婦產(chǎn)科學(xué)課件：多囊卵巢綜合征英文版

PolycysticOvarianSyndrome

(PCOS)

WhatisPCOS?

Polycysticovariansyndrome(PCOS),alsocalledStein-Leventhalsyndrome，isamultisystemreproductivemetabolicdisorder.

Clinicalcharacteristics:

1.Irregularmenstruation2.Hyperandrogenism3.Polycysticovariesorovary4.Metabolicdysfunction:insulinresistance,dyslipidemia,obesity

EpidemiologyTheprevalenceofPCOSinChinesewomenaged19-45yearsis5.6%.Alarge-scaleepidemiologicalstudyOctober2007toSeptember201115,924HanChinesewomenofreproductiveagefromthe10provincesandmunicipalitiesinChinaHumReprod.2013Sep;28(9):2562-9

Etiology

Itisnotclear.FamilialOccurrence:PCOStendstoaggregatewithinfamilies.First-degreerelativesofwomenwithPCOSareatsignificantriskforPCOS.

EnvironmentFactors:bodyweight,lifestyle,intrauterineenvironmentareassociatedwithPCOS.

PathophysiologyClinicalManifestationsMenstrualdysfunctionHyperandrogenismPolycysticovariesInsulinresistanceInfertilityClinicalManifestations1.Menstrualdysfunction:duetochronicanovulationoroligo-ovulation

(1)Amenorrhea

Oligomenorrhea(menstrualcycle>35d)

(2)Hypomenorrhea

Menorrhagia

IrregularbleedingClinicalManifestations2.Hyperandrogenism:(1)Hirsutism(多毛）

ClinicalManifestations2.Hyperandrogenism:(2)Acne（痤瘡）

ClinicalManifestations2.Hyperandrogenism:(3)Obesity:BMI≥30(kg/m2)

presentin50%-60%ofpatientswithPCOSThebodyfatisusuallydepositedcentrally(androidobesity),andahigherwaist-to-hipratioindicatesanincreasedriskofdiabetesmellitusandcardiovasculardisease.

ClinicalManifestations3.Polycysticovaries:

(1)thepresenceofatleast12antralfolliclesperovary(Thediameterofantralfollicleis2-9mm)(2)ovarianvolume>10ml(1)or(2)

ClinicalManifestations3.Polycysticovaries:

AbilateralenlargedovarieswithasmoothandthickedcapsuleBoncutsection,multiplefollicularcysts?surrounded?byabundantovarian?stroma?are?found?throughoutthe?cortex?of?the?ovaryClinicalManifestationsInsulinresistance:20%to40%,mayworsentheclinicalmanifestationsofPCOS(1)Compensatoryhyperinsulinemia(2)InobesePCOSpatients:impairedglucosetolerance(33%),type2diabetesmellitus(7.5%to10%)(3)Acanthosis?nigricans:

darkened,?velvety?plaque?along?the?nape?of?theneckClinicalManifestations5.Infertility:

Anovulationwouldappeartobetheprimarydefectresponsibleforthefailuretoachievepregnancyinthisdisorder.

Besides,PCOShaveahigherincidenceofspontaneouspregnancyloss.LaboratoryEvaluation1.Hyperandrogenemia:serumtotaltestosterone,freetestosterone2.Hyperinsulinemia:

normalvaluesdonotprecludeinsulinresistance3.LH/FSHratio:>2-3

haslittleadditivevalueindeterminingthediagnosis

DiagnosisRotterdamcriteria（2003）:

(1)Oligo-and/oranovulation(2)Hyperandrogenism(clinicaland/orbiochemical)(3)

Polycysticovaries：either12ormorefolliclesmeasuring2-9mmindiameterorincreasedovarianvolume(>10ml）onaultrasoundscanNote:①accordancewithtwoofthethreeaboveitems②withanexclusionofotheraetiologies,suchas,congenitaladrenalhyperplasiaandCushingdiseaseDifferentialDiagnosisCongenitaladrenalhyperplasiaCushingdiseaseOvarianhyperthecosisAndrogen-producingtumorsoftheovaryandadrenalglandFunctionaluterinebleeding

Long-termrisks1.EndometrialcarcinomaChronicanovulationpersistentlyelevatedestrogenlevels,uninterruptedbyprogesteroneriskofendometrialcarcinoma2.BreastcancerHyperestrogenicstateriskofbreastcancer3.DiabetesmellitusWomenwithinsulinresistanceareatriskfordiabetesmellitus.4.Dyslipidemia,hypertension,cardiovasculardisease

Treatment1.Weightreductioninobesepatients

2.Drugtherapy3.Surgery4.AssistedreproductivetechnologiesTreatment1.Weightreductioninobesepatients

TheinitialrecommendationItreducesinsulin,SHBGandandrogenlevelsMayrestoreovulationeitherusedaloneorcombinedwithovulation-inductionagentsWeightlossofaslittleas5%to7%overa6-monthperiodcanreducetheserumtestosteronesignificantlyandrestore

ovulationandfertilityinsomewomen.Treatment2.Drugtherapy(1)Oralcontraceptives:Diane-35,

MarvelonProgestincomponent:suppressesLHovarianandrogenEstrogen:increasesSHBGfreetestosterone(2)Insulinsensitizers:MetforminLeadtoadropininsulinandandrogenlevelsImprovereproductivefunction(3)Ovulationinduction:Clomiphene,GonadotropinForthosepatientsdesiringpregnancy(4)ProgesteroneToinducewithdrawalbleedingandavoidhyperplasiaofendometrium

Treatment3.Surgery(1)OvarianwedgeresectionItisnotpopularnowadays.(2)Laparoscopicelectrocautery(ovariandrilling)ForSeverePCOSwhoseconditionisresistanttoclomipheneAfteroperation,AndrogenandLH,FSHSpontaneousovulation(73%)

Treatment4.Assistedreproductivetechnologies(1)ArtificialinseminationForthosepatientswithoutpregnancyafterovulationinductionorlaparoscopicelectrocautery(2)Invitrofertilization-embryotransferForthepatientspresentingwithrefractoryovulationdisordersorwithoutpregnancyafterovulationinductionandartificialinseminationorlaparoscopicelectrocautery

CaseFemale,27years,marriedChiefComplaints:

Menstrualdisordersfor3yearsMenstrualandobstetricalhistory:Menarchein13,4-5/50-90,hypomenorrhea,thecolourofmenstruationwasnormal,marriedat23,unprotectedintercoursefor4years,G0P0Physicalexamination:H158cm,W67kg,BMI=26.8(kg/m2)multiplefacialacne,hirsutism,thesizeofuterusisnormal,bilateralovariesarepalpatedandabout5cmindiameter.Basalserumsexhormone(M3):E235.0pg/ml,FSH6.1mIU/ml,LH18.9mIU/ml,T85.0ng/ml,P0.8ng/ml,PRL10.9ng/mlUltrasoundexamination:great