الفهرس | Only 14 pages are availabe for public view |
Abstract PCOS is the most common endocrinopathy in adult women, and is emerging as common cause of menstrual disturbances in adolescent population. Prevelance of PCOS could differ among different population. However prevelance of PCOS seems to increase rapidly owing to the world- wide epidemic of obesity related to unhealthy dietary habits and physical inactivity. The aetiology of PCOS remains uncertain but there is increasing evidence for auto immune disease so screening for auto antibodies in PCOS women may help in diagnosis of PCOS. It has been postulated that all women with PCOS may have insulin resistance. Insulin resistance has been demonstrated to be greater in both lean and obese women with PCOS compared with non-PCOS women of comparable weight, suggesting that the defect is intrinsic to this disorder. To establish the diagnosis of PCOS, the goal is to confirm ovarian hyperandrogenism, and exclude other causes of hyperandrogenism and menstrual dysfunction such as adrenal or ovarian tumours, non classical adrenal hyperplasia, cushing’s syndrome, hyperprolactinemia, and thyroid disease. The recent PCOS consensus meeting held in Rotterdam determined the diagnostic criteria for PCOS as (i) oligo-and /or anovulation, (ii) clinical and /or biochemical signs of hyperandrogensim and (iii) polycystic ovary morphology on ultrasound scan, defined as the presence of >12 folicles in each ovary (with one ovary being sufficient for diagnosis) measuring 2 to 9mm in diameter and /or increased overian volume >10 ml after exclusion of other causes of androgen excess. Two out of the three are required for the diagnosis of PCOS. In virgin polycystic ovary syndrome (PCOS) patients, transabdomenal sonography is the preferential method of pelvic examination. Magnetic resonance can provide vastly greater delineation of the structural components of the ovary in obese women with PCOS and thus can serve as an excellent investigational technique. Life-style modification is very important in the treatment of PCOS women, as weight loss and exercise show a striking improvement in ovulatory function and features of hyperandrogenism. Oral contraceptives may play a role in therapy for women with PCOS. Oral contraceptives decrease ovarian androgen production and increase SHBG, resulting in lower levels of biologically active androgens and stabilized hair growth. Anti-androgens (spironolactone, finasteride, flutamide) are useful in stopping hair growth in women whose condition is not responsive to oral contraceptives. For the severely hirsute patients with PCOS resistant to oral contraceptives and anti-androgens, GnRH agonists (e.g,leuprolide acetate 3.75 mg intramuscularly each month for 6 months). For patients with recurrent pregnancy loss, pituitary suppression with GnRH agonists or luteal support (progesterone, human chorionic gonadotropin) have been reported to be helpful. Gonadotropin therapy may also be effective and remains the most frequently used therapy in clomiphene-resistant cases. Surgical ovulation induction (laparoscopic ovarian drilling, wedge resection) has been shown to be effective. Insulin-sensitizing agents have been proposed as the treatment for this disorder. where as most current regimens treat the symptoms of PCOS, insulin-sensitizing agents are intended to correct the underlying metabolic defect of this syndrome. The aim of our study was to determine the association of autoimmunologic processes in women with PCOS. Thirty patients with PCOS were selected from Ain Shams University Hospital clinic compared with thirty agedmatched health fertile control as regard autoimmune markers (ANA, Anti-dsDNA). The results of our study show significant increase in autoimmune markers (Anti-dsDNA) in PCOS patients compared with healthy control. These results suggest that a role for auto immunologic processes might be present in the pathogenesis of PCOS. |