Ibáñez Lourdes, de Zegher Francis
Endocrinology, Pediatric Research Institute Sant Joan de Déu, Barcelona, Spain.
Network Biomedical Research Center of Diabetes and Associated Metabolic Disorders (CIBERDEM), Health Institute Carlos III, Madrid, Spain.
Pediatr Obes. 2020 Feb;15(2):e12586. doi: 10.1111/ijpo.12586. Epub 2019 Oct 30.
PCOS is already a prevalent endocrinopathy in adolescent girls, and its prevalence is rising further since, in essence, it is the result of a mismatch between an energy-sparing (epi)genetic background and a (relatively) obesogenic environment. This mismatch results in an excess of fat storage in ectopic depots, notably in the liver and viscera (= hepato-visceral, or central fat). There is still no FDA-approved treatment for adolescent PCOS. The prime aim should be a preferential loss of central fat, through lifestyle measures. Failure to sustain these measures is frequent, and the standard approach is to add an estroprogestagen contraceptive, even for girls who do not need contraception. Treatment with SPIOMET, a low-dose combination of spironolactone (to antagonize androgen and mineralocorticoid effects, and to activate BAT thereby raising energy expenditure), pioglitazone (to raise circulating HMW adiponectin concentrations) and metformin, is an alternative approach that holds the potential to revert the PCOS phenotype.
多囊卵巢综合征（PCOS）在青春期女孩中已是一种常见的内分泌疾病，而且其患病率还在进一步上升，因为从本质上讲，它是一种节能型（表观）遗传背景与（相对）致肥胖环境不匹配的结果。这种不匹配导致异位脂肪堆积过多，尤其是在肝脏和内脏（即肝内脏脂肪，或中心性脂肪）。目前仍没有美国食品药品监督管理局（FDA）批准的针对青少年PCOS的治疗方法。首要目标应该是通过生活方式干预措施优先减少中心性脂肪。经常无法持续这些措施，标准方法是添加一种雌孕激素复方避孕药，即使对于不需要避孕的女孩也是如此。使用SPIOMET进行治疗是一种替代方法，它是一种低剂量的螺内酯（拮抗雄激素和盐皮质激素作用，并激活棕色脂肪组织从而增加能量消耗）、吡格列酮（提高循环中高分子量脂联素浓度）和二甲双胍的组合，有可能逆转PCOS表型。
