Leondires M P, Berga S L
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, USA.
J Endocrinol Invest. 1998 Jul-Aug;21(7):476-85. doi: 10.1007/BF03347331.
Polycystic ovary syndrome may result from multiple mechanisms, but full expression of the PCO syndrome with hyperandrogenic anovulation depends upon sustained LH drive and relative FSH deficiency. We have described possible intrinsic and extrinsic factors capable of modifying the hypothalamic-pituitary-ovarian axis. Available evidence suggests the presence of an intrinsic alteration in GnRH-LH drive. The long-term natural history of HAA is variable and depends on several factors including obesity, aberrations in insulin action, intrinsic ovarian function, and end-organ responsiveness to androgens. Figure 1 presents a conceptualization of the pathogenesis of PCOS diagramming the multiple modulators of its expression. Long-term suppression of androgens when fertility is not desired should modify the full expression of the PCO syndrome. It is important to appreciate that therapy with oral contraceptive agents has few drawbacks and many immediate and potential long-term benefits for women with HAA. This therapy may be of greatest benefit when started in adolescence prior to the progression of obesity, hirsutism, and thecal-stromal hyperplasia. Women with HAA represent a large subgroup of patients who require individualization of their health care with sensitivity to issues surrounding anovulation, obesity, hirsutism, and infertility.
多囊卵巢综合征可能由多种机制引起，但伴有高雄激素性无排卵的多囊卵巢综合征的完全表现取决于持续的促黄体生成素（LH）驱动和相对的促卵泡生成素（FSH）缺乏。我们已经描述了可能影响下丘脑-垂体-卵巢轴的内在和外在因素。现有证据表明促性腺激素释放激素（GnRH）-LH驱动存在内在改变。高雄激素性无排卵（HAA）的长期自然病程是可变的，并且取决于几个因素，包括肥胖、胰岛素作用异常、卵巢内在功能以及终末器官对雄激素的反应性。图1展示了多囊卵巢综合征（PCOS）发病机制的概念图，描绘了其表达的多种调节因素。当不期望生育时，长期抑制雄激素应能改变多囊卵巢综合征的完全表现。重要的是要认识到，口服避孕药治疗对高雄激素性无排卵的女性几乎没有缺点，而且有许多直接和潜在的长期益处。这种治疗在青春期肥胖、多毛症和卵泡膜-间质增生进展之前开始可能益处最大。高雄激素性无排卵的女性代表了一大类患者群体，她们需要针对无排卵、肥胖、多毛症和不孕等问题进行个体化的医疗保健。
