Τροποποίηση του άξονα υποθάλαμος-υπόφυση-ωοθήκες στο σύνδρομο των πολυκυστικών ωοθηκών: επίδραση στις ορμονικές και μεταβολικές παραμέτρους
Creators: name: Σαρρής, Ιωάννης Δ.
Publisher: name: Aristotle University of Thessaloniki
Year: 2006
Subjects: Αντισυλληπτικά δισκία
Οξική κυπροτερόνη/φυσικά οιστρογόνα
Μετφορμίνη
Λιπίδια
Ανδρογόνα
Oral contraceptives
Cyproterone acetate/native estrugens
Metformin
Lipids
Androgens

description: Σκοπός: η μελέτη της επίδρασης διαφόρων συνδυασμών οιστρογόνων-προγεσταγόνων και της μετφορμίνης στα λιπίδια και τα ανδρογόνα σε γυναίκες με σύνδρομο πολυκυστικών ωοθηκών(PCOS). Υλικό-Μέθοδος : 130 γυναίκες με PCOS και 48 μάρτυρες. Στις Γυναίκες με PCOS χορηγήθηεκ αγωγή για ένα έτος 1)αντισυλληπτικά δισκία(Gynofen-35 ή Laurina) 2)αντισυλληπτικό μαζί με μεγάλη δόση οξικής κυπροτερόνης (Gynofen-35 ή Andrucurso) 3)φυσικά οιστρογόνα μαζί με μεγάλη δόση οξικής κυπροτερόνης και 4)μεταφορμίνη. Προσδιορίστηκαν λιπίδια και ανδρογόνα πριν και κατά τη διάρκεια της αγωγής. Αποτελέσματα : οι γυναίκες με PCOS είχαν σημαντικά υψηλότερα βασικά ολικής, LDL-αλλά και HDL-χοληστερόλης από τις μάρτυρες. Η αγωγή με αντισυλληπτικά δισκία προκάλεσε σημαντική αύξηση των τριγλυκεριδίων, μείωση της HDL-χοληστερόλης. Τουλάχιστον παροδική και παροδική αύξηση της LDL-χοληστερόλης. Η αγωγή με φυσικά οιστρογόνα και οξική κυπροτερόνη προκάλεσε σημαντική μείωση της HDL-χοληστερόλης. Η μετφορμίνη δε μετέβαλε τις λιπιδαιμικές παραμέτρους. Ολα τα σχήματα πλην της μετφορμίνης, μείωσαν σημαντικά τα ανδρογόνα. ολα τα σχήματα αύξησαν σημαντικά την SHBG και μείωσαν το δείκτη ελεύθερων ανδρογόνων(FAI)
description: INTRODUCTION: In addition to increased androgen production and disturbances of ovulation, PCOS is characterized by impaired metabolic profile, which comes from insulin resistance, at least partially. It is possible that metabolic disturbances increase cardiovascular risk for women with PCOS. Both estrogen – progestin combinations, which suppress hypothalamic- pituitary-ovarian axis, and metformin, which reduces hyperinsulinemia, are used to treat the skin disorders of the syndrome and restore a normal menstrual cycle. OBJECTIVE: To compare the effects of various estrogen – progestin combinations and metformin on lipid profile and androgen levels, in women with PCOS. PATIENTS AND METHODS: 130 women with PCOS (age 21,53±4,04 years, BMI 24,71±5,45 kg/m2) and 48 controls (age 28,63±5,81 years, BMI 24,29±5,17 kg/m2) were studied. Baseline hormone and lipid parameters were measured for all women. Afterwards, women with PCOS received treatment for one year: 22 women received the oral contraceprive Gynofen 35 (35 Μg ethinyl estradiol-EE with 2 mg cyproterone acetate- CPA). 19 women received the oral contraceprive Laurina (30-35 Μg EE with 50-150 Μg desogestrel). 26 women received the oral contraceprive Gynofen 35 plus a high dose of CPA(50 mg 10 days per cycle). 23 women received 2mg 17‚-estradiol with a high dose of CPA (50mg 10 days per cycle). 29 women received 1,25mg conjugated estrogens with a high dose of CPA (50 mg 10 days per cycle). 11 women received metformin (850 mg bid). Total cholesterol, HDL-cholesterol, triglycerides, Lp(•), apoA1, apoB, testosterone, ¶4-androstendione, DHEA-S, SHBG were measured and LDL-cholesterol and free androgen index (FAI) were calculated after three, six and twelve months of treatment. RESULTS: Baseline total and LDL chlolesterol levels had a significant positive correlation with androgen levels. Baseline HDL-cholesterol was significantly and negatively correlated with body mass index (BMI) and waist to hip ratio (WHR). Baseline triglyceride levels had a significant positive correlation with BMI and insulin levels. Women with PCOS had significantly higher total, LDL-cholesterol, but also significantly higher HDLcholesterol than controls. Treatment with oral contraceptives, with or without the addition of high dose of CPA, caused a significant increase of triglycerides, reduction of HDL-cholesterol, at least temporally, and a temporal increase of LDL-cholesterol. Treatment with high dose of CPA and native estrogens (2 mg 17‚-estradiol or 1,25 mg conjugated estrogens) decreased HDL-cholesterol significantly. Women who received oral contraceptives had significantly higher triglycerides and HDL-cholesterol than women who received native estrogens. Women who received an oral contraceptive combined with a high dose of CPA, had significantly lower HDLcholesterol than women who received only an oral contraceptive. Treatment with metformin did not change lipid parameters. All treatments, except for metformin, reduced androgen levels. All treatments increased SHBG and reduced FAI significantly. Women on oral contraceptives had significantly lower FAI than other groups. CONCLUSIONS: Treatment of PCOS women with progestins that have low androgenicity or antiandrogen action, causes a significant decrease of HDL-cholesterol, while oral contraceptives increase triglycerides significantly. Although metformin is less effective than oral contraceptives in free androgen reduction, it does not have any adverse effects on lipid profile