Characteristics of phenotypes (clinical variants)  of polycystic ovary syndrome in women  of reproductive age

Syusyuka, V.G.; Сергієнко, М.Ю.; Makurina, H. I.; Єршова, О.А.; Chornenka, A.S.

doi:10.30841/2708-8731.2.2021.232519

Cited by 4 publications

(6 citation statements)

References 11 publications

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“…Гамма-аміномасляна кислота (ГАМК) і антимюллерів гормон (АМГ) зв'язуються з рецепторами ГАМК A і рецепторами АМГ типу 2 (АМГР2) відповідно, стимулюючи пульсацію ГнРГ [7,8]. Порушення негативного зворотного зв'язку між естрадіолом та прогестероном спостерігається на рівні гіпоталамуса [9,10].…”

Section: патофізіологія та нейроендокринні порушення системи гіпотала...unclassified

Current perspectives on the metabolic aspects of polycystic ovary syndrome

Korchynska,

Khascha,

Shumilina

2023

RHW

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Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age and is characterized by excessive androgen levels and ovulatory dysfunction. PCOS with a wide range of heterogeneous syndromes affects the health of a large part of the female population of the world.PCOS is a complex endocrinopathy that includes a variety of symptoms, such as menstrual disorders, infertility, acne, hirsutism, and several metabolic disorders. Given the different clinical manifestations, unknown etiology, and complex pathophysiology, the diagnosis of PCOS is still controversial.The prevalence of PCOS is often estimated between 2% and 26%. This significant difference in prevalence may be due to differences in diagnostic criteria, sample heterogeneity, socioeconomic status, access to health care, and general health awareness. Furthermore, given the multiple phenotypes of PCOS and the fact that it is predominantly diagnosed by gynecologists and endocrinologists, while it is poorly studied in other specialties and primary care physicians, these estimates may sometimes be lower.The article is a review of the scientific literature on various pathogenetic aspects of the development of PCOS, which arises as a result of polygenic susceptibility in combination with environmental influences, which may include epigenetic changes and intrauterine programming. Racial and ethnic differences may influence clinical manifestations through the genetic and environmental predisposition to endocrinopathies and metabolic diseases. In addition to the well-known clinical manifestations of hyperandrogenism and ovulatory dysfunction, women with PCOS are at increased risk for adverse mental health outcomes, pregnancy complications, and cardiometabolic disease.Treatment methods have limited effectiveness, mostly due to the fact that the development of drugs is difficult by an incomplete definition of the main pathophysiological processes. Advances in adipocyte genetics, metabolomics, and structure have improved understanding of key changes in neuroendocrine, enteroendocrine, and steroidogenic pathways, including increased gonadotropin-releasing hormone pulsatility, androgen excess, insulin resistance, and changes in the gut microbiome.Many patients have high levels of 11-oxygenated androgens with high androgenic activity, which may pose a metabolic risk. These advances have prompted the development of new therapies, including those targeting the neurokinin–kispeptin axis upstream of gonadotropin-releasing hormone, with the potential to reduce adverse clinical outcomes and improve patient outcomes.

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Section: патофізіологія та нейроендокринні порушення системи гіпотала...unclassified

Current perspectives on the metabolic aspects of polycystic ovary syndrome

Korchynska,

Khascha,

Shumilina

2023

RHW

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“…Існує не так багато захворювань, які б такою самою мірою впливали на психоемоційний стан, соціальну адаптацію, кар'єрні можливості та сексуальне життя. До характерних проявів АД належать акне, алопеція, себорея та гірсутизм [66]. Зазвичай спеціалістом першого контакту у таких випадках є косметолог чи дерматолог.…”

Section: н а д о п о м о г у л і к а р ю -п р а к т и к уunclassified

“…У діагностиці ГА визначення рівня вільного та загального тестостерону має відносно низьку чутливість, а серед найбільш інформативних показників, згідно з рекомендаціями Європейського товариства ендокринологів (European Endocrine Society -ESS), виділяють індекс вільного тестостерону та андростендіон. Саме підвищення рівня андростендіону та індексу вільного тестостерону встановлено у понад 60 % жінок з проявами акне та СПКЯ [17,66]. Однак слід зазначити, що дослідження рівня андрогенів є допоміжним методом для встановлення діагнозу і в жодному разі не повинно використовуватися як основний критерій або заміна клінічної діагностики СПКЯ [9].…”

Section: н а д о п о м о г у л і к а р ю -п р а к т и к уunclassified

“…У пацієнтів з акне спостерігається збільшення продукування себуму (59%) порівняно з пацієнтами без акне, а також якісна зміна його складу: на 34% більше сквалену, на 19% більше тригліцеридів, на 16% менше воскових ефірів, на 53% менше вільних жирних кислот [55]. Окрім зга-даного вище, зниження вмісту лінолевої кислоти в епідермальних ліпідах при вугровій хворобі призводить до збільшення кількості висипань, оскільки лінолева кислота інгібує активність 5α-редуктази [66].…”

Section: н а д о п о м о г у л і к а р ю -п р а к т и к уunclassified

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A multidisciplinary approach in the management of patients with acne

Syusyuka

Makurina

Chornenka

et al. 2022

RHW

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The article summarizes the data of the scientific publications about the management of patients with androgen-dependent dermatopathies, namely acne, taking into account the current view on the pathogenesis, clinical manifestations and results of the examinations of this group of women. Androgen-dependent dermatopathies are not only a medical problem but also a socio-economic one, as they lead to impaired socialization and reduced quality of life. Acne is one of the most common dermatoses. Acne is a chronic multifactorial disease of the pilosebation complex, which is clinically manifested by polymorphic rash in the form of open and closed comedones, papules, pustules, nodules. The pathogenesis of the disease is based on four main links: changes in the quantitative and qualitative composition of sebum due to hypersecretion of androgens and/or increased sensitivity of receptors to their action, impaired follicular keratinization, inflammation and changes in skin microbiome. Besides the main pathogenetic aspects, trigger factors are taken into account, such as nutrition, stress, smoking, mechanical agents. The current treatment of acne according to dermatological protocols is presented in the article, which is based on a combination of topical therapy with local retinoids and antibiotics, benzoyl peroxide, azelaic acid, in case of severe or ineffective local therapy systemic antibiotics and systemic retinoids are used. However, despite the presence of many treatment regimens for dermatosis, it is often not possible to achieve a lasting effect of treatment, and the adherence of patients to follow the doctor’s recommendations decreases. Given that the leading role in the pathogenesis of acne is due to hyperandrogenic effects on the skin, as well as the fact that the disease reduces the quality of life and self-esteem in patients, it is necessary to involve a wider range of specialists, such as dermatologists, gynecologists, endocrinologists and psychotherapists for successful treatment and prevention of persistent aesthetic skin defects.

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“…In the diagnosis of HA, the determination of free and total testosterone levels is relatively low, the most informative indicators, according to the recommendations of the European Society of Endocrinology (ESE), are the index of free testosterone and androstenedione. It is the increase in androstenedione and free testosterone index found in over 60% of women with acne and PCOS [13,14]. It is important to remember that the study of androgen levels is an auxiliary method for diagnosis and in no case should be used as the main criterion or substitute for clinical diagnosis of PCOS [7].…”

Section: современные подходы к диагностике и лечению синдрома поликис...mentioning

confidence: 99%

Modern approaches to the diagnosis and treatment of polycystic ovary syndrome in adolescence

Serhiienko

Syusyuka

Makurina

et al. 2022

RHW

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Тhe diagnosis of polycystic ovary syndrome (PCOS) in adolescence still raises many questions. The problem is that the characteristics of normal puberty often coincide with the symptoms of PCOS. The article presents the criteria of a normal menstrual cycle, clinical and laboratory hyperandrogenism. In the diagnosis of the latter, the most informative indicators are the determination of the index of free testosterone and androstenedione, and the assessment of free and total testosterone are relatively low sensitivity. Clinical hyperandrogenism in adolescents includes only severe acne and hirsutism. The level of antimullerian hormone has no independent significance. Irregular menstrual cycles during the first year after menarche represent a normal period of puberty. At the second and third year after menarche , menstrual cycles of less than 21 days and more than 45 days are considered irregular, and from the fourth year – less than 21 days and more than 35 days. From the second year after menarche, menstrual irregularities are considered to be more than 90 days for any cycle. Primary amenorrhea is indicated by the absence of menarche at 15 years, or 3 years after telarche. Ultrasound is not used as a criterion for PCOS in the first 8 years after menarche due to the high frequency of ovarian multifollicularity in adolescence. Therefore, adolescent girls in the presence of menstrual disorders and hyperandrogenism may be diagnosed with «PCOS. Phenotype B» (ultrasound signs are not taken into account). Adolescents who have signs of PCOS but do not meet the diagnostic criteria are at risk for PCOS. The most important stage of PCOS therapy is lifestyle modification, normalization of body weight and metabolic processes. Combined oral contraceptives in adolescents are more often prescribed not for direct purposes (contraception), but as off-label therapy not only at diagnosis, but also in the «risk group», which involves the treatment of irregular menstrual cycles and / or clinical hyperandrogenism. In the absence of the effect of lifestyle changes, proper nutrition to correct metabolic disorders in addition to combined oral contraceptives may be prescribed metformin, inositol and etc.

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Characteristics of phenotypes (clinical variants) of polycystic ovary syndrome in women of reproductive age

Cited by 4 publications

References 11 publications

Current perspectives on the metabolic aspects of polycystic ovary syndrome

Current perspectives on the metabolic aspects of polycystic ovary syndrome

A multidisciplinary approach in the management of patients with acne

Modern approaches to the diagnosis and treatment of polycystic ovary syndrome in adolescence

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