sindroma ovarium polikistik - ninds
TRANSCRIPT
ASSOCIATIONS OF BIRTHWEIGHT AND GESTATIONAL AGE WITH REPRODUCTIVE AND METABOLIC
PHENOTYPES IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME AND THEIR FIRST-DEGREE RELATIVES
Oleh :
Nindya Meetasari
Mega Maharani
Ovy
Background
metabolic abnormalities including,
insulin resistance dyslipidemiaincreased risk for type 2 diabetes.
PCOS
Obesity
Barker hypothesis
maternal nutritional constraints during pregnancy
adaptive responses in the fetus
preferentially shunt nutritional resources to key organ systems
limit growth
Decreased birthweight
relative thinness at birth
increasing
the metabolic syndrome
cardiovascular disease
risk for developing obesity
type 2 diabetes
Purpose
examine the relationship between birthweight and gestational age and its association with reproductive and metabolic phenotypes in women with PCOS and their first-degree relatives.
Subjects
Criteria for PCOS (NIH)
no more than six menses per year
either total testosterone (T) greater than 58 ng/dl or non-SHBG-bound T (uT) greater than 15
ng/dl
Other causes of anovulation and
hyperandrogenemia were excluded by appropriate tests
Criteria for control (male-female)
no major medical or psychiatric illnesses
no personal history
of hypertension
and no personal or first-degree
family history of diabetes
normal glucose
tolerance according to
the WorldHealth
Organization criteria and
additionally for female controls
regular 27- to 35-d menstrual
cycles throughout
their reproductive
life
no clinical or biochemical evidence of
hyperandrogenism
Study procedures
All subjects
completed a questionnaire capturing their medical and reproductive
history including
birthweight and gestational age
morning blood samples
obtained after an overnight
fast
Height and weight in the
subjects studied off-site
were self-reported
waist circumference
was self-measured
Hirsutism grading using the modified
Ferriman Gallwey
assessment
Additional phenotyping
at least one ovary having a volume greater than 10 cm3 with no cysts or
follicles more than 10mm in mean diameter
transvaginal ultrasound
Polycystic ovaries
Assays
Plasma glucose, insulin, FSH, T, uT, dehydroepiandrosterone
sulfate (DHEAS), SHBG, total cholesterol, high-density lipoprotein
(HDL), lowdensity lipoprotein (LDL), and triglyceride
Non-SHBG T was obtained from serum total T and non-SHBG fraction by ammonium sulfate precipitation,
Data analysisSpearman correlation coefficient strength of the relationship between self-reported birthweight and the medical record birthweight in PCOS families
self-reported birthweight
low birthweight (<2500 g)
normal birthweight
(2500–4000 g)
high birthweight(>4000 g)
Analysis of covariance (ANCOVA) assess the relationship of birthweight with the continuous outcomes, such as metabolic parameters, adjusting for current subject age.
A generalized logits model the effect of birthweight on the reproductive phenotypes in sisters of probands, adjusting for current subject age
classified Sisters of probands
PCOS based on elevated T levels
and irregular menses
hyperandrogenic based on
elevated T levels and regular
menstrual cycles
unaffected based on normal T and DHEAS levels
and normal menses
unknown based on inability to
measure T levels due to
confounding medications, pregnancy,
menopause, hysterectomy, etc
Result
Birthweight validation Self-reported and actual birthweight
(Spearman correlation coefficient =0.81
95% CI, 0.66, 0.89;
P =0.001)
were highly correlated.
Association of birthweight with reproductivephenotypes in PCOS families
Women with PCOS
•no association of birthweight with reproductive parameters of the PCOS phenotype •P =0,42
Female relatives
•no significant associations
Male relatives
•no significant associations between birthweight and any phenotype
Association of birthweight with metabolic parameters in PCOS families
PCOS probands
•No significant metabolic changes in relation to birthweight
Female and male relatives
•no significant associations noted in either female or male relatives
Discussion
A study from England found associations of PCOS stigmata with length of gestation and birthweight.
the association high birthweight with hirsute women with polycystic ovaries who had higher than normal ovarian secretion of androgens
Another group in Spain has studied adolescent girls, primarily with premature pubarche, and has consistently found that low birthweight is associated with more severe reproductive and metabolic abnormalities.
Furthermore, these investigators have shown an inverse association between birthweight and ovarian volume
A large Finnish birth cohort study had findings consistent with this study, no relationship between birthweight andPCOSsymptoms.
We noted no other associations between birthweight and reproductive abnormalities in women with PCOS.
limitations sample size: although large for the PCOS
literature, is relatively small from an epidemiological standpoint, and, therefore,
may lack the power to detect the more consistent associations between low birthweight and adverse cardiovascular risk.
Birthweight is just one biometric marker of the intrauterine milieu
birthweight and gestational age were self-reported.
conclusion birthweight, even corrected for gestational age, has
little substantive association with reproductive and metabolic abnormalities in women with PCOS and their relatives.
However, there are other intrauterine factors, for instance exposure to elevated androgen levels, that could contribute to a PCOS phenotype and not affect birthweight.
Finally, accelerated and excessive growth after birth has been found to be an additional risk factor for adult disease as well as PCOS stigmata.
Tinjauan pustaka
Introduction
Prevalence of PCOS
AS & Europe 5-10% terjadi pada
wanita usia reproduksi
Penderita PCOS mempunyai resiko 7 kali lebih besar
terkena infark miokardium
50% wanita dengan PCOS adalah obesitas
Definition
PCOS
A set of symptomps:
chronic anovulation, hyperandrogenism, and polycystic ovaries
associated with endocrine and metabolic disorders
without a primary disease in the pituitary or adrenal glands that underlies
Ovarium terdiri dari :epitel, sel germinal, sel stroma & mesenkimal
ANATOMI OVARIUM
Ovulasi Pembentukan hormon sex steroid (estrogen-
progesteron-androgen)
FISIOLOGI OVARIUM
Patofisiologi
single defect in insulin action and secretion,
primary neuroendocrine defect, defects in androgen synthesis changes in the metabolism of cortisol
Diagnosis
clinical signs Hiperandrogenia jerawat, tumbuhnya rambut pada wajah,
leher serta abdomen. Perubahan tubuh menjadi tipe android dengan rasio waist to hip lebih dari 1.
Oligo ovulasi kurang dari delapan kali menstruasi per
tahun, dan menstruasinya seringkali terlewati selama beberapa bulan sekaligus, atau secara mudahnya mengalami amenore.
Obesity Lebih dari 65% wanita dengan SOPK
memiliki body mass index lebih dari 27. Distribusi lemak lebih banyak pada abdominal/visceral, yang berhubungan dengan kelainan metabolik seperti hipertensi, dislipidemia, resistensi insulin dan glukosa intolerans.
Sebagian besar berat badan normal sampai usia menarke dan kemudian mulai naik secara tajam pada usia 20 an.
laboratory signs
hormonal examination dehidroepiandrosteron sulfat (DHEAS) testoteron sex hormone binding protein. Glucose and insulin kolesterol total, LDL, HDL dan trigliserid
ultrasonografi
NIH
Diferential diagnosis
Adrenal lession: congenital adrenal hyperplasia, cushing’s syndrome, androgen secreting neoplasms
other pituitary or adrenal disorders hyperprolactinemia
MANAGEMENT• Lifestyle Modification• Diet• Exercise• bariatric surgery• Pil kontrasepsi oral kombinasi• Androgen receptor antagonist• 5-α Reduktase inhibitor• Clomiphene citrate• Insulin Sensitizing Agent• Gonadothropin dan GnRH analog• Combination of GnRH analogue and gonadotrophins• Laparoscopic ovarian surgery
Prognosis
Women who have this condition can get pregnant with the right surgical or medical treatments.
Pregnancies are usually normal.
complication
Increased risk of endometrial cancer Infertility (early treatment of polycystic
ovary disease can help prevent infertility or increase the chance of having a healthy pregnancy)
Obesity-related (BMI over 30 and waist circumferance greater than 35) conditions, such as high blood pressure, heart problems, and diabetes
Possible increased risk of breast cancer
TERIMAKASIH