Syndrom der polyzystischen Ovarien (PCOS) – Diagnostik und Therapie

Polycystic ovary syndrome (PCOS), including chronic anovulation, hyperandrogenism and polycystic ovaries, is the most common endocrine disorder in women of reproductive age, affecting around 5–10% with familial clustering. The symptoms of PCOS range from the cutaneous stigmata of hyperandrogenism and sterility to metabolic syndrome. Patients with PCOS differ in part considerably, therefore studies dealing with PCOS are hard to compare. The etiology of PCOS remains obscure. Its diagnosis should include all aspects of the disease in a multidisciplinary approach involving dermatologists and general practitioners. An optimal treatment that targets all symptoms does not exist. This review sheds light on some important aspects of PCOS with the aim of sensitizing for its complexity.     

Das Karzinomrisiko von Frauen mit Syndrom der polyzystischen Ovarien (PCOS)

Epidemiological studies as well as experimental data suggest that endocrine disturbances in the insulin/insulin-like growth factor (IGF) system, hyperandrogenemia, or the unopposed estradiol, which are typical of the polycystic ovary syndrome (PCOS), might lead to an increased risk, especially of breast cancer and endometrial carcinoma. The scope of the present data is small; thus, the level of evidence is not very high. However, biological plausibility is convincing. Patients with PCOS should be informed about their potential carcinoma risk. Appropriate modifications of behavior should be recommended (e.g., change of nutrition, weight reduction, and regulation of the menstrual cycle) to reduce the risk of malignant tumors and other health risks of this group at risk as well.     

Das Syndrom der polyzystischen Ovarien

The polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder of women in the reproductive phase. Important determinants for the extent and course of the disorder are the presence of a metabolic syndrome with obesity, insulin resistance and hypercortisolism. The metabolic syndrome is influenced by behavioral factors like eating behavior and physical activity. There are data hinting to a link between PCOS, eating disorders, depressive disorders and other psychiatric disorders. This opens a behavioral medicine perspective to the treatment of PCOS.     

Syndrom der polyzystischen Ovarien: Klinische Einteilung

The definition of polycystic ovary syndrome is still subject to debate. Ultrasonographic diagnosis alone does not suffice. Clinical relevance is only reached when additional endocrinological alterations exist such as irregular menstrual cycles, hyperandrogenemia, or a disorder of glucose metabolism. An endocrinological work-up is thus indispensable. The pathophysiological associations are still not completely clarified so that primarily ovarian as well as disturbances of different hormonal systems can be present. It appears that various factors such as an elevation of testosterone or even insulin levels lead to an increase of LH concentrations and thus to hyperandrogenemia. Only when the cause has been determined adequate therapy can be instituted. Special attention should be paid to possible insulin resistance or metabolic syndrome because of the harmful cardiovascular after-effects.     

Die gestörte Gonadotropinsekretion beim Syndrom der polyzystischen Ovarien (PCOS) und Erklärungsmodelle aus In-vitro-Experimenten

A characteristic of the polycystic ovary syndrome (PCOS) is hyperandrogenemia, that might be due to an increased intraovarian secretion of 17α-hydroxylase and/or a tonically increased LH secretion. Vice versa, hyperandrogenemia and other typical signs of PCOS like insulin resistance and hyperinsulinemia could contribute to LH hypersecretion. We examined how the ovarian androgens testosteron and DHT, the adrenal androgen DHEA, insulin, and IGF-I influence LH secretion in female rat pituitary cells. 48 h of treatment with testosterone and DHT lead to a significant suppression of LH secretion. High concentrations of DHEA (10^?6 M) augmented LH secretion significantly. Cells treated with insulin (10^?9 M) for 24 h showed an increase in GnRH-induced LH secretion. IGF-I caused a significant increase in LH secretion.     

Funktioneller Hyperandrogenismus (sog. “Syndrom polyzystischer Ovarien”)

The classification of functional hyperandrogenism (FHA) presented in this article is based on known clinical findings that have been corroborated by recent concepts in molecular biology. It can be assumed that FHA consists of various organ- or system-specific entities that ultimately entail different strategies for diagnosis and therapy. The designation “polycystic ovary syndrome,” which is an imprecise term encompassing divergent entities, should be replaced by appropriate definitions. Although considerable knowledge of the molecular biological sequence of events in FHA and approaches are already available, the etiologic principles have not yet been established, with the exception of group III FHA which is not discussed here, and diagnostic as well as therapeutic consequences remain limited. However, further rapid developments can be expected in the near future based on recent discoveries regarding the human genome and modern genetic screening possibilities (microassays).     

PCOS und metabolisches Syndrom

Ohne Zusammenfassung     

Syndrom polyzystischer Ovarien und Adipositas im Jugendalter

Nearly 20% of the adolescent females in Germany are overweight. A typical comorbidity of overweight is polycystic ovary syndrome (PCOS). The diagnosis of PCOS in adolescents needs to be based on the criteria hyperandrogenemia and/or hirsutism as well as oligomenorrhea or amenorrhea. All other diseases with hyperandrogenism need to be excluded. PCOS is caused, among other things, by insulin resistance, which is increased particularly in central obesity. Therefore, other diseases associated with insulin resistance such as metabolic syndrome, type 2 diabetes mellitus, or fatty liver are frequent in girls with PCOS. The treatment of choice for obesity and PCOS is weight reduction, which is difficult to achieve in clinical practice. Drug treatment for hirsutism or menstrual irregularities depends on the accompanying risk factors.     

Ovulationsinduktion mit niedrigdosierter FSH-Gabe bei Frauen mit polyzystischen Ovarien und Oligomenorrhoe oder sekunderer Amenorrhoe

Ohne Zusammenfassung     

Klinische Probleme bei der Behandlung von Borderline-Tumoren der Ovarien

Zusammenfassung 1. Das Stadium Ia rechtfertigt eine operativ-organerhaltende Vorgehensweise bei jungen Frauen mit noch bestehendem Kinderwunsch. 2. Frauen mit abgeschlossener Familienplanung sollten nach Schnellschnittuntersuchung so radikal wie m?glich operiert werden, um ihnen eine postoperative Chemotherapie zu ersparen. 3. Die Chemotherapie nach dem CMF-Schema ist bei fortgeschrittenem Tumorbefall indiziert und es sollte ein Second-Look-Eingriff zur Therapiekontrolle erfolgen.     

Hormonelle Therapie des polyzystischen Ovarsyndroms (PLOS)

Zusammenfassung Zur endokrinen Therapie des heterogenen polyzystischen Ovarsyndroms (PCOS) stehen verschiedene Strategien zur Verfügung, die individuell auf die Patientin abgestimmt werden. Sind hyperandrogenämische Symptome wie Akne und Hirsutismus zu behandeln, wird antiandrogen therapiert und ein Zyklus etabliert. Orale Kontrazeptiva mit antiandrogenen Gestagenen sind dazu Mittel der ersten Wahl, in schwereren Fällen werden zusätzlich höher dosierte Gestagene eingesetzt. Bei Kinderwunsch erfolgt eine ovarielle Stimulation, ideal mit niedrig dosiertem FSH. Die Risiken einer ovariellen Überstimulation und höhergeradigen Mehrlingsschwangerschaft sind zu beachten. Zur Behandlung einer Insulinresistenz können Insulinsensitizer eingesetzt werden. Sie führen in einem großen Anteil der Patientinnen zu Ovulationen, durch Kombination mit einer ovariellen Stimulation lässt sich dieser Effekt noch weiter verbessern.