapıldı. Hastalar insülin resistansına (IR) göre gruplara ayrıldı. İnsüline dirençli 25 hastaya 3 ay süreyle 1500 mg/gün metformin kullanması önerildi. Tedavi bitimi tüm ölçümler tekrarlandı. Hastalar menstrüel fonksiyonlar açısından sorgulandı, siklusun 19-21. günlerinde progesteron düzeyi 3 ng/ml’nin üzerindeki değerlerde ovulasyonun gerçekleştiği kabul edildi. Bulgular: Gruplar arasında ortalama yaş ve VKI açısından anlamlı fark yoktu. İnsülin rezistansı olan grubun bel çevresi kontrol grubuna göre fazla olup, tedavi sonrası kontrollerle benzer seviyelere inemediği gözlendi. DHEA-S ve T testosteron düzeyleri gruplar arasında benzerdi. F testosteron seviyeleri, IR+ hastalarda IR negatiflere kıyasla daha yüksekti ve tedaviden sonra önemli ölçüde azaldı(2.67'ye karşı 1.98 ng/mL, p>0.05) SHBG düzeylerinin metformin tedavisi ile arttığı, dolayısıyla serbest androjen indeksinin azaldığı izlendi(>0.05). 17 OH progesteron seviyeleri IR+ grubunda anlamlı olarak daha yüksekti ve tedavi sonrası IR negatifler ile benzer seviyelere geriledi. IR+ grubunda ortalama açlık insülin düzeyi 19.21IU/ml iken tedavi sonrası 13.14IU/ml'ye geriledi. Ayrıca açlık glukoz/insülin oranı 5,36 iken metforminden sonra 8,35'e kadar arttı. Menstrüel düzensizlikte tedavi grubunda belirgin düzelme gözlendi. Tedavi sonucu ovulatuar siklus oranı artış oldu ancak istatistiksel olarak anlamlı değildi. Hirsutizm skorları gruplar arasında benzerdi ve tedaviden sonra değişmedi. Sonuç: Bu çalışma, insülin rezistan adolesan PKOS’lu hastalarda üç aylık metformin tedavisinin açlık kan şekeri ve açlık insülin seviyelerinde düşüşe neden olarak insülin rezistansının gerilemesine, buna sekonder olarak da serbest testosteron düzeylerini anlamlı oranda azalttığını göstermektedir. Ayrıca çalışmamız metforminin ovulatuar fonksiyonları iyileştirdiği sonucunu da desteklemektedir.

Anahtar Kelimeler:

adolesan, polikistik over sendromu, insülin direnci, metformin

The effects of metformin on hyperandrogenism and menstrual functions in insulin resistant adolescents with PCOS

Aim: To investigate the effects of metformin therapy on hyperandrogenism and menstrual functions in adolescent patients with polycystic ovary syndrome (PCOS) and insulin resistance (IR). Materials and Methods: In this study, 50 adolescents with PCOS were included. Hormonal and ultrasonographic assessments were done at the early follicular phase. On the day of 19-21 of the cycle, progesterone levels were measured and patients were questioned for menstrual periods. Body-mass-indexes (BMI), waist-hip ratios, and Ferriman-Gallwey scores were calculated for all patients. IR is diagnosed according to HOMA index and insulin-resistant patients were instructed to use 1500 mg/day metformin for 3 months. After treatment ended, measurements were repeated by the same researcher. Results: Mean age and BMI values were similar between groups. Although the values of BMI and waist/hip ratio decreased after treatment, the decrement didn't reach the values of the IR- group. Free testosterone levels were significantly higher in IR+ subjects compared to IR negatives and significantly decreased after treatment. Sex hormone-binding globulin levels were increased with metformin treatment and as a result, free androgen indexes were decreased. 17 OH progesterone levels were significantly higher in the IR+ group and regressed to similar levels with IR negatives after treatment. While mean levels of fasting insulin were 19.21IU/ml in the IR+ group, it regressed to 13.14IU/ml after treatment. Also fasting glucose/insulin ratios were increased as expected. Finally, a significant improvement in the treatment group was observed at menstrual irregularity. Conclusion: Consequently, this study supports the conclusion that metformin reduces hyperandrogenism and improves menstrual and ovulatory functions.

Keywords:

adolescent, polycystic ovary syndrome, insulin resistance, metformin,

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