Polikistik over sendromunda metforminin klinik, metabolik ve endokrin etkileri
Date
2002
Authors
Atakan, Türkan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Polikistik over sendromu (PCOS) hiperandrojenizm ve anovulasyonla karakterize heterojen bir klinik durumdur. Etiyolojisi halen bilinmemekle birlikte insulin direnci, kompanzatuar hiperinsulinemi ve hiperandrojenizm arasındaki ilişki sendromun patogenezine yeni bir bakış kazandırmıştır, insulin direncinin hiperandrojenizmden sorumlu olduğu düşünülmektedir. PCOS'da hiperandrojenizm ile hiperinsulinemi arasındaki teorik bağ sendromun tedavisinde metformin gibi insulin duyarlaştırıcı ilaçların kullanımının temelini oluşturur. Çalışmamızda PCOS'lu hastalarda metforminin klinik, endokrin ve metabolik etkilerini araştırdık. Çalışmaya 32 hasta alındı. 2 hasta şiddetli yan etkiler nedeniyle, 4 hasta kendi isteğiyle çalışmadan ayrıldı. 1 hasta gebe kaldı. Çalışmayı tamamlayan 25 hasta 1700 mg/gün dozunda metformin 6 ay boyunca aldı. Tedavi öncesi, 3.ay ve 6.ay sonrası hastaların menstrual hikayeleri, endokrin ve metabolik profilleri belirlendi. Sonuçta; metformin tedavisi boyunca %76 hastanın menstrual bozukluklarında ve Ferriman Gallwey skorunda çarpıcı düzelme oldu. Serum insulin düzeyinde belirgin azalma (açlık insulin p< 0.001) saptandı. Beraberinde serum total testesteronunda belirgin düşme izlendi (p< 0.05). Bu değişiklikler başlangıç açlık glukoz/insulin oranı >4.5 olan hasta grubunda da benzerdi. Sonuç olarak insulin duyarlaştırıcı ilaç olan metformin PCOS'nda klinik, metabolik ve endokrin bozukluklarını düzeltmede insulin direncinden bağımsız olarak kullanılabilir.
Polycystic ovary syndrome (PCOS) is a heterogeneous clinical pathology, which is characterized by hyperandrogenism and anovulation. Although the etiology is not known; the relationship between insulin resistance, compensatory hyperinsulinism and hyperandrogenism creates a new view for the pathogenesis of the syndrome. Insulin resistance is thought to be responsible for hyperandrogenism. In PCOS, theoretic relationship between hyperandrogenism and hyperinsulinism; makes up the basis for the use of insulin-sensitizing drugs, such as metformin, in the treatment of PCOS. In our study, we studied the clinical, endocrinologic and metabolic effects of metformin on patients with PCOS. 32 PCOS patients were included in the study. 6 patients were excluded from the study; 2 of which had severe adverse effects and 4 of which wanted to be excluded from the study. One patient became pregnant. 25 patients who completed the study had metformin at a dose of 1700 mg/day for six months. Patients menstrual history and endocrinologic and metabolic profiles were determined before the therapy, during the third month of therapy and at the sixth month, the end of treatment. As a result of metformin therapy, in % 76 of patients there has been a striking impovement in menstrual disorders and Ferriman Gallwey score. A striking decrease was determined in serum insulin level (fasting insulin, p<0.001 ). Besides these, a prominent decrease was detected in serum total testesterone level (p<0. 001 ). These changes were similar in the group, for which initial fasting glucose/insulin proportion were above 4.5. In conclusion metformin-which is an insulin-sensitizing drug can be used effectively patients with PCOS without any limitation regarding to insulin resistance.
Polycystic ovary syndrome (PCOS) is a heterogeneous clinical pathology, which is characterized by hyperandrogenism and anovulation. Although the etiology is not known; the relationship between insulin resistance, compensatory hyperinsulinism and hyperandrogenism creates a new view for the pathogenesis of the syndrome. Insulin resistance is thought to be responsible for hyperandrogenism. In PCOS, theoretic relationship between hyperandrogenism and hyperinsulinism; makes up the basis for the use of insulin-sensitizing drugs, such as metformin, in the treatment of PCOS. In our study, we studied the clinical, endocrinologic and metabolic effects of metformin on patients with PCOS. 32 PCOS patients were included in the study. 6 patients were excluded from the study; 2 of which had severe adverse effects and 4 of which wanted to be excluded from the study. One patient became pregnant. 25 patients who completed the study had metformin at a dose of 1700 mg/day for six months. Patients menstrual history and endocrinologic and metabolic profiles were determined before the therapy, during the third month of therapy and at the sixth month, the end of treatment. As a result of metformin therapy, in % 76 of patients there has been a striking impovement in menstrual disorders and Ferriman Gallwey score. A striking decrease was determined in serum insulin level (fasting insulin, p<0.001 ). Besides these, a prominent decrease was detected in serum total testesterone level (p<0. 001 ). These changes were similar in the group, for which initial fasting glucose/insulin proportion were above 4.5. In conclusion metformin-which is an insulin-sensitizing drug can be used effectively patients with PCOS without any limitation regarding to insulin resistance.
Description
Keywords
Polikistik over sendromu, Metformin, İnsulin direnci, Polycystic ovary syndrome, Insulin resistance
Citation
Atakan, T. (2002). Polikistik over sendromunda metforminin klinik, metabolik ve endokrin etkileri. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.