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Ìåòàáîëè÷åñêèé ñèíäðîì ?Ãèïîòàëàìè÷åñêàÿ äèñôóíêöèÿ?
Çäðàâñòâóéòå! ß â÷åðà òîëüêî óçíàëà î ýòîì ñàéòå è çàðåãèñòðèðîâàëàñü, ïîýòîìó áóäüòå ñíèñõîäèòåëüíû, åñëè ÿ äîïóùó ëÿïñóñû.
Ó ìîåé äî÷åðè íåðåãóëÿðíûå ìåñÿ÷íûå,ñåé÷àñ ìû ëå÷èìñÿ ó î÷åíü îïûòíîãî è çíàþùåãî âðà÷à, íî îíà ÷àñòî óåçæàåò íà ñèìïîçèóìû è ðàçíûå êîíôåðåíöèè.Ìû ñåé÷àñ ñäàëè âñå àíàëèçû è îáñëåäîâàíèÿ, îíà óåõàëà è íåò ïðèåìà òðè íåäåëè ïîäðÿä,ïðè÷åì ïðèíèìàåò îíà îäèí ðàç â íåäåëþ.Íà ñàéòå ÿ íàïèñàëà âñå ðåçóëüòàòû èññëåäîâàíèé è îíà íàçíà÷èëà íàì ïðèíèìàòü 2 íåäåëè ñèîôîð,ñ êîíòðîëåì óðîâíÿ èíñóëèíà ÷åðåç äâå íåäåëè. ß ïî÷èòàëà ôîðóìû è õî÷ó óçíàòü, êàêóþ äèåòó íàäî ñîáëþäàòü, ÷òîáû íå áûëî òîøíîòû è äðóãèõ íåïðèÿòíîñòåé.Ñèîôîð íàì íàçíà÷èëè ïîñëå ñäà÷è òåñòà òîëåðàíòíîñòè ê ãëþêîçå ñ èíñóëèíîì. Âîò ðåçóëüòàòû ýòîãî àíàëèçà. ãëþêîçà íàòîùàê(0 òî÷êà) 4,00 èíñóëèí 3,04 õîëåñòåðèí5,89 ãëþêîçà (120 ìèí) 5,6 èíñóëèí (180 ìèí) 34,9 (íîðìà 2,1-27) Åùå õî÷ó óçíàòü, ÷òî çíà÷èò âûñîêèé èíñóëèí ïîñëå ïðèåìà ãëþêîçû, ýòî ñàõàðíûé äèàáåò? Äî÷åðè 20 ëåò, âåñ 54 êã, ðîñò 167 êã. Âîò ãîðìîíû:26.03.09.(3 äåíü öèêëà) Ëà 13,4 ôñã 9,8 ïðë695 ýñòðàäèîë 371 êîðòèçîë 502 Äãà-Ñ 9,1 òòã 2,2 Ò4-ñâ 22,1 17-îíð 3,4 àìã 12,0 Ïîñòàâëåí äèàãíîç ìåòàáîëè÷åñêèé ñèíäðîì è ãèïîòàëàìè÷åñêàÿ äèñôóíêöèÿ. Íàñ÷åò ïîëèêèñòîçà ÿ òàê è íå ïîíÿëà, ìû ñäåëàëè òðåõìåðíîå óçè ðýã è ýýã. Åñëè íàäî, ÿ íàïèøó âñå ðåçóëüòàòû. 28 àïðåëÿ ïðèøëè ìåñÿ÷íûå ïîñëå ïðèåìà äþôàñòîíà.Çàâòðà ïëàíèðóåì íà÷èíàòü ïðèíèìàòü ñèîôîð. Âîëíóþñü, íå áóäåò ëè åé ïëîõî è êàê ïðàâèëüíî ïèòàòüñÿ.Ìîæíî ëè åñòü ñàõàð ?  àííîòàöèè ê ñèîôîðó íàñ÷åò äèåòû íå íàïèñàíî.Ïîæàëóéñòà, ïîìîãèòå. È ÷òî çíà÷èò èíñóëèíîðåçèñòåíòíîñòü? |
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ß ðåøèëà íàïèñàòü âñå ñ ñàìîãî íà÷àëà:.Êàòÿ, 20 ëåò, ðîäèëàñü îò ïåðâîé áåðåìåííîñòè, ïðîòåêàâøåé áåç îñëîæíåíèé,ðîäû ñâîåâðåìåííûå,ñàìîïðîèçâîëüíûå, âåñ-2450,ðîñò-47ñì. ìëàäåí÷åñòâå ãèïåðòîíóñ ìûøö, íàáëþäàëàñü ó íåâðîïàòîëîãà. Ðàçâèâàëàñü ñîîòâåòñòâåííî âîçðàñòó.Ãðóäíîå âñêàðìëèâàíèå 12 ìåñ. Ìàòåðè20 ëåò, îòöó 24.ïðîô âðåäíîñòåé íåò..Èç àíàìíåçà:ìåíñòðóàöèè íåðåãóëÿðíûå.Âïåðâûå îáðàòèëèñü ê âðà÷ó â 14 ëåò ,ðåêîìåíäîâàíà âèòàìèííàÿ òåðàïèÿ.Áåç ýôôåêòà. 17 ëåò îáðàòèëèñü â íàó÷íî-ïîëèêëèíè÷åñêîå îòäåëåíèå "ÍÖèÏ èì.Êóëàêîâà",îáñëåäîâàíû.Ãîðìîíû êðîâè îò22.11.06.
prl-125 E2-600 ËÃ-8,7 Ò-2,7(íîðìà1,0-2,5) ôñã-2,7 DýÀ-s-6,5(íîðìà0,3-6,0) òòã-0,94(N) 17îêð-13,4(N äî 9,0) 2) óçè îðã ìàëîãî òàçà îò16þ11 06(68 äåíü öèêëà) ìàòêà â retroflexio .Ðàçìåðû ìàòêè: äëèíà 4,8ñì,òîëùèíà 3,4ñì.,øèðèíà4,4 ìèîìåòðèé îáû÷íîéýõî-ñòðóêòóðû.Ïîëîñòü ìàòêè íå ðàñøèðåíà.Ì-ýõî1,1ñì,áåç âèäèìîé ïàòàëîãèè Ïðàâûé ÿè÷íèê 3,3ñìÕ2,3ñìõ2ñì ñ ìåëêèìè ôîëëèêóëàìè Ëåâûé ÿè÷íèê3,5ñìõ3,2ñìõ2,6ñì â íåì æåëòîå òåëî.  ìàëîì òàçó ñâîáîäíàÿ æèäêîñòü â íåáîëüøîì êîë-âå. Ðåêîìåíäîâàí ïðèåì Äèàíå-35,ïðèíèìàëà â òå÷åíèå 2 öèêëîâ,â ñâÿçè ñ îòðèöàòåëüíûì êîñìåòè÷åñêèì ýôôåêòîì ïðåêðàòèëà ïðèåì ïðåïàðàòà.Äàëåå ïåðåøëà íà ïðèåì ßðèíû. Ïîñëå 3 ìåñÿöåâ ïðèåìà ,ñàìîñòîÿòåëüíî ìåíñòðóàöèÿ ïðèøëà ñ çàäåðæêîé 70 äíåé.,ñëåäóþùèå 3 ìåíñòðóàöèè ñàìîñòîÿòåëüíî ÷åðåç 30 äíåé!.Äàëåå íà ôîíå ñòðåññà,ñåññèè ïðèâèâêè îò êðàñíóõè (ðàçâèëàñü ïðèâèâî÷íàÿ êðàñíóõà) âíîâü çàäåðæêà ìåíñòðóàöèè íà 60 äíåé. Äàëåå ïðîäîëæèëà ïðèåì ÿðèíû â òå÷åíèå 4 öèêëîâ äî 12.08 .Ñ 12 08 ìåíñòðóàöèè îòñóòñòâîâàëè. Îáúåêòèâíî: Îáùåå ñîñòîÿíèå óäîâëåòâîðèòåëüíîå,Êîæíûå ïîêðîâû è ñëèçèñòûå ôèçèîëîãè÷åñêîé îêðàñêè,÷èñòûå.Ìàññà54êã, ðîñò 167ñì, Ìîëî÷íûå æåëåçû ìÿãêèå, ñîñêè âûðàæåíû, ßçûê îáëîæåí íàëåòîì.Ùèòîâèäíàÿ æåëåçà íå ïàëüïèðóåòñÿ. Íïî ðàçâèòû ïðàâèëüíî, Îâîëîñåíèå ïî æåíñêîìó òèïó. Øåéêà ìàòêè öèëèíäðè÷åñêîé ôîðìû, òåëî ìàòêè íîðìàëüíûõ ðàçìåðîâ,ïëîòíîå,ïîäâèæíîå.Ïàëüïèðóåòñÿ óâåëè÷åííûå ÿè÷íèêè (áîëüøå ñëåâà) ïëîòíîâàòûå. DS: äèñôóíêöèÿ ÿè÷íèêîâ (îëèãîìåíîðåÿ )Ïîëèêèñòîç-? ðåêîìåíäîâàíî1 äþôàñòîí10 ìã 10 äíåé.Íà 2-3 äåíü öèêëà ãîðìîíû ,óçè(òðåõìåðíîå) ýýã,ðýã áèîõèìèÿè ëèïèäû òåñò òîëåðàíòíîñòè ê ãëþêîçå + èðè. ãîðìîíû íà 3 äåíü öèêëà:Ëã13,4 Ôñã-9,8 ïðë-659! ýñòðàäèîë371 êîðòèçîë502! äãà-s9,1 òòã 2,2 Ò4ñâ-22,1 17îíð-3,4 àìã-12,0 ãëþêîçà 4,3 áåëîê85,5 õîëåñòåðèí-6,2! ëïâï-õñ1,6 ëïíï-4,3 êîýôô àòåðîã 2,2 òðèãëèöåðèäû 0,5(íîðìà0,7-1,7) ìî÷åâèíà 4,8 êðåàòèíèí 92,0 áèëèðóáèí6,6 Ïð.áèëèðóáèí 3,1 Ãëþêîçà íàòîùàê èç âåíû4,00 (íîðâà3,9-6,4) èíñóëèí 3,04 (íîðìà 2,1-27) õîëåñòåðèí 5,89 (íîðìà3,1-5,2) ãëþêîçà(120 ìèí)5,6 (íîðìà3,9-6,4) èíñóëèí(180 ìèí)34,9 (íîðìà 2,1-27) ÐÝà :Âñäïî ñìåøàííîìó òèïó ñ íàðóøåíèåì âåíîçíîãî îòòîêà áîëüøå ïðèôóíêö íàãðóçêàõ â áàññåéíå ñîííûõ è ïîçâîíî÷íûõ àðòåðèé.Ñêîëèîç. ÝÝà  ïîêîå îáùåìîçãîâûå èçìåíåíèÿ ñ ïðèçíàêàìè äèñôóíêöèè ìåçîäèýíöåôàëüíûõ ñòðóêòóð.Íà ôîíå ãèïåðâåíòèëÿöèè ïîâûø âëèÿíèÿ ñòâîëîâûõ ñòðóêòóð ìîçãà íà ðàçíûõ óðîâíÿõ ñòâîëà. Ñîáèðàåìñÿ ïðèíèìàòü ñèîôîð. Ïî îäíîé òàáëåòêå ñ ïîñëåäíèì ïðèåìîì ïèùè 2 íåäåëè.Ïîòîì êîíòðîëü èíñóëèíà è ãëþêîçû. Êàê ïðàâèëüíî ïèòàòüñÿ, íóæíî ëè ñîáëþäàòü äèåòó? Ìîæíî ëè ñîâìåùàòü ïðèåì äþôàñòîíà è ñèîôîðà? Îòâåòòüòå! Áåñïîêîþñü! |
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Èìåéòå òåðïåíèå, êîíñóëüòàíòû íå ñèäÿò íà ôîðóìå ñóòêàìè. Âðåìÿ îæèäàíèÿ ëó÷øå âñåãî ïîòðàòèòü íà òî, ÷òîáû ïîëó÷èòü ñîãëàñèå äî÷åðè 20 ëåò îò ðîäó íà ýòó êîíñóëüòàöèþ è ïðèâåñòè åå íà ôîðóì ñàìó.
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Lead, follow, or get out of the way. — Thomas Paine |
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×òî çíà÷èò íå ðåãóëÿðíûå ìåñÿ÷ûå? Êàêèå çàäåðæêè? Ñî ñêîëüêè ëåò íà÷àëèñü? Ìíîãî âîëîñ íà òåëå?
È åùå: Âàøà äî÷ü , íåñìîòðÿ íà òî ÷òî äëÿ âàñ îíà âñåãäà îñòàíåòñÿ ðåáåíêîì) óæå âçðîñëàÿ. è ïî ïðàâèëàì ôîðóìà âîïðîñû ÷åðåç òðåòüèõ ëèö íå ðåêîìåíäîâàíû. |
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Ðîñò âîëîñ íàä âåðõíåé ãóáîé, íåìíîãî âîêðóã ñîñêîâ.Íà ðóêàõ è íîãàõ Ó ìåíÿ òîæå íåìíîãî "âîëîñàòîñòü"ïîâûøåíà.Ìîÿ äî÷ü íå ïðîòèâ ýòî êîíñóëüòàöèè.
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Äàâàéòå ïîêà íà÷íåì ñ äèàãíîçà. Ìåòàáîëè÷åñêèé ñèíäðîì - íå ñîâñåì äèàãíîç, ýòî ñîáèðàòåëüíîå ïîíÿòèå. Íî ó ýòîãî ïîíÿòèÿ åñòü êðèòåðèè, êîòîðûì Âàøà äî÷ü íå óäîâëåòâîðÿåò. ×åëîâåê ñ òàêèì èíäåêñîì ìàññû òåëà (à îæèðåíèÿ ó äî÷åðè íåò è áëèçêî) íó íèêàê íå ìîæåò ïðåòåíäîâàòü íà äèàãíîç ìåòàáîëè÷åñêîãî ñèíäðîìà. ×òî òàêîå "ãèïîòàëàìè÷åñêàÿ äèñôóíêöèÿ" è ïî÷åìó ýòî ñëîâîñî÷åòàíèå ïîÿâèëîñü - òîæå çàãàäêà. Íåò òàêîãî äèàãíîçà.
Ñîîòâåòñòâåííî, íåïîíÿòíî, ÷òî ëå÷èò çíàþùèé âðà÷.  ÷àñòíîñòè, ñ êàêîé öåëüþ íàçíà÷åí ñèîôîð. Ïðîâåäåíèå ãëþêîçîòîëåðàíòíîãî òåñòà òðåáóåòñÿ ïðè ÑÏÊß, íî îí ïîäðàçóìåâàåò îïðåäåëåíèå ÃËÞÊÎÇÛ íàòîùàê è ÷åðåç 2 ÷ ïîñëå íàãðóçêè. Öèôðû ïîëó÷åíû íîðìàëüíûå. Çà÷åì-òî ïîñìîòðåëè èíñóëèí - íî îí è îáÿçàí áûòü ïîâûøåí ïîñëå óãëåâîäíîé íàãðóçêè. Íîðìà (äî 27) - ýòî íîðìà ÍÀÒÎÙÀÊ, è îöåíêà ïî ýòèì íîðìàì ïîñëåíàãðóçî÷íîãî çíà÷åíèÿ - ñòóäåí÷åñêàÿ îøèáêà. Çà÷åì ñèîôîð ñ êîíòðîëåì èíñóëèíà - íåèçâåñòíî. Ïîäîáíûõ ïîêàçàíèé ê íàçíà÷åíèþ ñèîôîðà íå ñóùåñòâóåò.
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Àííà, âðà÷-ýíäîêðèíîëîã Âîðîíåæ, êëèíèêà Íåïëàöåáî |
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Ìåíÿ òîæå ñìóùàåò, ÷òî ñèîôîð âûïèñûâàþò ëþäÿì ñ îæèðåíèåì.Áîþñü, ÷òî îíà ñîâñåì èñõóäàåò îò íåãî. Âèäèìî, ìåòàáîëè÷åñêèé ñèíäðîì ïîñòàâëåí èç-çà ïîâûøåííîãî õîëåñòåðèíà è ðåçóëüòàòîâ ðýã è ýýã. À ïðè ïîëèêèñòîçå íàçíà÷àþò ñèîôîð? Äåëî â òîì, ÷òî êîãäà ìû äåëàëè óçè, âðà÷ ñêàçàëà, ÷òî âðîäå ïîõîæå íà ïîëèêèñòîç, íî è âðîäå íåò.Âîò ïèøó ðåçóëüòàòû óçè:31.03.09.(7 äåíü öèêëà)
Òåëî ìàòêè îòêëîíåíî âïðàâî,ðîòèðîâàíî.44õ29õ44 ñèììåòðè÷í..Ýíäîìåòðèé íå èçìåíåí,ãèïîýõîãåííîé ñòðóêòóðû,ýõîïîçèòèâíûé áàçàëüíûé ñëîé.Ïîëîñòü ìàòêè íå ðàñøèðåíà.Ì-ýõî10,3ìì.Øåéêà ìàòêè30õ20õ26.ñòðîåíèå èçìåíåíî çà ñ÷åò àíýõîãåííûõ åäèíè÷íûõ âêëþ÷åíèé ñ ÷åòêèìè êîíòóðàìè îêðóãëîé ôîðìû,îò 3 äî 4,5â äèàìåòðå Òîëùèíà ýíäîöåðâèêñà 3,9(1ñò),öåðâèêàëüíûé êàíàë ðàñøèðåí äî 2,5 ìì.Âàñêóëÿðèçàöèÿ ìèîìåòðèÿ âûðàæåíà ,èíòðàýíäîìåòðèàêíàÿ? íå çàðåãèñòðèðîâàíà Q è àd R1=0,84-vps=30,01 ad R1=0,84 Ps=23,03 A è a.s.R1=0,84 VPS=29.8cì/ñ d.s. 0,84 22,1ñì/ñ Ëåâûé ÿè÷íèê ìóâåëè÷åí 35õ24õ23; V10,19 ñì(â êâàäðàòå) Ïðàâûé ÿè÷íèê 31õ26õ20 v8,12 ñì(â êâàäðàòå) ìóëüòèôîëëèêóë. ôîëëèêóëû â ïðàâîì ÿè÷íèêå è ëåâîì. ïðàâîì ÿè÷íèêå äèàìåòð äî 7ìì, â ëåâîì- äî 9 ìì. Èìåþòñÿ ãðóïïû ñëåâà ¹6 ; ñïðàâà¹3-5. Âàñêóëÿðèçàöèÿ áîëåå âûðàæåíà ñïðàâà.DS:ìóëüòèôîëëèêóëÿðíûå ÿè÷íèêè (?ñïêÿ) ×òî íàì äåëàòü äàëüøå? Ñåé÷àñ íàø âðà÷ óåõàëà,âñå âðåìÿ ñèäåòü íà äþôàñòîíå íå õî÷åòñÿ, íàäî âûÿâèòü ïðè÷èíó è ëå÷èòü. ß â ïàíèêå. Ïîæàëóéñòà, ïîäñêàæèòå, êàê äåéñòâîâàòü.? Ñ óâàæåíèåì.Àðèíà. P.s. À ñ äî÷êîé ó íàñ äîâåðèòåëüíûå îòíîøåíèÿ, îíà ìíå ðàçðåøèëà êîíñóëüòèðîâàòüñÿ íà ñàéòå.Ïðîñòî ýòî çàíèìàåò ìíîãî âðåìåíè, à îíà ó÷èòñÿ è ðàáîòàåò, è íà äîðîãó òðàòèò ìíîãî âðåìåíè è ñèë. Ñïàñèáî çà ó÷àñòèå. |
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ÓÇÈ 7 äåíü öèêëà- íîðìà.
Ìóëüòèôîëèêóëÿðíûå ÿè÷íèêè- íîðìà, ïðîñòî íóæíî ÷òî òî â çàêëþ÷åíèè íàïèñàòü( âàðèàíò íîðìû , ïî÷åìó òî íå âîñïðèíèìàåòñÿ Òàê ìåñÿ÷íûå êàê èäóò? |
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Åëåíà!Ìåñÿ÷íûå íåðåãóëÿðíûå, ìû ïîøëè ê âðà÷ó, êîãäà áûëà çàäåðæêà 3 ìåñÿöà.Òîëüêî îäèí ðàç, ïîñëå 3-õ ìåñÿ÷íîãî êóðñà ÿðèíû, òðè öèêëà ïîäðÿä áûëè ìåñÿ÷íûå âîâðåìÿ, ýòî áûëî ãîä íàçàä.Ïîòîì áûëà ñåññèÿ, íåðâû, íàãðóçêè è åùå â èíñòèòóòå íå äîïóñêàëè ê ñåññèè, ïîêà íå ñäàøü ïðèâèâêè.È îíà ñäåëàëà ïðèâèâêó îò êðàñíóõè. Áûëà òåìïåðàðóðà ÷åðåç íåäåëþ, íåìíîãî óâåëè÷èëèñü ëèìôîóçëû.Ïîñëå ýòîãî ìåñÿ÷íûå ïðîïàëè íà 4 ìåñÿöà.Ñåé÷àñ 2 ìåñÿöà(ñ 15 äíÿ) ïüåì äþôàñòîí.Ñåãîäíÿ 5 äåíü öèêëà.
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#10
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Öèòàòà:
Áîÿòüñÿ Âàì íóæíî íå òîãî, ÷òî äî÷ü èñõóäàåò îò ñèîôîðà, à òîãî, ÷òî íàçíà÷åí ëåêàðñòâåííûé ïðåïàðàò íåèçâåñòíî çà÷åì ïðè îòñóòñòâèè äèàãíîçà. Íè ÐÝÃ, íè ÝÝà íå èìåþò íèêàêîãî îòíîøåíèÿ ê ìåòàáîëè÷åñêîìó ñíèäðîìó, êîòîðîãî ó Âàøåé äî÷åðè ÍÅÒ. Âàì äàòü ññûëêó íà êðèòåðèè? ÐÝà - áåññìûñëåííîå îáñëåäîâàíèå, êîòîðîå íå ïðîâîäÿò íèãäå, êðîìå ñòðàí ÑÍÃ. ÝÝà çà÷åì áûëî - áûë ïîâîä äóìàòü îá ýïèëåïñèè?
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Àííà, âðà÷-ýíäîêðèíîëîã Âîðîíåæ, êëèíèêà Íåïëàöåáî |
#11
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Ñïàñèáî,Àííà! Ñèîôîð ïðèíèìàòü ìû íå áóäåì,ýòî ðåøåíî.Ñåé÷àñ âîïðîñ î áåðåìåííîñòè íå ñòîèò, íî â áóäóùåì âñòàíåò.Ñåé÷àñ õî÷åòñÿ íàëàäèòü öèêë è äîêîïàòüñÿ äî ïðè÷èíû ñáîÿ.Âîëíóþñü, êàê áû íå äîâåñòè äî ïîëèêèñòîçà. Îá ýïèëåïñèè ðå÷è íåò.Åñòü áîëüøèå íàãðóçêè è óòîìëÿåìîñòü. Ãèïîäèíàìèÿ.Êàêèå îáñëåäîâàíèÿ íóæíî ñäåëàòü åùå ,÷òîáû óñòàíîâèòü âåðíûé äèàãíîç. Íàïðèìåð, èñêëþ÷èòü èëè ïîäòâåðäèòü ïîëèêèñòîç. Ïðèíèìàòü ëè åé äþôàñòîí. Êîãäà îíà ïðèíèìàëà ÿðèíó, ìåñÿ÷íûå áûëè áåçáîëåçíåííûå, à ïðè ïðèåìå äþôàñòîíà ñ áîëÿèì, êàê ïðè ñâîèõ.
À êàê áûòü ñ ïîâûøåííûì ïðîëàêòèíîì? Ìîæåò ýòî ïîñëå ïðèåìà äþôàñòîíà? ×òî ïîêàçûâàåò ãîðìîí ÀÌÃ, îí ó íàñ ïîâûøåí? Ñ óâàæåíèåì.Àðèíà. |
#12
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Ïðîäîëæàþ ñêëàäûâàòü ïàçëû â ñâîåé ãîëîâå è äîäóìàëàñü âîò äî ÷åãî:ãîä íàçàä òðè ìåíñòðóàöèè ïîäðÿä áûëè ðåãóëÿðíûå.ß òî÷íî íå ïîìíþ, íî åñòü âåðîÿòíîñòü, ÷òî â ýòî âðåìÿ ÿ êóïèëà éîäîìàðèí 200 è ìû åãî ïðèíèìàëè ïîä äåâèçîì: "áîðüáà ñ éîäîäåôèöèòîì." Ýòî ìîãëî ïîâëèÿòü?
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#13
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Êðèòåðèè äèàãíîçà - òóò (öèòèðóþ ðåñóðñ UpToDate) - íàäåþñ`åãî àâòîðèòåòíîñòü Âû ïîä ñîìíåíèå íå ñòàâèòå.
NIH consensus criteria 1. Menstrual irregularity due to oligo- or anovulation 2. Evidence of hyperandrogenism, whether clinical (hirsutism, acne, or male pattern balding) or biochemical (high serum androgen concentrations) 3. Exclusion of other causes of hyperandrogenism and menstrual irregularity, such as congenital adrenal hyperplasia, androgen-secreting tumors, and hyperprolactinemia. ÿ íå ãîâîðþ, ÷òî ìåòàáîëè÷åñêèå íàðóøåíèÿ ÿâëÿþòñÿ êðèòåðèåì äèàãíîñòèêè ÑÏÊß, íî òî ÷òî ýòè ìåòàáîëè÷åñêèå íàðóøåíèÿ î÷åíü÷àñòî ïðèñóòñòâóþò, äóìàþ, íå âîïðîñ Ïî ïîâîäó íàðóøåíèé îáìåíà ãëþêîçû è èíñóëèí-ðåçèñòåíòíîñòè - òóò A number of professional organizations, including the American College of Obstetricians and Gynecologists (ACOG), AACE , the Androgen Excess Society [14] , and a consensus panel representing the European Society of Human Reproduction and Embryology (ESHRE) and the American Society of Reproductive Medicine (ASRM) [3] recommend a baseline two-hour OGTT (with measurement of fasting and 2-hour glucose) in all women with PCOS. We also suggest performing a two-hour OGTT in women with PCOS. If this is not feasible, a fasting glucose should be obtained. Insulin resistance — There currently is no validated test for measuring insulin resistance in a clinical setting. The euglycemic clamp and frequently sampled glucose tolerance test are research procedures. While calculated indices using fasting insulin and glucose concentrations are sometimes used (eg, homeostasis model assessment of insulin resistance [HOMA-IR or HOMA]), there are limitations to their use À ÂÎÒ ÏÎ ÏÎÂÎÄÓ ÌÅÕÀÍÈÇÌÀ ÄÅÉÑÒÂÈß ÌÅÒÔÎÐÌÈÍÀ ÏÐÎ ÑÏÊß INSULIN RESISTANCE — The pathophysiology of PCOS has not been fully characterized. Many have evidence of abnormal LH secretion (increased LH pulse amplitude and frequency), and a significant percentage of women with PCOS display insulin resistance. The combination of insulin resistance and increased LH secretion appears to stimulate ovarian androgen production. In addition, elevated insulin levels inhibit hepatic synthesis of sex hormone binding globulin. These changes result in increased bioavailability of free androgens. The molecular defects that cause insulin resistance have not been fully determined. In some patients, insulin resistance appears related to mutations in the insulin receptor gene that result in abnormal function of the insulin receptor [6] . Dysregulation of local follicle regulatory systems by androgens and other factors impedes normal follicular growth, resulting in follicular arrest at the 4 to 8 mm diameter size [7] . A dominant follicle (ie, 18 to 25 mm in diameter) does not develop, and therefore ovulation does not occur. Thus, the combination of elevated LH, hyperinsulinemia, ovarian androgen overproduction, and disruption of follicle growth produces the PCOS phenotype of oligoovulation and hyperandrogenism. METFORMIN — Metformin's major effect is to decrease hepatic glucose production thus reducing the need for insulin secretion; it also decreases intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilization) and has an antilipolytic effect that lowers fatty acid concentrations, thus reducing gluconeogenesis. It is used primarily for the treatment of type 2 diabetes, but it has also been used to treat insulin resistance in women with PCOS with the goals of reducing ovarian androgen production and inducing ovulation È ÂÎÒ ÅÙÎ ÏÎ ÏÎÂÎÄÓ ÐÅÏÐÎÄÓÊÒÈÂÍÛÕ ÝÔÔÅÊÒΠÌÅÒÔÎÐÌÈÍÀ Many trials and a meta-analysis have reported both metabolic and ovulatory benefits of metformin in women with PCOS (alone or combined with clomiphene) [15,30-37,43,56-58] . In a meta-analysis of 13 trials, women treated with metformin had a four-fold higher chance of ovulating than women treated with placebo or clomiphene [15] . Of note, many of these trials included only women with clomiphene-resistance (previously failed to achieve ovulation with clomiphene), and many studies had methodologic flaws, including failure to perform intention-to-treat analyses. Çíà÷èò, âñå-òàêè ìåòôîðìèí îáëàäàåò ðåïðîäóêòèâíûì ýôôåêòîì è óëó÷øàåò îâóëÿöèþ ïðè ñïêÿ? |
#14
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Öèòàòà:
Ðàç Âû ëîïàòèòå UpToDate, òî ïîèùåòå òåïåðü êðèòåðèè ìåòàáîëè÷åñêîãî ñèíäðîìà. Òîëüêî ñþäà èõ íå ïîñòèòå, ïîæàëóéñòà. Ìû èõ çíàåì.
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Àííà, âðà÷-ýíäîêðèíîëîã Âîðîíåæ, êëèíèêà Íåïëàöåáî |
#15
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Íàäåþñü, çàâòðà ìû ïîïàäåì ê âðà÷ó,ïðèåìà íå áûëî óæå 3 íåäåëè .À ñ 7 ìàÿ îíà óõîäèò â îòïóñê.Åñëè íàì íå ïîâåçåò, áóäó ïðîñèòü î êîíñóëüòàöèè!
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