Polikistik Over Sendromu’nda Metabolik Sendrom

Dr. Burak Hacıhanefioğlu

polikistikover.net internet sitesinde yer alan tıp içerikli yazı ve videoların tümü Kadın Hastalıkları ve Doğum Uzmanı Dr. Burak Hacıhanefioğlu tarafından hazırlanmış olup, telif hakları yasal koruma altına alınmıştır. İzinsiz kaynak gösterilerek dahi başka bir yerde yayınlanamaz.

Kalp ve damar hastalığı (kalp, beyin ve bacaklara oksijen taşıyan damarların tıkanması veya daralması) ihtimalini arttıran en az 3 özellik biraraya gelerek metabolik sendromu oluşturmaktadır(1,2,3,4);

1-Kan basıncı yüksekliği (≥ 130 /85 mmHg)

2-Vücudun üst kısmında yani karın ve bel bölgesinde bulunan yağ miktarının artması (bel çevresi ≥ 80 cm)

3-Açlık kan şekeri (glukoz) yüksekliği (≥ 100 mg/dL)

4-Kan yağlarından faydalı olan HDL-C miktarının azalması (≤ 50 mg/dL)

5-Kan yağlarından trigliserid miktarının artması ( ≥150 mg/dL)

Polikistik over sendromu olan kadınlarda metabolik sendrom daha sık görülmektedir.(12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36).

Polikistik over sendromu olan normal kilolu veya zayıf ya da fazla kilolu veya şişman kadınların bir kısmında karın ve bel çevresinde yağ miktarı fazla (erkek tipi yağlanma) olduğu için bel çevresi kalınlığı görülmektedir(5,6,7,8,9). Polikistik over sendromu olan ve bel çevresi kalın kadınlarda bel çevresi kalın olmayan aynı kiloya sahip kadınlara göre daha fazla oranda metabolik sendrom görülmektedir(10,11).

Polikistik over sendromu’nda fazla kilolu ve şişman olan veya normal kilolu fakat bel çevresi kalın (erkek tipi yağlanma) olan kadınların büyük çoğunluğunda insülin direnci görülmektedir(37,38,45,46). İnsülin direncinin ilerlemesi, kötüye gitmesi sonucunda bozulmuş glukoz (şeker) toleransı ve şeker hastalığı (Diabetes mellitus) gelişmektedir(39,40,41,42,43,44,47). Polikistik over sendromu olan kadınlarda genellikle insülin direnci daha hızlı bir şekilde ilerlediği, kötüye gittiği için bozulmuş şeker toleransı ve şeker hastalığı ergenlik (adolesan) döneminden itibaren daha genç yaşlarda ortaya çıkmaktadır(41,43,48). Bu nedenle polikistik over sendromu olan kadınlarda genç yaşlardan itibaren metabolik sendrom daha çok görülmektedir(14,16,24,25,49,50,51,52).

Erkeklik hormonlarının (androgen) etkisinin fazla olduğunu (hiperandrogenism) gösteren tüylenme artışı, erkek tipi saç dökülmesi, ciltte yağlanma artışı ve sivilce şikayetleri ile birlikte yumurta gelişiminin durması (anovulasyon) ya da yavaşlaması (oligoovulasyon) nedeniyle adet kanamasının gecikmesi (oligomenorrhea) veya olmaması (amenorrhea) şeklinde adet düzensizliği yaşayan kadınlar polikistik over sendromu’nun A grubuna girmektedir(53,54,55,56). A grubuna giren kadınlarda insülin direnci, bozulmuş şeker toleransı ve şeker hastalığı ve bunun sonucunda da metabolik sendrom ergenlik döneminden itibaren genç yaşlarda (< 40 yaş) polikistik over sendromu olmayan kadınlara göre daha sık görülmektedir(57,58,59,60,61,62,63,64).

Polikistik over sendromu’nun etkisi ve şiddeti 30 lu yaşlardan itibaren 40 lı yaşları takiben ve menopoz sonrası dönemde gittikçe azalmaktadır. Polikistik over sendromu olan kadınlarda fazla olan erkeklik hormonlarının miktarları (hiperandrogenism) yaş ilerledikçe 20 li yaşlardan itibaren özellikle 40 lı yaşları takiben azalmaktadır(72). Fazla sayıda olan yumurta (antral folikül) sayısının azalmasına bağlı olarak da yaş ilerledikçe bu kadınların  adet kanamaları daha düzenli (eumenorrhea) olmaya başlamakta ve hatta 30 lu yaşların ortalarından itibaren daha kolay gebe kalabilmektedirler(73,74,75,76). Polikistik over sendromu’nda görülen bu iyileşme nedeniyle 40 yaşından sonra ya da menopoz sonrasındaki dönemde fark kapanmakta olup polikistik over sendromu olan kadınlarda insülin direnci, bozulmuş şeker toleransı, şeker hastalığı ve metabolik sendrom polikistik over sendromu olmayanlarla aynı sıklıkta görülmektedir(33,65,66,67,68,69,70,71).

Polikistik over sendromu olan kadınların bir kısmında faydalı bir yağ olan HDL-kolesterol kan dolaşımında normalden daha az miktarda bulunurken, trigliserid ve LDL-kolesterol ise normalden daha fazla miktarlarda bulunmaktadır(77,78,79,80). Polikistik over sendromu olan kadınların büyük bir kısmında görülen insülin direnci HDL-kolesterol ve trigliserid miktarlarını etkilemektedir. LDL-kolesterol miktarındaki artış ise daha çok erkeklik hormonlarının (androgen) etkisinin fazla olması (hiperandrogenism) ile ilişkilidir(58,77,78,79,80).

Kalp ve damar hastalığı ihtimalini arttıran metabolik sendrom’un özelliklerden biri de kan basıncının yüksek (130 /80 mmHg) olmasıdır(58,81). Polikistik over sendromu olan kadınlarda kan basıncı yüksekliği sık görülmektedir(58,81,82). Bu kadınlarda kan basıncını en çok insülin direnci etkilemektedir(83). Erkeklik hormonlarının (androgen) etkisinin fazla olması (hiperandrogenism) da kan basıncını insülin direncinden daha az olmakla birlikte etkilemektedir(58,84,85,86).

Polikistik over sendromu olan kadınların kalp ve damar hastalıkları açısından mutlaka değerlendirilmesi gerekmektedir! Bu kadınların çok genç yaşlarda adet düzensizliği, çocuk isteği, tüylenme artışı, sivilce ve saç dökülmesi için kadın doğum uzmanına ya da cildiye uzmanına başvurmaları aslında yüksek olan kalp ve damar hastalıkları ve metabolik sendrom riskinin erken yaşlarda tespit edilmesi açısından önemli bir avantaj sağlamaktadır. Fakat, maalesef çoğunlukla kendi branşlarının dışında olduğu için ya da hastanın başvuru şikayetiyle ilgili olmadığı için kadın doğum ve cildiye uzmanları çok basit bir şekilde ölçülebilen kan basıncı, bel ve basen çevresi ölçümünü çoğunlukla yapmamaktadır. Çok genç yaşlarda doktora başvurmalarına rağmen bu kadınlarda sorun çıkma ihtimali yüksek olan kan yağları (trigliserid, kolesterol), insülin direnci, bozulmuş şeker toleransı ve şeker hastalığı testleri de çoğunlukla yapılmamaktadır.

Kaynaklar

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78-Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. Talbott E, Clerici A, Berga SL, Kuller L, Guzick D, Detre K, Daniels T, Engberg RA. J Clin Epidemiol. 1998 May;51(5):415-22.

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83-Hyperinsulinemia and obese phenotype differently influence blood pressure in young normotensive patients with polycystic ovary syndrome. Mioni R, Cà AD, Turra J, Azzolini S, Xamin N, Bleve L, Maffei P, Vettor R, Fallo F. Endocrine. 2017 Feb;55(2):625-634.

84-Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome. Chen MJ, Yang WS, Yang JH, Chen CL, Ho HN, Yang YS. Hypertension. 2007 Jun;49(6):1442-7.

85-Androgen receptor (AR) in cardiovascular diseases. Huang CK, Lee SO, Chang E, Pang H, Chang C. J Endocrinol. 2016 Apr;229(1):R1-R16.

86-Hypertension in women with polycystic ovary syndrome: prevalence and associated cardiovascular risk factors. Shi Y , Cui Y, Sun X, Ma G, Ma Z, Gao Q, Chen ZJ.Eur J Obstet Gynecol Reprod Biol. 2014 Feb;173:66-7.

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