Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Fertil Steril. 2010 Jul;94(2):684-9. doi: 10.1016/j.fertnstert.2009.06.025. Epub 2009 Sep 1.
To test the hypothesis that women with polycystic ovary syndrome (PCOS) are distinguishable from those with 21-hydroxylase-deficient nonclassic adrenal hyperplasia on the basis of having polycystic ovaries and metabolic dysfunction.
Prospective observational.
Tertiary care center.
PATIENT(S): Fifty-two lean and 54 obese women with PCOS according to the 1990 National Institutes of Health criteria, 23 women with nonclassic adrenal hyperplasia, and 27 controls.
INTERVENTION(S): History and physical examination, blood sampling, ovarian sonography, oral glucose tolerance, and acute adrenocorticotropin stimulation testing.
MAIN OUTCOME MEASURE(S): The frequency of clinical, biochemical, and metabolic features.
RESULT(S): Women with PCOS had a higher frequency of oligomenorrhea or amenorrhea than those with nonclassic adrenal hyperplasia. Mean androstenedione and DHEAS levels were highest in nonclassic adrenal hyperplasia. The degree of metabolic dysfunction was greatest in obese women with PCOS; women with nonclassic adrenal hyperplasia and lean women with PCOS did not differ in degree of metabolic dysfunction. Women with nonclassic adrenal hyperplasia had a lower prevalence of polycystic ovaries than those with PCOS. The proportion of patients with an LH/FSH ratio >2 was greater in women with PCOS, compared with those with nonclassic adrenal hyperplasia. Basal 17-hydroxyprogesterone levels >2 ng/mL were found in 87%, 25%, 20%, and 7% of women with nonclassic adrenal hyperplasia, lean women with PCOS, obese women with PCOS, and controls, respectively.
CONCLUSION(S): Nonclassic adrenal hyperplasia should be excluded in all women presenting with hirsutism, with use of a basal follicular phase 17-hydroxyprogesterone level, regardless of the presence of polycystic ovaries or metabolic dysfunction; however, women with nonclassic adrenal hyperplasia have a higher prevalence of normal ovulation and lower likelihood of having an LH/FSH ratio >2 or polycystic ovaries.
检验下述假说，即患有多囊卵巢综合征（PCOS）的女性与患有 21-羟化酶缺乏型非经典肾上腺增生的女性之间存在可区分的特征，这种特征基于多毛症和代谢功能障碍。
前瞻性观察性研究。
三级医疗中心。
根据 1990 年美国国立卫生研究院标准诊断的 52 例瘦型 PCOS 患者、54 例肥胖型 PCOS 患者、23 例非经典肾上腺增生患者和 27 例对照。
病史和体格检查、血样采集、卵巢超声检查、口服葡萄糖耐量试验和急性促肾上腺皮质激素刺激试验。
临床、生化和代谢特征的发生频率。
与非经典肾上腺增生患者相比，PCOS 患者中月经稀发或闭经更为常见。非经典肾上腺增生患者的平均雄烯二酮和 DHEAS 水平最高。肥胖型 PCOS 患者的代谢功能障碍程度最严重；而非经典肾上腺增生患者和瘦型 PCOS 患者的代谢功能障碍程度无差异。非经典肾上腺增生患者的多囊卵巢发生率低于 PCOS 患者。PCOS 患者的 LH/FSH 比值>2 的比例大于非经典肾上腺增生患者。非经典肾上腺增生患者中，基础卵泡期 17-羟孕酮水平>2ng/ml 的患者比例分别为 87%、25%、20%和 7%，而瘦型 PCOS 患者、肥胖型 PCOS 患者和对照患者的比例分别为 25%、20%、7%和 0%。
所有多毛症患者，无论是否存在多囊卵巢或代谢功能障碍，均应排除非经典肾上腺增生，方法是测定基础卵泡期 17-羟孕酮水平；然而，非经典肾上腺增生患者更常出现正常排卵，且 LH/FSH 比值>2 或多囊卵巢的可能性更小。
