14 research outputs found
Hipogonadyzm hipogonadotropowy u kobiet
This article presents the role of the hypothalamus in reproduction, the definition of hypogonadotropic hypogonadism (HH), and the causes
of acquired and syndromic HH and idiopathic HH (IHH). The authors present a short review of major causes of acquired HH, but most
of the causes of IHH will not be discussed because they do not fall within the scope of the article. More attention is devoted to idiopathic
HH, especially the genetic basis of IHH. Also presented in the article are clinical criteria of CHARGE syndrome. Later, the article discusses
the clinical presentation, establishing the diagnosis, and management of IHH. The article ends with a brief overview of nutritional hypothalamic
dysfunction and athletic amenorrhea. (Pol J Endocrinol 2011; 62 (6): 560–567)Artyku艂 przedstawia rol臋 podwzg贸rza w reprodukcji, definicj臋 hipogonadyzmu hipogonadotropowego (HH), przyczyny nabytego
i systemowego HH oraz idiopatycznego HH. Autorzy prezentuj膮 kr贸tki przegl膮d najwa偶niejszych przyczyn nabytego HH, ale wi臋kszo艣膰
nie zosta艂a om贸wiona, poniewa偶 nie wchodz膮 w zakres tego artyku艂u. Wi臋cej uwagi po艣wi臋cono idiopatycznemu HH, szczeg贸lnie jego
genetycznym podstawom. Przedstawiono kliniczne kryteria zespo艂u CHARGE. Om贸wiono r贸wnie偶 kliniczne objawy, ustalanie rozpoznania
oraz post臋powanie w IHH. Artyku艂 ko艅czy si臋 kr贸tkim przegl膮dem 偶ywieniowych zaburze艅 podwzg贸rza i braku miesi膮czki
u m艂odocianych stosuj膮cych intensywny trening fizyczny. (Endokrynol Pol 2011; 62 (6): 560–567
Clinical observations and hormone screenings of patients with non-standard hypertrophy of the adrenal cortex
Background: Non-standard hypertrophy of the adrenal cortex is a rare endocrinopathy causing the incidence of hyperandrogenism
among women of procreative age.
The primary objective of this paper is the specification of the clinical picture and modifications of the concentration of pituitary, ovarian
and adrenal hormones in the blood of female patients with the syndrome of non-standard hypertrophy of the adrenal cortex (NPKN).
Material and methods: In the Gynaecological Endocrinology Clinic of the Silesian Medical University in Katowice, Poland, 2,353 female
patients were hospitalised between 1 January 2003 and 30 June 2009 with symptoms of hyperandrogenism. Of these, 55 were selected for
the study. Eventually, 25 female patients with diagnosed NPKN, and 30 randomly selected patients with the polycystic ovarian disease
polycystic ovary syndrome (PCOS) were enrolled in the study.
Results: Of the 2,353 female patients hospitalised in the Gynaecological Endocrinology Clinic with symptoms of hyperandrogenism between
1 January 2003 and 30 June 2009, NPKN was found in 1.2% of them. Patients with NPKN displayed a strong hirsutism, which was
significantly more intense than in the comparative group. Insulin resistance was found more frequently in the group of female patients
with PCOS (67%) compared to the group with NPKN (40%). Polycystic ovarian disease was more frequently observed in the group of
patients with PCOS (93%), compared to the group with NPKN (72%). The average concentration of androstendione in the blood serum
in the group of patients with NPKN amounted to 7.60 ng/ml (SD = 3.57) and was significantly higher than in the group of patients with
PCOS where it was 3.46 ng/ml (SD = 1.53). The average concentration of free testosterone in the blood serum in the group of patients
with NPKN amounted to 7.30 pg/ml (SD = 4.13) and was significantly higher than in the group of patients with PCOS, where it was 2.90
pg/ml (SD =1.43 ). The average concentration of DHEAS in the blood serum in the group of patients with NPKN accounted for 403.23 μg/dl
(SD = 192.59), and in the group with PCOS it was 257.39 μg/dl (SD = 63.67). This concentration was statistically significantly higher in the
group with NPKN than in the group with PCOS. The average concentration of estradiole in the blood serum in the group with NPKN
amounted to 111.98 pg/ml (SD = 113.68), while in the group with PCOS it was 62.39 pg/ml (SD = 31.18). The difference of concentrations
between the groups NPKN and PCOS was statistically significant. We found a positive correlation between the 17-OHP concentration
after 60 minutes of the ACTH test and the severity of hirsutism in the group of patients with NPKN (r = 0.77896). In addition, we found
a correlation between the free testosterone and the 17-OHP concentration after 60 minutes of the ACTH test in the group of patients
with NPKN (r = 0.48149). A positive correlation was also reported between the symptom of hypertrophy of the clitoris and the 17-OHP
concentration after 60 minutes of the ACTH stimulation test in the group of patients with NPKN (r = 0.77221).
In the comparative group of patients with PCOS, there was no correlation between the free testosterone and 17-OHP concentration after
60 minutes of the ACTH test (r = 0.3059). There was also no correlation between the severity of hirsutism and the concentration of 17-OHP
concentration analysed after 60 minutes of the ACTH test. In all female patients from the PCOS group, there was a correct size of clitoris.
Conclusions: Analysing the clinical picture of the examined population of patients with NPKN enabled us to specify symptoms of disease
which were significant for diagnosis, and which helped differentiate NPKN from other endocrinopathies involving hyperandrogenism,
including in particular PCOS. Taking everything into consideration, non-standard hypertrophy of the adrenal cortex is a rare cause of
hyperandrogenism in women of procreative age. Intense hirsutism and features of virilisation presenting as hypertrophy of the clitoris
predominate in the clinical picture of non-standard hypertrophy of the adrenal cortex.
The laboratory confirmation of diagnosis of NPKN constitutes the analysis of the 17-OHP level in blood in the ACTH stimulation test. The
analyses of free testosterone and its unbound fraction, androstendione and estradiole, help differentiate NPKN from polycystic ovarian
disease. (Pol J Endocrinol 2011; 62 (3): 230–237)Wst臋p: Nieklasyczny przerost kory nadnerczy jest rzadk膮 endokrynopati膮 powoduj膮c膮 wyst膮pienie hiperandrogenizmu u kobiet w wieku
rozrodczym. Celem pracy jest ustalenie obrazu klinicznego i zmian st臋偶e艅 hormon贸w przysadkowych, jajnikowych i nadnerczowych we
krwi pacjentek z zespo艂em nieklasycznego przerostu kory nadnerczy (NPKN).
Materia艂 i metody: W Klinice Endokrynologii Ginekologicznej 艢l膮skiego Uniwersytetu Medycznego w Katowicach hospitalizowano 2353
pacjentki z objawami hiperandrogenizmu w okresie od 01.01.2003–01.07.2009 r. Spo艣r贸d nich do bada艅 zakwalifikowano 55 kobiet. Ostatecznie
do bada艅 w艂膮czono 25 pacjentek z rozpoznanym NPKN i 30 wybranych losowo pacjentek z zespo艂em policystycznych jajnik贸w (PCOS). Wyniki: W liczbie 2353 pacjentek hospitalizowanych w Klinice Endokrynologii Ginekologicznej z objawami hiperandrogenizmu w okresie
od 01.01.2003–01.07.2009 r. NPKN wyst膮pi艂 u 1,2% z nich. U pacjentek z NPKN odnotowano silny hirsutyzm, istotnie bardziej nasilony
ni偶 w grupie por贸wnawczej. Insulinooporno艣膰 wyst臋powa艂a cz臋艣ciej w grupie pacjentek z PCOS (67%) w por贸wnaniu z grup膮 z NPKN
(40%). Obraz policystystyczno艣ci jajnik贸w cz臋艣ciej obserwowano w grupie pacjentek z PCOS (93%) w por贸wnaniu z grup膮 z NPKN
(72%). 艢rednie st臋偶enie androstendionu w surowicy krwi w grupie z NPKN wynosi艂o 7,60 ng/ml (SD = 3,57) i by艂o istotnie wy偶sze ni偶
w grupie z PCOS, w kt贸rej wynosi艂o 3,46 ng/ml (SD = 1,53). 艢rednie st臋偶enie testosteronu wolnego w surowicy krwi w grupie z NPKN
wynosi艂o 7,30 pg/ml (SD = 4,13) i by艂o istotnie wy偶sze ni偶 w grupie z PCOS, w kt贸rej to wynosi艂o 2,90 pg/ml (SD = 1,43 ). 艢rednie st臋偶enie
DHEAS w surowicy krwi w grupie z NPKN wynosi艂o 403,23 μg/dl (SD = 192,59), a w grupie z PCOS 257,39 μg/dl (SD = 63,67). St臋偶enie to
by艂o istotnie statystycznie wy偶sze w grupie z NPKN ni偶 PCOS. 艢rednie st臋偶enie estradiolu w surowicy krwi w grupie z NPKN wynosi艂o
111,98 pg/ml (SD = 113,68), a w grupie z PCOS 62,39 pg/ml (SD = 31,18). R贸偶nica st臋偶e艅 pomi臋dzy grupami z NPKN i PCOS by艂a istotna
statystycznie. Stwierdzono dodatni膮 korelacj臋 pomi臋dzy st臋偶eniem 17OHP w 60. minucie trwania testu z ACTH a nasileniem hirsutyzmu
w grupie pacjentek z NPKN (r = 0,77896). Ponadto stwierdzono korelacj臋 pomi臋dzy st臋偶eniami wolnego testosteronu i 17OHP badanego
w 60. minucie trwania testu z ACTH w grupie pacjentek z NPKN (r = 0,48149). Dodatni膮 korelacj臋 wykazano r贸wnie偶 pomi臋dzy objawem
przerostu 艂echtaczki a st臋偶eniem 17OHP w 60. minucie trwania testu stymulacyjnego z ACTH w grupie pacjentek z NPKN (r = 0,77221).
W grupie por贸wnawczej pacjentek z PCOS nie wykazano korelacji pomi臋dzy st臋偶eniami wolnego testosteronu i 17OHP badanego w 60.
minucie trwania testu z ACTH (r=0,3059). Brak by艂o tak偶e korelacji pomi臋dzy nasileniem hirsutyzmu a st臋偶eniem 17OHP oznaczonego
w 60. minucie trwania testu z ACTH. U wszystkich pacjentek z grupy PCOS odnotowano prawid艂owe wymiary 艂echtaczki.
Wnioski: Analiza obrazu klinicznego badanej populacji pacjentek z NPKN pozwoli艂a wytypowa膰 istotne dla rozpoznania objawy chorobowe,
pomocne w r贸偶nicowaniu choroby z innymi endokrynopatiami przebiegaj膮cymi z hiperandrogenizmem, w tym g艂贸wnie z PCOS.
Podsumowuj膮c, nieklasyczny przerost kory nadnerczy jest rzadk膮 przyczyn膮 hiperandrogenizacji kobiet w okresie rozrodczym. W obrazie
klinicznym nieklasycznego przerostu kory nadnerczy dominuje silnie nasilony hirsutyzm oraz cechy wirylizacji pod postaci膮 przerostu
艂echtaczki. Potwierdzeniem laboratoryjnym rozpoznania nieklasycznego przerostu kory nadnerczy jest oznaczenie st臋偶enia 17-OHP we
krwi w te艣cie stymulacyjnym z ACTH. Pomocnymi w r贸偶nicowaniu zespo艂u nieklasycznego przerostu kory nadnerczy z zespo艂em policystycznych
jajnik贸w s膮 oznaczenia wolnego testosteronu i jego niezwi膮zanej frakcji, androstendionu i estradiolu.
(Endokrynol Pol 2011; 62 (3): 230–237
HRT in 2006
Zgodnie z przyj臋tym wsp贸艂cze艣nie nazewnictwem poj臋cie hormonalnej terapii zast臋pczej, stosowane dla podawania hormon贸w jajnikowych u kobiet po menopauzie, zast膮piono poj臋ciem systemowej terapii estrogenowej (ET), lub estrogenowo-progestagennej (EPT). Stosowanie estrogen贸w i progestagen贸w w tym okresie 偶ycia kobiety nale偶y uzna膰 za interwencj臋, kt贸ra przy zachowaniu 艣ci艣le okre艣lonych warunkach jest medycznie uzasadniona. Niniejsza praca przedstawia zasady stosowania systemowej ET i EPT zgodne z uzgodnieniami ekspert贸w towarzystw naukowych zajmuj膮cy si臋 menopauz膮.According to present terminology, the name: hormonal replacement therapy (as the use of ovarian hormones in postmenopausal women) is replaced by the systemic estrogen therapy (ET) and combined combined estrogen-progestogen therapy (EPT). Treatment with estrogen and progestagens in this period of women’s life is accepted intervention only when the strict defined conditions of this therapy are maintained.
This paper introduces present rules of the use of systemic ET and EPT according to statements of experts who are interested of menopausal women’ treatment
A case of premature ovarian failure (POF) in a 31-year-old woman with a 47,XXX karyotype
Przypadek POF u 31-letniej kobiety z kariotypem 47, XXX (zesp贸艂 przedwczesnego wygasania czynno艣ci jajnik贸w [POF, premature ovarian
failure]). Celem pracy by艂a analiza przypadku 31-letniej kobiety diagnozowanej z powodu POF, u kt贸rej stwierdzono polisomi臋 47,XXX.
Opisywany kariotyp zwykle nie jest zwi膮zany z charakterystycznymi cechami fenotypowymi. Tylko w niekt贸rych przypadkach stwierdza
si臋: zaburzenia miesi膮czkowania, niep艂odno艣膰, wt贸rny brak miesi膮czki, zesp贸艂 przedwczesnego wygasania czynno艣ci jajnik贸w i deficyty
intelektualne.
Obserwacja autor贸w pracy wykaza艂a konieczno艣膰 badania cytogenetycznego u wszystkich kobiet w wieku rozrodczym z objawami POF.
Dost臋pne dane z pi艣miennictwa identyfikuj膮 pacjentki z POF i nieprawid艂owo艣ciami kariotypu jako grup臋 zagro偶on膮 przedwczesnymi
zgonami - g艂贸wnie z przyczyn kardiologicznych. U艣wiadomienie ryzyka tym pacjentkom mo偶e wp艂yn膮膰 na korzystne zmiany stylu
偶ycia i regularno艣膰 bada艅. (Endokrynol Pol 2010; 61 (2): 217-219)A case of POF in a 31-year-old woman with karyotype 47,XXX. The aim of the study was to discuss a case of POF in a 31-year-old patient
with polysomy 47,XXX. The described karyotype is not usually associated with this characteristic physical phenotype. In some rare cases,
menstrual disorders, sterility, secondary amenorrhoea, premature menopause, and low intelligence are found.
Our observations revealed the necessity for cytogenetic examination in all women at reproductive age with symptoms of premature
ovarian failure. According to the data found in literature, patients with POF and karyotype disorders belong to the risk group of premature
death, mostly for cardiological reasons. Raising patient awareness about the risk may have a positive effect on quality of life and regularity
of check-ups.
(Pol J Endocrinol 2010; 61 (2): 217-219
The metabolic aspects of polycystic ovarian syndrome
Zesp贸艂 policystycznych jajnik贸w (PCOS) jest uwa偶any za najcz臋stsz膮 przyczyn臋 hiperandrogenizmu u kobiet w okresie rozrodczym. W przebiegu tego zespo艂u do艣膰 cz臋sto dochodzi do zaburze艅 metabolicznych w zakresie gospodarki w臋glowodanowej i t艂uszczowej oraz do wyst臋powania oty艂o艣ci, chocia偶 stwierdzenie tych objaw贸w nie stanowi kryterium rozpoznawczego. Badania wykaza艂y, 偶e zwi臋kszenie insulinowra偶liwo艣ci poprzez zmian臋 stylu 偶ycia lub zastosowanie lek贸w normalizuje czynno艣膰 wewn膮trzwydzielnicz膮 i metabolizm prowadz膮c do wznowienia cykl贸w menstruacyjnych i owulacji. Niniejsza praca przedstawia obecny stan wiedzy w zakresie diagnostyki i leczenia zaburze艅 metabolicznych wyst臋puj膮cych w przebiegu zespo艂u PCOS.Polycystic ovarian syndrome (PCOS) is considered to be the main reason of hyperandrogenism in reproductive women. There are often metabolic disorders connected with carbohydrate and adipose metabolism in the patients with PCOS. However, presence of metabolic disorders does not influence the diagnosis of the syndrome. The investigations demonstrated that the changes in lifestyle and use of proper medications could normalize endocrine system and metabolism through insulin-sensitivity increase and in the result it could restore the menses and ovulations. This paper introduces present knowledge concerning metabolic disorders associated with PCOS
Anti-M眉llerian hormone dynamics during ovulation induction treatment with recombinant follicle-stimulating hormone in women with polycystic ovary syndrome
Wst臋p: Hormon anty-M眉llerowski (AMH) jest uznawany za marker odpowiedzi jajnik贸w na stymulacj臋 owulacji.
Materia艂 i metody: Do badania w艂膮czono 26 kobiet pragn膮cych zaj艣膰 w ci膮偶臋 i wykazuj膮cych oporno艣膰 na leczenie cytrynianem klomifenu.
Wszystkie pacjentki by艂y stymulowane rekombinowan膮 folitropin膮.
Wyniki: W grupie dobrze odpowiadaj膮cej na stymulacj臋 st臋偶enia lutropiny i estradiolu by艂y ni偶sze ni偶 w grupie nieodpowiadaj膮cej. St臋偶enie wolnego
testosteronu, indeks wolnych androgen贸w i insulinooporno艣膰 by艂y wi臋ksze w grupie nieodpowiadaj膮cej na stymulacj臋. W grupie odpowiadaj膮cej
st臋偶enie AMH obni偶y艂o si臋 w kolejnych dniach stymulacji i spadek ten by艂 wyra藕niejszy u pacejntek z wi臋ksz膮 liczb膮 wzrastaj膮cych p臋cherzyk贸w.
Pacjentki z PCOS wykazuj膮 niskie st臋偶enia FSH i wysokie AMH. Uwa偶a si臋, 偶e obni偶enie st臋偶enia AMH poprzedza wzrost p臋cherzyk贸w
w trakcie stymulacji rekombinowanym FSH. U bezowulacyjnych pacjentek z PCOS 艂agodny wzrost w surowicy FSH hamuje AMH,
odblokowuj膮c ekspresj臋 aromatazy przez wybrane p臋cherzyki, co pozwala na wy艂onienie rosn膮cych p臋cherzyk贸w. Kobiety z nasilonym
hiperandrogenizmem, insulinooporno艣ci膮 i wysokim poziomem LH nie odpowiadaj膮 na stymulacj臋.
Wnioski: Obni偶enie st臋偶enia AMH u pacjentek z PCOS po tygodniu stymulacji rekombinowanym FSH jest praktycznym, cennym
markerem pozwalaj膮cym wy艂oni膰 pacjentki z wysokim ryzykiem zespo艂u hiperstymulacji. Bezowulacyjne pacjentki z PCOS z ci臋偶kim
hiperandrogenizmem, insulinooporno艣ci膮 i hiperinsulinemi膮 nie powinny by膰 kwalifikowane do stymulacji owulacji rekombinowanym
FSH. (Endokrynol Pol 2013; 64 (3): 203–207)Introduction: Anti-M眉llerian hormone (AMH) has been suggested as a predictor of ovarian response to ovulation induction and controlled
ovarian hyperstimulation.
Material and methods: Twenty-six women, wishing to become pregnant and who showed resistance to clomiphene citrate, were included
in the study. All women received recombinant follicle-stimulating hormone (recFSH).
Results: In the group of good responders, luteinising hormone (LH) and oestradiol levels were lower than in the group of non-responders.
Free testosterone levels, free androgen index, and insulin resistance were higher in the group of non-responders. In the group of good
responders, AMH levels decreased on successive days of ovarian stimulation and a greater slope of AMH levels was observed in patients
with a higher number of increasing follicles.
PCOS patients have low FSH and high AMH levels. It could be suggested that the serum AMH decrease preceded growth of many follicles,
which is a consequence of the FSH stimulation. In anovulatory PCOS women, gently increasing the serum FSH level reduces the
AMH excess, thus relieving the inhibition from the latter on aromatase expression by selectable follicles and allowing the emergence of
growing follicles. Patients with severe hyperandrogenism, insulin resistance and high level of LH do not respond to stimulation.
Conclusions: The decrease of AMH levels in PCOS women after one week of ovarian stimulation is a practical, valuable indicator which
could predict the patients with a high risk of ovarian hyperstimulation. Anovulating PCOS patients with severe hyperandrogenism, insulin
resistance and hyperinsulinaemia should not be qualified for recFSH ovarian stimulation. (Endokrynol Pol 2013; 64 (3): 203–207
The influence of anti-Mullerian hormone on folliculogenesis
Abstract The main biological role of the anti-Mullerian hormone (AMH) is to induce the involution of the Muller ducts in embryos during differentiation of masculine gender. In case of women, AMH is produced in granular cells of primary, preantral and antral follicles. The expression of AMH initiates at the moment of the follicle recruitment and it lasts until the stage of an antral follicle. The level of this hormone decreases with age and in postmenopausal period is undetectable in blood. Therefore, AMH could be a useful marker of ovarian reserve. Multiple investigations have revealed higher AMH levels in the blood of PCOS patients. It is believed to be the consequence of the increased amount of small antral follicles. AMH is considered to have an essential role in folliculogenesis. It inhibits the process of recruitment of primordial follicles and modifies the growth of preantral and antral follicles by diminishing the sensitivity of follicles for FSH stimulation. The paper is a review of the present knowledge of the structure and activity of AMH. AR gene and protein. Participation of AMH in folliculogenesis and changes of AMH levels depending on structure and age of the ovary have also been discussed. Recent findings concerning the possibility of using AMH to assess ovarian reserve and efficiency of the stimulation of ovulation in infertile women have been presented. It is believed that increased knowledge concerning AMH might improve the diagnosis and treatment of infertility caused by lack of ovulation