An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence
An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence
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青少年多囊卵巢综合征的病理生理学、诊断和治疗
DOI：
10.1159/000479371
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发表时间：
2017-01-01
影响因子：
3.2
通讯作者：
Lee, Peter A.
中科院分区：
文献类型：
--
作者：
Ibanez, Lourdes;Oberfield, Sharon E.;Lee, Peter A.
本文代表了国际儿科内分泌学联盟（ICPE）下儿科内分泌和其他学会（列于附录）的国际合作，旨在改善全球多囊卵巢综合征（PCOS）少女的护理（1）。该手稿探讨了青春期多囊卵巢综合征的诊断和治疗的病理生理学和指南。PCOS的复杂病理生理学涉及遗传和表观遗传变化、原发性卵巢异常、神经内分泌改变以及内分泌和代谢调节剂如抗苗勒管激素、高胰岛素血症、胰岛素抵抗、肥胖和脂联素水平的相互作用。青春期多囊卵巢综合征的正确诊断应包括充分和仔细的症状评估，如多毛症，严重痤疮，月经初潮后2年的月经不规律，雄激素水平升高。超声显示的多囊卵巢形态不伴有高雄激素血症或月经不调不应用于诊断青春期PCOS。高胰岛素血症、胰岛素抵抗和肥胖可能存在于PCOS青少年中，但不被认为是诊断标准。青少年PCOS的治疗应包括生活方式干预，局部治疗和药物治疗。胰岛素增敏剂如二甲双胍和口服避孕药对PCOS症状提供短期益处。关于抗雄激素药物和联合治疗的数据有限，显示了对青少年的累加/协同作用。在管理青少年时，应考虑到生殖方面和过渡问题。(C)2017 S. Karger AG，巴塞尔。
This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)(1). The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Mullerian hormone, hyper-insulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents. (C) 2017 S. Karger AG, Basel.