Polycystic Ovary Syndrome (PCOS)
多囊性卵巢症候群

綜論 -key points
病理生理及臨床特徵-pathophysiology and clinical features
病因-pathogenesis
診斷-diagnosis
治療-management
後遺症-long term sequelae and risks

綜論 -key points
         *佔生育年齡婦女的4-12%,
*是不排卵性不孕症最常見的原因,
*有幾個特點:
含較高的雄性賀爾蒙(hyperandrogen) 長青春痘(acne), 多毛(hirsutism)
對胰島素抵抗性增加(insulin resistance) 高胰島素血症(hyperinsulinemia)
加速GnRH的搏動性(accelerated GnRH pulsatile activity 月經不規則(ovarian acyclicity)
肥胖(obesity), hypersecretion of LH
hypofunction of FSH-granulosa cell axis theca-stromal cell hyperactivity
長期下來的後遺症包括:子宮內膜癌, type II 糖尿病, 心血管疾病 follicular arrest
        

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病理生理及臨床特徵-pathophysiology and clinical features
         Clinical features        
　 　
1 hyperandrogenism: hirsutism, acne, alopecia, elevated concentration of testosterone and androstenedione.
2 Chronic anovulation: oligomenorrhea, amenorrhea, and polycystic ovaries.
3 Obesity: due to insulin resistance, hyperinsulinemia, impaired GH secretion.
　 Accelerated GnRH/LH pulsatile activity
　 　
1 Nonobese PCOS:increased LH pulse amplitude and accelerated LH pulse frequence resulting in threefold in 24hrs mean LH levels.
2 Obese PCOS: attenuate the evidence of hypersecretion of LH, elevated LH/FSH ratio, and heightened LH response to GnRH.
3 The mechanism in accelerated GnRH/LH pulse frequency in PCOS is unclear.
4 　

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病因-pathogenesis
         確實的病因雖仍未明朗, 但還是可以歸納出以下幾個可能性:         
　 　 。Abnormal secretion of pituitary gonadotropins suggests a hypothalamic origin.
。Abnormal steroidogenesis raises the possibility of adrenal or ovarian origin.
。Insulin resistance points to an abnormality in insulin action.
Hereditary and Genetic Factors
最近的研究傾向於遺傳或是基因得突變, 其中有些已獲得證實, 這包括如下:
。Study by Ehrman and colleagues  showed that women with PCOS having a first-degree relative with type 2 diabetes were more likely to have more severe insulin resistance. An affected woman-unaffected sister pair analysis showed a 55% correlation of dehydroepiandrosterone sulfate (DHEAS) levels suggesting an inherited problem with adrenal androgen production.

。很多PCOS的病人, 其 PvuII polymorphism of the estrogen receptor gene的機率增高 , 這可以解釋為什麼PCOS的病人會有不正常的 ovarian estrogen action.

。一些研究則發現PCOS的病人, 其Gly972Arg polymorphism of insulin receptor substrate (IRS)-1/增加很多, 這又可以解釋為什麼PCOS的病人會insulin resistance.

。Escobar-Morreale 則發現到PCOS的病人,其tumor necrosis factor (TNF)-receptor polymorphism很顯著的升高, 所以TNF system的受到侵犯, 應也與PCOS的病因有關.

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診斷-diagnosis
         診斷的原則        
The most widely accepted diagnostic criteria are the National Institute of Child Health and Human Development (NICHD) criteria: clinical or laboratory evidence of hyperandrogenism without other endocrine disorder and oligoanovulation.
　 依據臨床徵象Clinical Presentation
肥胖(obesity), 多毛(hirsutism),月經不規則(ovarian acyclicity), 或無月經.
　 依據檢驗數據Laboratory Diagnosis
　 　 。ultrasonography shows enlarged ovaries with increased stroma and multiple subcapsular small follicles.
。reveals elevated serum androgen levels (total and free testosterone, androstenedione),
。increased luteinizing hormone (LH)/follicle-stimulating hormone ratio,
。decreased sex-hormone binding globulin (SHBG) levels,
。lipid abnormalities, and insulin resistance.

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治療-management
         Anovulation
　 　 　
　 Dysfunctional Uterine Bleeding
　 　 　
　 Metabolic Abnormalities
　 　 　

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PCOS的長期後遺症-long term sequelae and risks
         Endometrial Cancer子宮內膜癌
　 　 　
　 Diabetes Mellitus糖尿病
　 　 　
　 Cardiovascular Disease心血管疾病
　 　 　

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