高雄激素血症的药物治疗

高雄激素血症是临床上常见的妇科内分泌疾病之一,指女性血中雄激素水平过高、活性增强.多囊卵巢综合征（PCOS）是女性高雄激素血症的常见病种.高雄激素血症的药物治疗方法主要是抑制雄激素的产生以及对抗雄激素的作用.如何合理选择有效药物、用药剂量和疗程是临床医师共同关注的热点.     

多囊卵巢综合征药物治疗的研究进展

多囊卵巢综合征(PCOS)的临床症状是月经稀发、闭经、不孕、多毛和肥胖,是育龄期女性最常见的生殖内分泌紊乱性疾病。其临床表现呈多样性,主要包括高雄激素血症及胰岛素抵抗。治疗方法主要针对改善高雄激素血症和高胰岛素血症以恢复月经和排卵及改善内分泌代谢。本文就目前多囊卵巢综合征的药物治疗进展进行综述。     

总睾酮、胰岛素、性激素结合球蛋白、游离睾酮指数对诊断多囊卵巢综合征高雄激素血症不孕患者的意义

目的 探究总睾酮(T)、胰岛素(FINS)、性激素结合球蛋白(SHBG)、游离睾酮指数(FAI)在诊断多囊卵巢综合征(PCOS)高雄激素血症不孕患者中的临床价值。方法 采用回顾性分析,选取2018年7月至2019年7月东莞市妇幼保健院接收的90例PCOS高雄激素血症的不孕患者和90例非PCOS高雄激素血症的不孕患者进行研究,将PCOS高雄激素血症的不孕患者作为观察组(n=90),将非PCOS高雄激素血症的不孕患者作为对照组(n=90),观察两组患者的一般情况T、FINS、SHBG、FAI,并分析两组患者指标的变化。结果 观察组患者月经正常例数明显低于对照组(P 0.05),多毛症以及痤疮例数明显高于对照组(P 0.05),观察组患者的BMI以及T、FINS、FAI水平明显高于对照组,SHBG水平明显低于对照组(P 0.05)。结论 T、FINS、FAI、SHBG等水平均与PCOS高雄激素血症相关,临床可通过对患者体内T、FINS、FAI、SHBG水平进行全面检测来诊断PCOS高雄激素血症。     

警惕女性高雄激素血症

雄激素是女性生殖生理过程中非常重要而不可缺少的一种激素。因为它是卵泡合成雌激素的前体。血中雄激素水平高,或是其活性增强,均称为高雄激素血症。此种内分泌紊乱,可引起月经失调,不孕,男性化表现及代谢紊乱。正常月经妇女体内雄激素主要来源于卵巢、肾上腺。此外还有部分是由腺外组织转化而来。卵巢卵巢主要合成睾酮0.1mg/d,雄烯二酮1-2mg/d,脱氢表雄酮<1mg/d。卵巢合成雄激素受LH的调控,LH与泡膜细胞的受体结合,激活酶活性,合成雄激素。     

综合干预措施治疗多囊卵巢综合征临床观察

多囊卵巢综合征（polycystic ovarysyndrome,PCOS）是女性最常见的内分泌紊乱性疾病,是一种复托的多系统综合征,临床表现以高雄激素血症、高胰岛素血症及胰岛素抵抗（IR）为其重要特征,是生育期女性月经紊乱最常见的原因之一。     

多囊卵巢综合征的心理健康与心理疏导

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是育龄女性最常见的内分泌及代谢紊乱疾病，临床表现轻重不等，典型的临床表现是由于排卵功能障碍，临床表现为不同程度的异常月经、高雄激素血症、卵巢多囊性改变，不孕、痤疮、肥胖、多毛及脱发，是导致生育期女性月经紊乱与不孕的最常见病因之一。由于患者多毛、痤疮等高雄激素体征及肥胖、     

多囊卵巢综合征 肥胖与炎症

多囊卵巢综合征（polycystic ovary syndrome，PCOS）为育龄女性最常见的内分泌疾病之一。其确切病理生理机制较为复杂，至今未明。一种假说认为妊娠期增加对过多雄激素的暴露可诱导青春期高雄激素血症。青春期后期，这种早期高雄激素对子宫的影响可造成黄体生成素（LH）的异常分泌以及易于形成腹部脂肪的堆积。     

抗癫痫药对育龄期女性癫痫患者生殖相关激素的影响

女性癫痫患者比普通健康女性有更高的生殖内分泌障碍。这些生殖激素的改变多见于多囊卵巢综合征,高雄性激素血症,高泌乳素血症,不育和停经。生殖内分泌的异常不仅与癫痫发作有关,而且还与抗癫痫药有关。癫痫发作通过影响下丘脑-垂体系统来干扰生殖内分泌系统,而抗癫痫药物通过影响下丘脑-垂体-性腺激素系统,性激素的代谢以及性激素的结合蛋白,致使生殖内分泌异常。女性癫痫患者应用丙戊酸钠有更高的多囊卵巢综合征和高雄性激素血症发生率。新型抗癫痫药物对生殖内分泌的影响还缺乏广泛研究。传统抗癫痫药会使胎儿出生缺陷增加2～3倍,妊娠期癫痫的控制不良也会增加女性癫痫患者的死亡率。     

二甲双胍和达英-35治疗高雄激素性多囊卵巢综合征的临床观察

多囊卵巢综合征（PCOS）是一种发病多因性，临床表现是多态性的内分泌综合征。其重要内分泌特征是高雄激素血症，而主要的代谢紊乱是高胰岛素血症及胰岛素抵抗。本研究对52例高雄激素血症的PCOS患者分别运用二甲双胍和达英一35片治疗，总结分析如下。     

复方醋酸环丙孕酮和罗格列酮序贯用药对多囊卵巢综合征患者的影响

多囊卵巢综合征(PCOS)是女性常见的内分泌紊乱疾患,临床表现为闭经、肥胖、多毛和不孕,病理生理学特征是胰岛素抵抗(IR)、高雄激素血症、持续性无排卵以及糖脂代谢异常,     

肾上腺良性无功能瘤39例临床分析

总结肾上腺良性无功能瘤３９例,其中３３例因健康查体或其他疾病就诊时发现,仅６例因腰腹不适或腹部包块而就诊。肾上腺内分泌激素检查均正常。肿瘤位于一侧肾上腺的３８例,双侧的１便。３０例病灶直径〉２．２ｃｍ的患者经治疗,病理结果：肾上腺皮质腺瘤２２例,蛹地腺髓性脂肪瘤４例,肾上腺节能细胞神经瘤２例,肾上腺囊肿１例,肾上腺神经鞘瘤１例。对肾上腺无功能瘤的诊断和治疗进行了讨论。     

Evaluating hyperandrogenism: a challenge in acne management

Acne vulgaris may be a manifestation of hyperandrogenism. An appropriate, thorough history and physical exam will identify evidence of androgen excess. An understanding of normal androgen production and conditions of androgen excess is critical when evaluating for hyperandrogenism. Laboratory screening for hormonal abnormalities is imperative when clinical signs of hyperandrogenism are present.     

The effect of atorvastatin on cardiometabolic risk factors in women with non-classic congenital adrenal hyperplasia: A pilot study

BackgroundIndividuals with non-classic congenital adrenal hyperplasia (NC-CAH) often show evidence of hyperandrogenism, including premature pubarche, accelerated linear growth velocity, short final height, hirsutism, acne, alopecia, impaired ovulation, menstrual dysfunction and subfertility. Although statins were found to reduce elevated levels of androgens in subjects with this disorder, no previous study has investigated whether 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors affect cardiometabolic risk factors in patients with NC-CAH.MethodsWe studied 12 women with NC-CAH, 6 of whom because of coexisting hypercholesterolemia received atorvastatin (20–40 mg daily). Circulating levels of lipids, glucose homeostasis markers, plasma levels of androgens, 17-hydroxyprogesterone, high-sensitivity C-reactive protein (hsCRP), uric acid, fibrinogen, homocysteine and 25-hydroxyvitamin D, as well as urinary albumin-to-creatinine ratio (UACR) were determined at the beginning of the study and 12 weeks later.ResultsBeyond affecting plasma lipids, atorvastatin reduced circulating levels of testosterone, dehydroepiandrosterone sulphate, androstenedione and 17-hydroxyprogesterone, and decreased free androgen index. Moreover, atorvastatin caused a decrease in plasma levels/urinary loss of uric acid, hsCRP, homocysteine and UACR, and insignificantly increased circulating levels of 25-hydroxyvitamin D. The drug produced no effect on plasma fibrinogen. The effect of atorvastatin on hsCRP, uric acid, homocysteine, 25-hydroxyvitamin D and UACR correlated with the magnitude of reduction in 17-hydroxyprogesterone and androgens.ConclusionOur results suggest that statin therapy reduces cardiometabolic risk in women with NC-CAH.     

肾上腺偶发瘤43例临床分析

目的 提高肾上腺偶发瘤的诊断和治疗水平。方法回顾性分析1985年至2003年5月收治的肾上腺偶发瘤43例。结果所有患者均行手术治疗,术后病理诊断：肾上腺皮质腺瘤12例,肾上腺囊肿10例,肾上腺节细胞神经瘤7例,肾上腺皮质癌4例,肾上腺转移癌3例,肾上腺髓性脂肪瘤3例,肾上腺嗜铬细胞瘤4例。结论对于肾上腺偶发瘤,均应常规行内分泌检查,CT对确诊肾上腺占位病变有较高价值。对于确诊为恶性肿瘤、功能性肿瘤及直径大于3．5cm的肿瘤,应积极采取手术治疗,应警惕偶发性嗜铬细胞瘤的潜在危险性,对非功能性、直径小于3．5cm的肿瘤可行CT随诊。     

后腹腔镜肾上腺肿瘤切除术——附15例报告

目的:探讨并总结腹腔镜下肾上腺肿瘤切除术在县级基层医院开展的可行性及安全性。方法:回顾性总结分析某院2007年10月～2010年5月腹腔镜下肾上腺肿瘤切除术15例的临床资料。结果:本组15例,男13例,女2例,年龄39～54岁,平均47.5岁,左侧8例,右侧7例,肾上腺肿瘤大小2.5～6cm,平均直径3.8cm;13例病人以高血压、体型异常等就诊,2例因体检偶然发现住院,手术采用后腹腔镜下肾上腺肿瘤切除术,2例中转开放,手术时间平均146min,1例术中输红细胞悬液400ml,2例术后输红细胞悬液200ml,没有术后出血、伤口感染、邻近脏器损伤等并发症发生;近期3～29月的随访,所有患者的临床症状消除,血液学指标恢复正常局部无复发;病理结果:原发性醛固酮增多症8例均为皮脂腺瘤,皮质醇增多症4例中3例为腺瘤、1例为肾上腺癌,嗜铬细胞瘤1例,无功腺瘤2例。结论:基层医院在拥有良好的腹腔镜技术基础,完备较好的腹腔镜设备条件,充分做好术前准备,腹腔镜肾上腺肿瘤切除术在线及基层医院来站安全.效果良好。     

肾上腺腺瘤样瘤临床病理观察

目的探讨肾上腺腺瘤样瘤的临床病理特征。方法报道1例64岁男性肾上腺腺瘤样瘤,包括其临床、影像及病理学特征,并复习相关文献。结果肾上腺腺瘤样瘤多发生于左侧,影像学无特征性表现;组织病理学特征,包括浸润周围组织、印戒样细胞,可能考虑侵袭性肿瘤,免疫表型calretinin、CK5/6、CK、EMA、Vim阳性。结论肾上腺腺瘤样瘤是一种罕见的良性病变,仅靠CT和磁共振成像(MRI)很难与肾上腺常见肿瘤相鉴别,根据病理组织形态学特点并结合免疫组化染色,可以明确诊断。     

Cyclosporin A is a hormonal immunomodulator. II. Mouse study.

The present study investigated the effects of hydrocortisone (HCA) and cyclosporin A (CS) on the wet weights of various target tissues and on the plasma levels of 6 steroids and cholesterol (CH) in Swiss mice of both sexes. The effects of CS on the weights of the spleen and forestomach, as viewed from their steroid dependencies in weight change, were different for each tissue and for each sex: CS effect on the male spleen was characterized as a mixture of a major androgenic element and a minor corticosteroid-like element, whereas that on the female spleen was scored as purely androgenic. Similarly, CS effects on the male and female forestomachs were interpreted respectively as estrogenic and androgenic in nature. Both the sole use of HCA (CS-free treatment) and the combined use of HCA and CS (CS-aided treatment) increased plasma testosterone (T) and plasma CH at the expense of other plasma steroids, though minor differences were detectable between the two treatments as regards the deviation profiles of 6 steroids and cholesterol with mice of both sexes. Plasma hydrocortisone (F) in males and plasma estradiol (E2) in females were consistently resistant to the depressing effects of the 2 immunosuppressants. In conclusion, the effect of CS on the mouse immune system, as judged from the response of the spleen, was to create a state of hyperandrogenism in favor of the production of immune unresponsiveness.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of luteinizing hormone releasing hormone (LHRH) agonists on body weight in rats

As the potential clinical applications of LHRH agonists increase, the issue of side effects on nonreproductive organ systems assumes greater significance. LHRH agonists administered continuously or in twice-daily injections accelerated body weight gain in female rats. Two different LHRH agonists produced similar effects on body weight in female rats. When Leuprolide (LHRHa) was given to female rats in twice-daily injections, the adrenal weight increased after 21 days of treatment, whereas administration by osmotic minipumps produced no significant effect on adrenal weight. When another agonist, Zoladex (LHRHz), was given continuously for 52 and 229 days to female rats, the adrenal weight decreased. No change was noted in adrenal weight or body-weight gain of male rats given LHRHz continuously for 51 and 62 days. Reproductive-organ weights were significantly reduced in all LHRH-agonist-treated animals. Serum progesterone in female rats and testosterone in male rats were significantly decreased following treatment with LHRHz. No significant differences were noted in serum prolactin, growth hormone, or corticosterone. The mechanisms and significance of these findings are discussed.     

达英-35及妈富隆治疗青春期多囊卵巢综合征的疗效

目的观察妈富隆与达英-35治疗青春期多囊卵巢综合征（PCOS）的临床疗效。方法将60例患者随机分为2组,A组给予妈富隆治疗,B组给予达英-35治疗,治疗3个周期后,复查女性激素6项,并记录患者月经、多毛及痤疮情况的变化,停药后随访3个月。结果两组患者经过治疗后,月经稀发、痤疮明显改善（P〈0.05）;治疗前后多毛改善均不明显（P〉0.05）。停药后,A组月经失调复发者8例,B组9例。结论妈富隆及达英-35对治疗青春期PCOS的月经失调均有良好疗效,妈富隆对LH/FSH值高的PCOS患者更合适,而达英-35对高雄激素血症的患者疗效更佳。     

Polycystic ovary syndrome: treatment strategies and management

Background: The polycystic ovary syndrome (PCOS) is possibly the most common endocrine disorder in premenopausal women, with prevalences in the 6 – 7% range reported worldwide. Although PCOS is primarily a disorder of androgen excess, affected women frequently present with abdominal adiposity and insulin resistance, explaining the association of PCOS with metabolic comorbidities and an increased cardiovascular risk. Abdominal adiposity, and very especially the compensatory hyperinsulinism resulting from insulin resistance, further contribute to hyperandrogenism. These pathophysiological mechanisms must be considered when deciding the optimal therapy for PCOS patients. Objective: To review the impact of the current approaches to the treatment of PCOS on the metabolic associations and the cardiovascular risk of these women. Methods: Review of published studies addressing the effects of different treatment strategies of PCOS. Results: The resolution of PCOS after the marked and sustained weight loss attained after bariatric surgery makes this therapeutic option a first-line strategy in women presenting with severe obesity. In patients with lesser grades of obesity who desire fertility, a short trial of metformin, followed by classic ovulation induction and/or assisted reproductive techniques in case pregnancy is not achieved in a few months, is a reasonable approach. If fertility is not an immediate concern, third generation oral contraceptive pills containing a neutral or antiandrogenic progestin remains the drug of choice, considering their efficacy, their excellent tolerability, and their overall metabolic safety. Conclusion: Strategies targeting obesity and abdominal adiposity, insulin resistance and hyperandrogenism, alone or in combination, are effective in ameliorating the signs and symptoms of hyperandrogenism while improving the metabolic comorbidities and the cardiovascular risk of these patients in most cases.