Rudimentary ovary syndrome

21 patients with rudimentary ovary syndrome were studied with a review of the literature. Rudimentary ovary syndrome is one of the syndromes of primary ovarian failure characterised by limited ovarian function around puberty. Some cases are associated with chromosomal abnormalities, some others may be due to immunologic defect. Treatment considerations are discussed.     

Diagnosing polycystic ovary syndrome

Polycystic ovary syndrome has adverse effects on many organ systems and on women's quality of life, so recognition is important. The diagnosis now requires at least two of the following: (i) polycystic ovarie; (ii) oligo-ovulation or anovulation; (iii) clinical and/or biochemical evidence of androgen excess. The spectrum of presentations of PCOS is wide, ranging from severe hirsutism, obesity and amenorrhoea at one end to mild hirsutism or slight disturbance of menstrual pattern at the other (Figure 2). In the author's clinic, PCOS is the most common cause of anovulatory infertility (73% of cases), amenorrhoea or oligomenorrhoea and hirsutism (> 75% of cases). The diagnosis of PCOS is made primarily on clinical and ultrasonographic criteria (Figure 3). A discussion follows on useful hormonal investigations, careful history and appropriate initial investigations which will usually help distinguish PCOS from other causes of androgen excess and menstrual disturbance.     

Polycystic ovary syndrome.

Many adolescents present with hirsutism and irregular menses. The challenge for the clinician is to distinguish physiologic anovulatory cycles from true menstrual disorders such as PCOS, and to differentiate PCOS from other causes of hyperandrogenism in hirsute adolescents. Common clinical features seen in adolescents with PCOS include hirsutism, acne, menstrual irregularity, and obesity. Biochemical abnormalities include hyperandrogenism, acyclic estrogen production, LH hypersecretion, decreased levels of SHBG, and hyperinsulinemia. Management strategies for a patient with PCOS include treatment of features which may cause distress to the adolescent, such as hirsutism, acne, and irregular menses, and prevention of long-term sequelae. Oral contraceptive pills, antiandrogens, and cosmetic treatments are used to treat hirsutism, acne, and menstrual irregularity. Oral contraceptive pills or medroxyprogesterone acetate are given to prevent endometrial hyperplasia and carcinoma. Counseling about weight loss and nutrition are essential, as weight loss may improve signs of hyperandrogenism and menstrual irregularity and may prevent NIDDM and cardiovascular disease. Insulin-sensitizing agents show promise in terms of decreasing hyperandrogenism, restoring ovulatory cycles, treating infertility, and preventing long-term sequelae. Finally, it is important to recognize that adolescents with PCOS may experience psychological distress because of the clinical manifestations of hyperandrogenism or when confronted with the information that they have a chronic illness. Psychological support should be available for these young women. Future research is likely to further elucidate the pathophysiology of PCOS, identify candidate genes, and clarify which adolescents are at risk for long-term sequelae. Prospective studies are needed to identify which therapies could potentially reduce the risk of infertility, diabetes, cardiovascular disease, and endometrial carcinoma in young women with PCOS.     

抗性淀粉与代谢综合征

抗性淀粉是不能被人体小肠吸收的,而在结肠中发酵的淀粉.目前的研究认为,它可以降低餐后血糖、血清胆固醇和三酰甘油的水平,增强胰岛素的敏感性,从而达到防治代谢综合征的目的.     

饮食与多囊卵巢综合征

多囊卵巢综合征是育龄期女性常见的内分泌紊乱性疾病,其病因不明,遗传及环境因素可能在其发病过程中起一定作用.饮食因素是环境因素的主要组成部分,其对多囊卵巢综合征的影响主要是通过对胰岛素抵抗及生殖能力的影响而实现.同时,多囊卵巢综合征患者有饮食能量摄入异常、结构比例失调及暴饮、暴食等饮食特点.饮食治疗是多囊卵巢综合征患者主要的干预方式之一,通过探讨不同的饮食方案的疗效,为多囊卵巢综合征患者合理饮食方案的制定提供一定的依据.     

Polycystic ovary syndrome in adolescents

Recent findings suggest substantial metabolic sequelae to polycystic ovary syndrome (PCOS), including risk of diabetes and cardiovascular disease. Primary treatment of the metabolic sequelae should be the focus of the clinician. The definition of PCOS has been expanded from a disorder that presents at menarche and ends at menopause to a disorder that may be present from birth to senescence. The earliest recognized PCOS phenotype to date is premature pubarche characterized by excessively elevated levels of dehydroepiandosterone sulfate and hyperinsulinemia. Such girls are at high risk to develop the full PCOS phenotype, including ovarian hyperandrogenism and chronic anovulation. A fasting glucose-to-insulin ratio of < 7 is a useful index of insulin resistance in adolescents. However, each patient should be evaluated for glucose intolerance and lipid abnormalities on a regular basis by completing a 2-hour oral glucose tolerance test and a fasting lipid profile. Primary prevention of diabetes and cardiovascular disease by lifestyle modifications, regular exercise, and a balanced diet are of utmost importance, especially in adolescents who have the opportunity to establish healthy habits before entering adulthood. The role of insulin-sensitizing medications is still under study. Although no clinical trials over 6 months in duration have assessed the long-term efficacy of metformin use in adolescents, short-term trials have shown promising effects in lowering insulin secretion, improving insulin sensitivity, restoring normal menstrual cycles, and correcting lipid abnormalities.     

Management of polycystic ovary syndrome

Polycystic ovary syndrome can cause distressing symptoms of hyperandrogenism (such as hirsutism), may impair fertility and is associated with the metabolic syndrome. Management has traditionally been guided by symptoms or by the wish to conceive, but prevention of the possible long-term consequences of the metabolic disturbance characteristic of anovulatory women with PCOS is now an important element of management. By focusing on the treatment of infertility, menstrual regulation, the treatment of symptoms of hyperandrogenism and the prevention of possible consequences of the metabolic disturbance, this article reviews the important elements in the management of PCOS     

多囊卵巢综合征与卵巢多囊化的血流参数分析

目的 分析多囊卵巢综合征(PCOS)与卵巢多囊样改变(PCO)在彩色多普勒下的血流指标变化,探讨二者之间的差异.方法 选取PCOS及PCO患者各50例,行阴道彩色多普勒超声检查,观察卵巢间质动脉、子宫动脉、子宫螺旋动脉血流阻力指数(RI)变化,并进行统计学分析.结果 统计结果 显示:PCOS组患者卵巢间质动脉RI明显低于PCO组(0.43±0.10 vs 0.69±0.24,t=7.07,P<0.05);PCOS组子宫动脉RI明显高于PCO组(0.87±0.05 vs 0.59±0.03,t=12.33,P<0.05),子宫螺旋动脉两组间无明显差异(0.59±0.07 vs 0.58±0.06,t=0.77,P>0.05).结论 彩色多普勒超声检查为PCOS与PCO的鉴别提供了较为客观的定量指标,具有重要的辅助诊断价值.     

雄激素受体在多囊卵巢综合征卵巢中表达的研究

目的探讨卵巢组织雄激素受体(androgen receptor,AR)与多囊卵巢综合征(polycystic ovary syndrome,PCOS)发病机理及其临床特征的关系,以期为多囊卵巢综合征的预防和治疗提供理论依据。方法选择因多囊卵巢综合征行卵巢楔形切除的卵巢病理组织15例为病例组,同时选择年龄相匹配的非多囊卵巢综合征并于卵泡期行手术切除的正常卵巢组织13例为对照组。HE染色,采用双盲读片,比较两组中各级卵泡的数目;免疫组织化学染色法检测AR在各级卵泡颗粒细胞中的表达情况。结果两组卵巢组织切片始基卵泡数、闭锁卵泡数比较,差异均无统计学意义;PCOS组初级卵泡数、次级卵泡数、窦卵泡数较对照组增多,差异均有统计学意义(均有P<0.05)。AR在始基卵泡及生长卵泡的卵母细胞表达,在生长卵泡的颗粒细胞表达更明显。结论多囊卵巢综合征患者卵巢局部组织的AR表达与多囊卵巢综合征的发生有一定的相关性。     

青春期多囊卵巢综合征的治疗

多囊卵巢综合征以雄激素过多和持续无排卵为特征。对青春期多囊卵巢综合征的治疗包括调整月经周期、控制多毛症和痤疮、减轻体重。传统疗法主要是抑制雄激素过多和持续无排卵症状,而新近疗法是应用胰岛素增敏剂纠正体内代谢紊乱,但胰岛素增敏剂的疗效和适用人群需要进一步研究证实。     

Early origins of polycystic ovary syndrome

The prenatally androgenised female rhesus monkey has become a model for polycystic ovary syndrome (PCOS) in women, with early prenatal androgenisation entraining a permanent PCOS-like phenotype characterised by luteinising hormone (LH) hypersecretion due to reduced hypothalamic sensitivity to steroid negative feedback and relative insulin excess associated with increased abdominal adiposity. These combined reproductive and metabolic abnormalities occur in combination with ovarian hyperandrogenism and follicular arrest in adulthood, and with premature follicle differentiation and impaired embryo development during gonadotrophin therapy for in vitro fertilization (IVF). The ability of prenatal androgen excess in fetal rhesus monkeys to entrain multiple organ systems in utero provides evidence that the hormonal environment of intrauterine life programmes target tissue differentiation, raising the possibility that hyperandrogenism in human fetal development promotes PCOS in adulthood. This hypothesis developed in prenatally androgenised female rhesus monkeys, however, also must include data from clinical studies of PCOS to clarify the homology between human and non-human primates in intrafollicular steroidogenesis and its impact on oocyte developmental competency. By doing so, future studies promise to develop new clinical strategies that will lead to improved pregnancy outcome and reduced pregnancy loss in women with disorders of insulin action, including PCOS, obesity and diabetes mellitus.     

多囊卵巢综合征与神经内分泌功能异常

多囊卵巢综合征是育龄妇女最常见的妇科内分泌疾病之一,是引起无排卵性不孕的主要原因,其内分泌异常表现为黄体生成素(促性腺激素释放激素)脉冲波持续快速升高,黄体生成素/重组绒促卵泡激素的比例失调,重组绒促卵泡激素水平下降,卵泡形成受损及高雄激素产生.通过增强下丘脑对黄体酮的敏感性,可以抑制黄体生成素持续快速升高,体内过多的雄激素分泌却减弱了下丘脑对黄体酮的敏感性,进而削弱了黄体酮对促性腺激素释放激素的减速调节,加速黄体生成素(促性腺激素释放激素)脉冲波持续升高.促性腺素分泌的异常、高雄激素的产生和卵巢功能障碍都可能是多囊卵巢综合征内分泌功能异常的重要原因.     

青春期多囊卵巢综合征的生殖内分泌学特点

多囊卵巢综合征是目前育龄妇女最常见的内分泌疾病,多起病于青春期,其临床表现和生殖生理改变与青春期的生理变化有一定的联系.由于患有多囊卵巢综合征的青少年逐年增多,所以减少多囊卵巢综合征患者患有不孕、糖尿病以及代谢综合征等方面疾病至关重要.该文就促性腺激素分泌失调、雄激素分泌过多、月经不规则及卵巢形态学特征方面对青春期多囊卵巢综合征生殖内分泌学特点作以综述.     

青春期多囊卵巢综合征的筛查

多囊卵巢综合征好发于青春期,以高雄激素血症和高胰岛素血症为特征.目前发现青春期多囊卵巢综合征患者在其青春期后发展为2型糖尿病,心血管疾病,以及不孕症的危险性增加,而且多囊卵巢综合征的一些症状对于青少年身心健康是有害的.所以做出青春期多囊卵巢综合征的早期诊断是重要的,为了达到提高早期诊断的目的,筛查就显得尤为重要.该文将对青春期多囊卵巢综合征的筛查做如下论述.     

The polycystic ovary syndrome: Psychosexual correlates

Eleven women with the polycystic ovary syndrome (POS) were interviewed prior to treatment to assess psychosexual and behavioral characteristics. Because the polycystic ovary syndrome is characterized by an elevated plasma level of free testosterone that presumably develops after birth, we examined specifically the six areas traditionally explored in prenatally androgenized women — play preference, energy expenditure level, interest in dress and appearance, career vs. family preference, sexual arousal to narrative and visual stimuli, and sexual initiative. While these women described patterns in all categories similar to those reported in the earlier studies of prenatally androgenized women, their behavior was significantly different only in sexual initiative from that of two normal control groups. These findings suggest that increased sexual initiative may be a heretofore unemphasized clinical feature of the polycystic ovary syndrome and conceivably a concomitant of elevated free plasma testosterone.This work was supported in part by PHS-NIMH Fellowship No. 2 TO1 MH 11528 (Dr. Gorzynski).