课件：青春期多囊卵巢综合征诊治共识.ppt

青春期PCOS的治疗-社会心理因素的调整 青春期女性具有特殊的社会心理特点，多毛症、痤疮及肥胖对青春期ＰＣＯＳ患者的心理健康产生负面影响，一些患者会出现焦虑和抑郁，应关注青春期ＰＣＯＳ的心理健康，必要时给予积极治疗及专科处理。 THANK YOU SUCCESS * * 可编辑 The central abnormality in polycystic ovary syndrome is predisposition to excess ovarian androgen secretion. The resulting raised serum androgen levels affect pituitary LH secretion and contribute to the mechanism of anovulation. Hyperandrogenism also affects insulin sensitivity and secretion, but independent genetic and dietary factors might also have a role. Once established, both hypersecretion of LH and hyperinsulinaemia further exacerbate ovarian theca cell androgen production. Hyperinsulinaemia also contributes to androgen-dependent hirsutism by suppression of hepatic secretion of SHBG, which increases the bioavailability of testosterone. When present, insulin resistance is the main factor that increases the risk of type 2 diabetes mellitus in women with polycystic ovary syndrome. Abbreviations: LH, luteinizing hormone; SHBG, sex hormone-binding globulin. * Diagnostic features of PCOS are hirsutism, anovulation, and polycystic ovaries, which show arrested follicular maturation; obesity and insulin resistance are frequently associated conditions. The major biochemical feature of PCOS is androgen excess, which causes hirsutism. Androgens also appear to inhibit the negative-feedback effects of estrogens and progesterone on pulsatile LH release. Women with PCOS have increased pulsatile GnRH release, which results in higher levels of LH and lower levels of FSH in most individuals. Higher LH (and insulin) levels seem to cause increased androgen production by follicular theca cells whereas lower FSH levels lead to anovulation. Obesity and insulin resistance decrease levels of sex-hormone-binding globulin and thereby increase testosterone bioactivity. If follicular granulosa cells are insulin resistant, it might affect their responses to FSH; otherwise, granulosa cells appear to be very capable of releasing estro