Bahar ÖZCABI, Feride Tahmiscioğlu BUCAK, Esma ŞENGENÇ, Evrim SUNAMAK, İbrahim ADALETLİ, Sebuh KURUOĞLU, Oya ERCAN, Olcay EVLİYAOĞLU

Ergen kızlarda polikistik over sendromu: klinik, endokrin ve metabolik bulgular

Amaç: Polikistik over sendromu tanısı alan ergen kızların başvurudaki klinik, metabolik ve endokrin bulgularını değerlendirmeyi amaçladık.Gereç-Yöntemler: Ocak 2008-Aralık 2012 tarihleri arasında Rotterdam tanı ölçütlerine göre tanılandırılan 53 olgunun yakınmaları, adet düzenleri, fizik bakı bulguları (antropometrik ölçümler, Ferriman Gallwey skoru, akantozis nigrikans varlığı), bazal/uyarılmış adrenal androjen, açlık glukoz/insülin değerleri, kan yağ ve lipoprotein düzeyleri, pelvik ultrasonografi bulguları kaydedildi. Yaşa göre vücut kitle indeksi (VKİ) %95 ve üzeri olgular şişman olarak tanımlandı. Oligo/amenore, hiperandrojenizm ve ultrasonografide polikistik over bulgularının hepsinin bulunduğu hastalar klasik grup olarak adlandırıldı. Kan trigliserit düzeyi yaşa göre %97 değerinden fazla ise yüksek olarak nitelendirildi; HOMA-IR değeri ≥ 3,82 olgularda insülin direnci var kabul edildi.Bulgular: Ortalama başvuru yaşı 15±1,5 yıldı. En sık yakınma adet düzensizliğiydi (%49,1). Adet düzeni ayrıntılı sorgulandığındaysa olguların %60,4’ünde oligo/amenore olduğu görüldü. Olguların %43,4’ü şişmandı. Akantozis nigrikans (%37,7) olan olgularda şişmanlık daha sıktı (p=0.010). Hirsutizm %41,5 olguda orta-ağır (Ferriman Gallwey skoru≥16) olarak belirlendi: orta-ağır olgularda oligo/amenore daha sıktı (p=0,007). İnsülin direnci %39,6 olguda (%81 obez) vardı ve akantozis nigrikans saptananlarda daha sıktı (p=0,001). Trigliserit yüksekliği 49 olgudan 7’sinde saptandı; bu olguların hepsinde insülin direnci de mevcuttu (p=0,033). Serum trigliserit düzeyi ile HOMA-IR değeri arasında korelasyon saptandı (r:0,415). Polikistik over bulgusu olguların % 96,2’sinde belirlendi. Klasik grupta diğer gruba göre oligo/amenore, hirsutizm, akantozis nigrikans, trigliserit yüksekliği anlamlı (p<0.005), total testosteron düzeyi anlamlılığa yakın yüksekti (p=0.056). Sonuç: Polikistik over sendromu tanısında adet düzeni ayrıntılı olarak sorgulanmalıdır. Akantozis nigrikans saptanan olgular insülin direnci açısından irdelenmeli, insülin direnci varlığında trigliserit yüksekliği araştırılmalıdır.

Anahtar Kelimeler:

akantozis nigrikans, hiperandrojenizm, hirsutizm, insülin direnci, polikistik over sendromu

Polycystic ovary syndrome in adolescent girls: Clinical, endocrinological and metabolic findings

Aim: We aimed to evaluate the clinical, metabolic, and endocrinological findings of adolescent girls with polycystic ovary syndrome. Material-Methods: The data about menstrual patterns, physical examination (anthropometric measurements, Ferriman Gallwey score, acanthosis nigricans), basal/stimulated adrenal androgens, fasting glucose/insulin, lipid/lipoprotein levels, and ultrasonography findings were obtained from the medical records of 53 cases diagnosed according to Rotterdam criteria between January 2008-December 2012. Patients with body mass index (BMI) percentile ≥95% according to age were defined as obese. Patients meeting all of the 3 criteria (menstrual irregularity, hyperandrogenism and polycystic ovaries on ultrasound) were defined as the classical group and the rest as the other group. Blood triglyceride level more than %97 percentile level according to age is considered high; insulin resistance was considered to be present in patients with HOMA-IR ≥3.82.Results: The mean age was 15±1.5 years. The most common complaint was menstrual irregularity(49,1%); oligo/amenorrhea was present in 60.4% of cases when questioned in detail. Acanthosis nigricans was more frequent in obese cases (p=0.010). Moderate-severe hirsutism (Ferriman Gallwey score ≥16) was present in 41.5% of patients in whom oligo/amenorrhea was more frequent (p=0.007). Insulin resistance was detected in 39.6% of the patients (81% obese) and more frequent in patients with acanthosis nigricans (p=0.001). Hypertriglyceridemia was determined in seven of 49 cases in which insulin resistance was significantly more frequent (p=0.033). A positive correlation was detected between triglyceride and HOMA-IR levels (r:0,415). Polycystic ovary on ultrasound was detected in 96.2% of patients. In classical group; oligo/amenorrhea, hirsutism, acanthosis nigricans, and hypertriglyceridemia were more frequent than the other group (p<0.005). Total testosterone level was higher in the classical group but the difference was not significant (p=0.056). Conclusion: The menstrual cycle of patients with polycystic ovary syndrome should be questioned in detail. In patients with acanthosis nigricans, insulin resistance must be considered and in the presence of insulin resistance hypertriglyceridemia should be investigated.

Keywords:

acanthosis nigricans, hirsutism, hyperandrogenism, insulin resistance, polycystic ovary syndrome,

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