POLYCYSTIC OVARY SYNDROME ENDOCRINE AND CARDIO-METABOLIC ABNORMALITIES: HOW TO MANAGE?

摘要

Polycystic ovary syndrome (PCOS), the main ause of androgen excess in women of reproductive age, is multifaceted, dynamic and clinically heterogenic disorder. :otterdam 2003 ESHRE/ASRM definition criteria were cently reinforced at the NIH Consensus Meeting 2012. !oncomitant identification of the clinical phenotypes of the yndrome is mandatory in medical care and clinical studies, s these are strongly related to reproductive, cardiovascular nd metabolic outcomes. Documentation of polycystic ovarian lorphology (PCOM) is challenging, with the AE/PCOS Task orce 2014 suggesting a threshold of follicles/ovary in 185 years old women when using high-frequency transducers.,levated levels of total testosterone and/or free testosterone nd/or low sex hormone-binding globulin (SHBG) stand for ndrogen excess in women, as stated by the ESE Position tatement 2014. Despite evidence of increased metabolic and ardiovascular risk, increased prevalence of cardiovascular vents linked to PCOS status per se is still insufficient ocumented, mainly because of the clinical heterogeneity of Ludies populations and lack of prospective data. First-line erapy in the medical management of PCOS is metformin, t least 1.5 g/d, in all patients with documented insulin sistance and hyperinsulinemia. According to Endocrine ociety Guidelines 2013, other insulin-sensitizers (e.g. iazolidinediones) raise safety concerns on the long-term, hereas statins need further evaluation to demonstrate their enefits in the treatment of PCOS, however, are indicated 1 dyslipidemic patients. Anti-androgens and combined ral contraceptives (COC) are targeting androgen excess, articularly in non-insulin resistant patients, with an overall enefit to risk ratio in PCOS favoring benefits.