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Neuro endocrine syndromes in gynecology

  1. 1. Neuro-endocrine syndromes in gynecology<br />Lecture by AndriyBerbets<br />
  2. 2. Polycystic ovarian syndrome <br /> PCOS is also known as Stein-Levental syndrome<br /> Frequency: <br />Approximately 1% of female population suffers from PCOS<br />30% among patients of gynecological endocrinologist<br />75% of infertility with endocrine genesis<br />
  3. 3. Polycystic ovarian syndrome<br /> Structural changes of the ovaries:<br />Ovaries are enlarged in size 2-6 times on both sides<br />Hyperplasia of stroma and theca cells<br />Presence of big amount of follicles with cystic changes and atresia<br />
  4. 4. Polycystic ovarian syndrome<br />Structural changes of the ovaries:<br />The average diameter of the follicle is 5-8 mm<br />Follicles form the “necklace” of ovarian<br />Ovarian capsule is thick<br />
  5. 5. Polycystic ovarian syndrome<br /> Normal metabolism of androgens in females<br />Androgens are synthesized in ovaries in follicles<br />Peak of synthesis of androgens in ovaries comes when follicle is 5-8 mm in size<br />Ovarian androgens (testosterone, andrestendion) are converted into estrogens (estradiol, estron)<br />
  6. 6. Polycystic ovarian syndrome<br />The enzyme Cytochrome P450c17 is responsible for conversion of estrogens into androgens<br />The synthesis of this enzyme is regulated by follicle-stimulating hormone (FSH) produced by pituitary<br />
  7. 7. Polycystic ovarian syndrome<br /> Pathogenesis<br />Develops in puberty age<br />Probable reasons are genetic, viral infections, obesity etc<br />Hypothalamic gonadotropine-releasing hormone (GRH) is increased<br />Consequently, level of luteinizing hormone (LH) increases, FSH decreases<br />
  8. 8. Polycystic ovarian syndrome<br />High level of LH provokes cystic atresia of follicles<br />Low level of FSH causes deficiency of enzyme P450c17<br />Androgens are not converted to estrogens enough -> hyperandrogenia and lack of ovarian estrogens<br />
  9. 9. Polycystic ovarian syndrome<br />
  10. 10. Polycystic ovarian syndrome<br />Patients with PCOS have more or less manifesting resistance to insulin (defect of insulin receptors)<br />Blood level of glucose increases<br />Obesity appears<br />Compensatory, levels of insulin and insulin-like growth factor-1 are increased<br />That substances cause high synthesis of androgens and estrogens by fat tissue<br />Process does not depend from pituitary<br />
  11. 11. Polycystic ovarian syndrome<br />
  12. 12. Polycystic ovarian syndrome<br />Clinical flow<br />The average age of menarche is normal but<br />Menstrual abnormalities (oligo- and amenorrhea) since the menarche<br />No ovulation<br />Primary infertility<br />Hyperplasia of endometrius (no phases of cycle, “fat estrogens” are present)<br />
  13. 13. Polycystic ovarian syndrome<br />“Female type” of obesity (circumference of waist/ circumference of hips <0.85)<br />Breasts are developed enough but 30% of patients have mastopathia<br />Hirsutism<br />Changes of glucose profile<br />
  14. 14. Polycystic ovarian syndrome<br />
  15. 15. Polycystic ovarian syndrome<br />
  16. 16. Polycystic ovarian syndrome<br /> Diagnostics:<br />Infertility (primary)<br />Obesity + hirsutism<br />Oligo- and amenorrhea<br />High level of glucose<br />Monophasal basal temperature, no ovulation<br />Ovaries are enlarged on BOTH sided<br />LH is increased, LH/FSH >2,5<br />
  17. 17. Polycystic ovarian syndrome<br />Ultrasound examination: Normal ovary<br />
  18. 18. Polycystic ovarian syndrome<br />Polycystic ovary<br />
  19. 19. Polycystic ovarian syndrome<br /> Treatment<br />Weight lose (at least 5%)<br />Ovulation stimulation: clomiphen<br /><ul><li> blocks hypothalamus estrogen receptors
  20. 20. GnRH level raises -> FSH level raises
  21. 21. Since 5th to 10th days of menstrual cycle 50 mg/day</li></ul>Gestagens (duphaston) 15th 25th days of cycle<br />
  22. 22. Polycystic ovarian syndrome<br />In case no pregnancy planned – oral hormonal contraceptive pills (OHCP)<br />Anti-androgenic treatment: dexamethasone 0.5 mg/day or prednisolone 5 mg /day <br /><ul><li>ACTG level decreases (negative feedback)
  23. 23. Androgens from suprarenal glands are lowering</li></li></ul><li>Polycystic ovarian syndrome<br />Hirsutism treatment: OHCP (Diane-35 which contains androcur)<br /><ul><li>Androcur blocks tissue receptors for androgens</li></ul>Hirsutism treatment: spironolactone (verospiron)<br />Surgical treatment: ovarian resection (usually laparoscopic)<br />
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