2018 Uluslarası kanıta dayalı polikistik over sendromu değerlendirme ve yönetim rehberi doğrultusunda tanıdaki ‘yeniler’ ve ‘yineler’

Year 2019, Volume: 12 Issue: 3, 595 - 602, 30.09.2019

Erkan Alataş , Derya Kılıç Tolga Güler

https://doi.org/10.31362/patd.563485

Cited By: 1

Abstract

Reprodüktif
çağda %8-13’lere kadar yüksek oranlarda görülen Polikistik Over Sendromu (PKOS)
önemli bir toplum sağlık sorunudur. Sendromun heterojen yapısı nedeniyle kimi
hastada reprodüktif, kimi hastada metabolik bozukluklar ön plana çıkmakta ve
tedavi modaliteleri kişiden kişiye ve uygulayıcı hekime hatta branşlara göre
farklılık gösterebilmektedir. Halbuki PKOS olgularının tanı ve yönetiminde
ideal olan uluslarası kabul görmüş tanı ve tedavi kriterlerini içeren ve
bireysel farklılıkları gözardı etmeyen rehberlerin oluşturulmasıdır. Birçok
dernek ve kuruluşun kendi bakış açılarıyla tanımlamaya çalıştığı PKOS’ un daha
objektif ve detaylı tanımlanması amaçlanarak ‘European Society of Human
Reproduction and Embriology’ (ESHRE) ve ‘American Society of Reproductive
Medicine’ (ASRM) nin de ortaklık ettiği ‘2018 Uluslarası kanıta dayalı PKOS
değerlendirme ve yönetim rehberi’ (2018 PKOS Rehberi) yakın tarihte yayınlanmıştır.
Bu rehberde birçok “yeni” nokta belirtilirken, bazı eski bilgiler ise “yine”
vurgulanmaya devam etmiştir. PKOS reprodüktif (irregüler menstruel sikluslar,
hirsutizm, infertilite, gebelik komplikasyonları..vb), metabolik (insulin
rezistansı, metabolik sendrom, diyabet, kardiyovasküler hastalıklar..vb),
psikolojik (anksiyete, depresyon, vücut algı bozuklukları, seksüel fonksiyon
bozuklukları, yeme bozuklukları vb) özellikleri ile multisitemik bir
hastalıktır. Bireysel komponentler üzerinden düşünüldüğü zaman belirgin klinik
varyasyon göstermesi tanı ve tedavide farklılıklarla sonuçlanmaktadır. Bu durum
ise gecikmiş tanı ve yetersiz bakıma yol açabilmektedir. Bu anlamda 2018
Uluslarası kanıta dayalı PKOS değerlendirme ve yönetim rehberinin eski rehberlerden
farklı olarak gündeme getirdiği net tanımlamalar ve pratik öneriler ile
olguların değerlendirilmesi ve yönetimindeki standardizasyonun sağlanması için
önemli bir adım olduğu düşünülmektedir.

 

    Polycystic ovary
syndrome (PCOS) is an important public health problem that can have a high
prevalence as 8-13%. This syndrome has a heterogeneous nature and may present
either with reproductive or metabolic problems in different women. The treatment
modalities therefore may differ among patients and also for distinct
specialties. However, the ideal approach should consist of standardized
diagnostic criteria and the therapeutic applications should consider individual
disparities.  ‘International evidence-based
guideline for the assessment and management of polycystic ovary syndrome’ has
been recently published. This guideline includes views of various groups and
societies, and defines PCOS more objectively and exhaustively. This consensus
guideline states some new perspectives along with reiterating several other
facts. PCOS is a multisystem disease consisting of reproductive (irregular
menstrual cycles, hirsutizm, infertility, pregnancy complications, etc.),
metabolic (insulin resistance, metabolic syndrome, diabetes, cardiovascular
disorders, etc.), and psychological (anxiety, depression, body dysmorphic
disorder, sexual function problems, eating disorders, etc.) aspects. Individual
disparities result in different diagnostic and therapeutic approaches. With
respect to the heterogeneous nature of the syndrome, this new consensus
guideline that brings new and more objective definitions along with practical
recommendations, has an important value to further improving evaluation and
management standards of the syndrome.

Keywords

polikistik over sendromu, amenore, obezite, insülin direnci

References

• Referans 1. Bozdag, G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod 2016;31:2841-2855.
• Referans 2. Ünlütürk U, Sezgin E, Yildiz BO. Evolutionary determinants of polycystic ovary syndrome: part 1. Fertil Steril 2016;106:33-41. https://www.doi.org/10.1016/j.fertnstert.2016.05.010.
• Referans 3. Szydlarska D, Machaj M, Jakimiuk A. History of discovery of polycystic ovary syndrome. Adv Clin Exp Med 2017;26:555-558. https://www.doi.org/10.17219/acem/61987
• Referans 4. Stein IF, Leventhal ML. Amenorrhoea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935;29:181-191.
• Referans 5. International evidence-based guideline for the assessment and management of polycstic ovary syndrome 2018. monash.edu/medicine/sphpm/mchri/pcos.
• Referans 6. Kahsar-Miller MD, Nixon C, Boots LR, Go RC, Azziz R. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil Steril 2001;75:53-58.
• Referans 7. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E; American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society (AES). American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the practices in the evaluation and treatment of polycystic ovary syndrome- Part 1. Endocr Pract 2015;21:1291-1300. https://www.doi.org/10.4158/EP15748.DSC
• Referans 8. Asagami T, Holmes TH, Reaven G. Differential effects of insulin sensitivity on androgens in obese women with polycystic ovary syndrome or normal ovulation. Metabolism 2008;57:1355-1360. https://www.doi.org/10.1016/j.metabol.2008.05.002
• Referans 9. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25. https://www.doi.org/10.1016/j.fertnstert.2003.10.004
• Referans 10. Azziz R, Carmina E, Dewailly D, et al. Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: An Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006;91:4237-4245. https://www.doi.org/10.1210/jc.2006-0178
• Referans 11. Carmina E, Lobo RA. Do hyperandrogenic women with normal menses have polycystic ovary syndrome? Fertil Steril 1999;71:319-322.
• Referans 12. Geisthövel F, Rabe T. The ESHRE/ASRM consensus on polycystic ovary syndrome (PCOS)--an extended critical analysis. Reprod Biomed Online 2007;14:522-535.
• Referans 13. Yildiz, B.O, Bolour S, Woods K, Moore A, Azziz R. Visually scoring hirsutism. Hum Reprod Update, 2010;16:51-64. https://www.doi.org/10.1093/humupd/dmp024
• Referans 14. Borgia F, Cannavò S, Guarneri F, Cannavò SP, Vaccaro M, Guarneri B. Correlation between endocrinological parameters and acne severity in adult women. Acta Derm Venereol 2004;84:201-204. https://www.doi.org/10.1080/00015550410023248
• Referans 15. Dewailly D, Lujan ME, Carmina E, et al. Definition and significance of polycystic ovarian morphology: A task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2014;20:334-352. https://www.doi.org/10.1093/humupd/dmt061
• Referans 16. Cassar, S, Teede HJ, Moran LJ, et al. Polycystic ovary syndrome and anti-Mullerian hormone: Role of insulin resistance, androgens, obesity and gonadotrophins. Clin Endocrinol (Oxf) 2014;81:899-906. https://www.doi.org/10.1111/cen.12557
• Referans 17. Iliodromiti, S, Kelsey TW, Anderson RA, Nelson SM. Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab 2013;98:3332-3340. https://www.doi.org/10.1210/jc.2013-1393