Karakas Sidika E
Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The University of California at Davis, Davis, CA, United States; Department of Veterans Affairs Northern California Health Care System, Mather, CA, United States.
Clin Chim Acta. 2017 Aug;471:248-253. doi: 10.1016/j.cca.2017.06.009. Epub 2017 Jun 15.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting young women. Even though the definition of PCOS has changed over the years, all diagnostic criteria include two or more of the following: oligomenorrhea/oligoovulation/anovulation, androgen excess and polycystic ovaries (PCO). Traditional method of assessing the ovarian morphology has been transvaginal pelvic ultrasound. Recent studies support that serum anti-Mullerian hormone (AMH) levels correlate with the number of ovarian follicles and cysts. Hence, measurement of AMH is adequate to make the diagnosis. Traditionally, hyperandrogenemia has been assessed by measuring total-testosterone. The literature stresses the importance of sex hormone binding globulin (SHBG) measurements and bioavailable-testosterone and free-testosterone calculations, because insulin resistance decreases SHBG, lowers total-testosterone, and leads to under-estimation of bioavailable- and free-testosterone. Since 50-60% of PCOS patients have metabolic syndrome, assessment of metabolic risk is also necessary. It is important to diagnose insulin resistance before development of glucose intolerance and diabetes. This requires measurements of not only plasma glucose but also insulin concentrations. Determination of HgBA1 can be informative as well. This review aims to present an accurate and cost-effective approach to diagnosis and management of PCOS.
多囊卵巢综合征（PCOS）是影响年轻女性的最常见内分泌疾病。尽管多年来PCOS的定义有所变化，但所有诊断标准都包括以下两项或更多项：月经过少/排卵稀少/无排卵、雄激素过多和多囊卵巢（PCO）。评估卵巢形态的传统方法是经阴道盆腔超声检查。最近的研究表明，血清抗苗勒管激素（AMH）水平与卵巢卵泡和囊肿数量相关。因此，测量AMH足以做出诊断。传统上，高雄激素血症通过测量总睾酮来评估。文献强调了性激素结合球蛋白（SHBG）测量以及生物可利用睾酮和游离睾酮计算的重要性，因为胰岛素抵抗会降低SHBG，降低总睾酮水平，并导致生物可利用睾酮和游离睾酮的低估。由于50%-60%的PCOS患者患有代谢综合征，因此评估代谢风险也很有必要。在出现葡萄糖不耐受和糖尿病之前诊断胰岛素抵抗很重要。这不仅需要测量血浆葡萄糖，还需要测量胰岛素浓度。测定糖化血红蛋白（HbA1c）也可能提供有用信息。本综述旨在提出一种准确且经济有效的PCOS诊断和管理方法。
