{"id":7937,"date":"2025-09-27T19:26:04","date_gmt":"2025-09-27T19:26:04","guid":{"rendered":"https:\/\/polikistikover.net\/yeni\/?page_id=7937"},"modified":"2025-12-03T00:23:56","modified_gmt":"2025-12-03T00:23:56","slug":"polikistik-over-sendromunda-klitoris-buyumesi-klitoromegali","status":"publish","type":"page","link":"https:\/\/polikistikover.net\/yeni\/polikistik-over-sendromunda-klitoris-buyumesi-klitoromegali\/","title":{"rendered":"Polikistik over sendromu\u2019nda Klitoris B\u00fcy\u00fcmesi (Klitoromegali)"},"content":{"rendered":"\n

1-<\/mark> Polikistik over sendromu ve b\u00f6brek \u00fcst\u00fc bezinin fazla \u00e7al\u0131\u015fmas\u0131n\u0131n (Non-Classic Congenital Adrenal Hyperplasia) neden oldu\u011fu klitoris b\u00fcy\u00fcmesinin tedavisi klitoris b\u00fcy\u00fckl\u00fc\u011f\u00fcne ve bu durumun ki\u015finin g\u00fcnl\u00fck hayat\u0131n\u0131 ne kadar etkiledi\u011fine ba\u011fl\u0131 olarak de\u011fi\u015fmektedir.<\/strong><\/p>\n\n\n\n

2-<\/mark> <\/strong>\u0130leri bir a\u015famaya ula\u015fm\u0131\u015f olan klitoris b\u00fcy\u00fcmesi ila\u00e7 tedavisi ile birlikte yap\u0131lan ameliyat (reduction clitoroplasty) ile k\u00fc\u00e7\u00fclt\u00fclebilmektedir<\/strong> (16). Fakat, ameliyat tedavisinden \u00f6nce altta yatan hormonal sorunun tedavi edilmesi gerekmektedir.<\/strong><\/mark><\/p>\n\n\n\n

\u0130drar \u00e7\u0131k\u0131\u015f\u0131n\u0131n oldu\u011fu yer olan \u00fcretran\u0131n yakla\u015f\u0131k 3 cm \u00fcst\u00fcnde sol ve sa\u011f i\u00e7 dudaklar\u0131n birle\u015fti\u011fi yerden, d\u0131\u015f dudaklar\u0131n birle\u015fti\u011fi yere kadar uzanan b\u00f6lgede kad\u0131nlarda erkeklik organ\u0131 penis in kar\u015f\u0131l\u0131\u011f\u0131 olan klitoris bulunmaktad\u0131r(1). <\/mark><\/strong><\/p>\n\n\n\n

1-<\/mark><\/strong> Klitoris b\u00fcy\u00fckl\u00fc\u011f\u00fc klitoral index denilen bir y\u00f6ntemle hesaplan\u0131r.<\/p>\n\n\n\n

2-<\/mark><\/strong> Clitoral index (Klitoral indeks); klitoris ba\u015f\u0131n\u0131n en (mm) ve boy uzunlu\u011funun (mm) \u00e7arp\u0131lmas\u0131 sonucu elde edilen (mm2<\/sup>) \u00f6l\u00e7\u00fcd\u00fcr (2).<\/p>\n\n\n\n

3-<\/mark><\/strong> \u00dcreme \u00e7a\u011f\u0131ndaki kad\u0131nlarda klitoral indeks ortalama 18 mm2 <\/sup>d\u0131r.<\/p>\n\n\n\n

 4-<\/mark><\/strong>17-35 ya\u015f aras\u0131nda bulunan kad\u0131nlar\u0131n da b\u00fcy\u00fck \u00e7o\u011funlu\u011funda (%95) klitoral indeks 35 mm2<\/sup> den k\u00fc\u00e7\u00fckt\u00fcr (3).<\/p>\n\n\n\n

5-<\/mark><\/strong> Klitoral indeksi 35  mm2 <\/sup>den daha fazla olan kad\u0131nlar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funda erkeklik hormonlar\u0131n\u0131n miktar\u0131 veya etkinli\u011fi artm\u0131\u015f olarak bulunmaktad\u0131r (3,4).<\/p>\n\n\n\n

Erkeklik hormonlar\u0131n\u0131n miktar\u0131n\u0131n veya etkinli\u011finin art\u0131\u015f\u0131n\u0131 g\u00f6steren t\u00fcylenme art\u0131\u015f\u0131, sivilce, sa\u00e7 d\u00f6k\u00fclmesi, adet d\u00fczensizli\u011fi, meme geli\u015fiminin ve b\u00fcy\u00fcmesinin durmas\u0131, kas miktar\u0131n\u0131n art\u0131\u015f\u0131, cinsel istek art\u0131\u015f\u0131, ses kal\u0131nla\u015fmas\u0131 gibi belirtilerden sadece bir tanesi olan kad\u0131nlar\u0131n yakla\u015f\u0131k yar\u0131s\u0131nda klitoris b\u00fcy\u00fcmesi de yani  35  mm2 <\/sup>den daha b\u00fcy\u00fck klitoral indeks g\u00f6r\u00fclmektedir (3).<\/mark><\/strong><\/p>\n\n\n\n

Klitoris b\u00fcy\u00fcmesi erkeklik hormonlar\u0131n\u0131n miktar\u0131n\u0131n ve etkinli\u011finin art\u0131\u015f\u0131n\u0131 g\u00f6steren t\u00fcylenme art\u0131\u015f\u0131, sivilce, erkek tipi sa\u00e7 d\u00f6k\u00fclmesi, meme geli\u015fiminin ve b\u00fcy\u00fcmesinin durmas\u0131, kas miktar\u0131n\u0131n art\u0131\u015f\u0131, cinsel istek art\u0131\u015f\u0131, ses kal\u0131nla\u015fmas\u0131 gibi ba\u015fka bir belirti olmadan tek ba\u015f\u0131na da g\u00f6r\u00fclebilmektedir (4,5,6).<\/mark><\/strong><\/p>\n\n\n\n

Ergenlik d\u00f6nemini de kapsayan \u00fcreme \u00e7a\u011f\u0131ndaki kad\u0131nlarda klitoris b\u00fcy\u00fcmesine en fazla polikistik over sendromu ve do\u011fu\u015ftan b\u00f6brek \u00fcst\u00fc bezinde 21-Hidroksilaz (21-Hydroxylase) enzim \u00fcretiminin az olmas\u0131 ya da hi\u00e7 olmamas\u0131na ba\u011fl\u0131 olarak ortaya \u00e7\u0131kan b\u00f6brek \u00fcst\u00fc bezinin fazla \u00e7al\u0131\u015fmas\u0131 (Non-Classic Congenital Adrenal Hyperplasia) neden olmaktad\u0131r.<\/mark><\/strong><\/p>\n\n\n\n

Klitorisin b\u00fcy\u00fcmesi b\u00f6brek \u00fcst\u00fc bezi fazla \u00e7al\u0131\u015fan kad\u0131nlar\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131nda g\u00f6r\u00fcl\u00fcrken, polikistik over sendromu olan kad\u0131nlarda daha az s\u0131kl\u0131kta g\u00f6r\u00fclmektedir (7,8,9,10,11).<\/mark><\/strong><\/p>\n\n\n\n

 B\u00f6brek \u00fcst\u00fc bezi fazla \u00e7al\u0131\u015fan ki\u015filerde klitoris b\u00fcy\u00fcmesi \u00e7o\u011funlukla ergenlik d\u00f6neminde veya daha k\u00fc\u00e7\u00fck ya\u015flarda ortaya \u00e7\u0131karken, polikistik over sendromu\u2019nda \u00e7o\u011funlukla ergenlik d\u00f6nemi veya daha ileri ya\u015flarda g\u00f6r\u00fclmektedir (7). <\/p>\n\n\n\n

Polikistik over sendromu ve b\u00f6brek \u00fcst\u00fc bezinin fazla \u00e7al\u0131\u015fmas\u0131na (Non-Classic Congenital Adrenal Hyperplasia) ba\u011fl\u0131 olarak g\u00f6r\u00fclen klitoris b\u00fcy\u00fcmesine g\u00f6re daha az s\u0131kl\u0131kla kar\u015f\u0131la\u015f\u0131lan erkeklik hormonu \u00fcreten yumurtal\u0131k ve b\u00f6brek \u00fcst\u00fc bezi t\u00fcm\u00f6rlerinin bir k\u0131sm\u0131 da klitoris b\u00fcy\u00fcmesine neden olmaktad\u0131r (12,13).<\/p>\n\n\n\n

Ergenlik d\u00f6neminde s\u0131k tekrarlanan masturbasyon yap\u0131lmas\u0131 ve klitoris te enfeksiyona ba\u011fl\u0131 abse, kist veya herhangi ba\u015fka bir kitle olmas\u0131 polikistik over sendromu, b\u00f6brek \u00fcst\u00fc bezinin fazla \u00e7al\u0131\u015fmas\u0131 veya erkeklik hormonu \u00fcreten t\u00fcm\u00f6rlerinden farkl\u0131 olarak erkeklik hormonlar\u0131na ba\u011fl\u0131 olmayan klitoris b\u00fcy\u00fcmesine neden olmaktad\u0131r (14,15).<\/p>\n\n\n\n

Erkeklik hormonlar\u0131n\u0131n (testosteron, dihidrotestosteron) b\u00fcy\u00fck bir k\u0131sm\u0131 b\u00f6brek \u00fcst\u00fc bezinde (Adrenal Gland) \u00fcretilen DHEA (Dehydroepiandrosterone) ve Androstenedione hormonlar\u0131n\u0131 hammadde olarak kullanarak k\u0131l k\u00f6kleri ve ya\u011f bezlerinin bulundu\u011fu deri gibi ayn\u0131 zamanda erkeklik hormonlar\u0131n\u0131n (testosteron, dihidrotestosteron) hedefi olan organlarda \u00fcretilirken ancak k\u00fc\u00e7\u00fck bir k\u0131sm\u0131 yumurtal\u0131k ve b\u00f6brek \u00fcst\u00fc bezinde \u00fcretilmektedir (Intracrinology)(17,18).<\/p>\n\n\n\n

Kan dola\u015f\u0131m\u0131nda bulunan testosteron miktar\u0131 sadece yumurtal\u0131k ve b\u00f6brek \u00fcst\u00fc bezinden direk olarak sal\u0131nan miktar\u0131 g\u00f6stermektedir.<\/p>\n\n\n\n

Kad\u0131nlarda testosteron hormonunun b\u00fcy\u00fck k\u0131sm\u0131n\u0131n \u00fcretildi\u011fi deri, ya\u011f dokusu, meme gibi organlardan ancak k\u00fc\u00e7\u00fck bir miktar (%10) testosteron kan dola\u015f\u0131m\u0131na girmektedir(19).<\/p>\n\n\n\n

Kan dola\u015f\u0131m\u0131na girmeyen testosteron hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu ise 5- \u03b1 reduktaz (reductase) enzimi taraf\u0131ndan dihidrotestosteron (dhydrotestosterone) hormonuna d\u00f6n\u00fc\u015fmektedir(20,21,22). Dihidrotestosteron hormonu testosteron hormonundan 10 kat daha g\u00fc\u00e7l\u00fc bir etkiye sahiptir(23).<\/p>\n\n\n\n

Dihidrotestosteron hormonunun da testosteron hormonu gibi b\u00fcy\u00fck \u00e7o\u011funlu\u011fu (%90) kan dola\u015f\u0131m\u0131na girmemektedir(21,24). Dhidrotestosteron (DHT) hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu UGT- enzimi ile herhangi bir hormon etkisi olmayan \u00fcr\u00fcnler (metabolit) olan 3 \u03b1- androstanediol glucuronide (3\u03b1 diol G) ve androsterone Glucuronide (ADT-G) d\u00f6n\u00fc\u015ferek deri h\u00fccresinden kan dola\u015f\u0131m\u0131na girmektedir(25,26,28).<\/p>\n\n\n\n

Kan dola\u015f\u0131m\u0131na kat\u0131lan 3 \u03b1- androstanediol glucuronide (3\u03b1 diol G) ve androsterone Glucuronide (ADT-G) idrar yolu ile v\u00fccuttan at\u0131lmaktad\u0131r(25,26,27,28).<\/p>\n\n\n\n

Tedavi;<\/strong><\/p>\n\n\n\n

1-<\/mark>Polikistik over sendromu ve b\u00f6brek \u00fcst\u00fc bezinin fazla \u00e7al\u0131\u015fmas\u0131n\u0131n (Non-Classic Congenital Adrenal Hyperplasia) neden oldu\u011fu klitoris b\u00fcy\u00fcmesinin tedavisi klitoris b\u00fcy\u00fckl\u00fc\u011f\u00fcne ve bu durumun ki\u015finin g\u00fcnl\u00fck hayat\u0131n\u0131 ne kadar etkiledi\u011fine ba\u011fl\u0131 olarak de\u011fi\u015fmektedir.<\/strong><\/p>\n\n\n\n

2-<\/mark>\u0130leri bir a\u015famaya\u00a0ula\u015fm\u0131\u015f olan klitoris b\u00fcy\u00fcmesi ila\u00e7 tedavisi ile birlikte yap\u0131lan ameliyat (reduction clitoroplasty) ile k\u00fc\u00e7\u00fclt\u00fclebilmektedir\u00a0(16).\u00a0Fakat, ameliyat tedavisinden \u00f6nce altta yatan hormonal sorunun tedavi edilmesi gerekmektedir.<\/strong><\/p>\n\n\n\n

Tedavi Y\u00f6ntemleri;<\/strong><\/p>\n\n\n\n

 Dihidrotestosteron hormonuna d\u00f6n\u00fc\u015fen erkeklik hormonlar\u0131n\u0131n (testosteron, androstenedione, DHEAS) etkinli\u011finin ve miktar\u0131n\u0131n azalt\u0131lmas\u0131, dihidrotestosteron hormonuna d\u00f6n\u00fc\u015f\u00fcm\u00fcn azalt\u0131lmas\u0131 ve Sex Hormon Binding Globulin miktar\u0131n\u0131n artt\u0131r\u0131lmas\u0131 sonucunda kan dola\u015f\u0131m\u0131nda serbest bulunan erkeklik hormonlar\u0131n\u0131n etkin formlar\u0131n\u0131n (serbest testosteron) miktar\u0131n\u0131n azalt\u0131lmas\u0131 tedavinin temel amac\u0131d\u0131r.<\/mark><\/strong><\/p>\n\n\n\n

1-<\/mark><\/strong>\u0130ns\u00fclin direnci olan kad\u0131nlarda ins\u00fclin duyarl\u0131l\u0131\u011f\u0131n\u0131n ila\u00e7 tedavisi ile artt\u0131r\u0131lmas\u0131na ba\u011fl\u0131 olarak kan dola\u015f\u0131m\u0131nda bulunan ins\u00fclin miktar\u0131n\u0131n azalmas\u0131 yumurtal\u0131kta fazla miktarda \u00fcretilen erkeklik hormonlar\u0131n\u0131 (androstenedione, testosteron) azaltmaktad\u0131r(29,30). \u0130ns\u00fclin direncinin azalmas\u0131 ayn\u0131 zamanda karaci\u011ferde \u00fcretilen SHBG miktar\u0131n\u0131 artt\u0131rmakta ve erkeklik hormonlar\u0131n\u0131n serbest dola\u015fan etkin formlar\u0131n\u0131n (serbest testosteron ) miktar\u0131n\u0131n azalmas\u0131na neden olmaktad\u0131r(29,30).<\/p>\n\n\n\n

2-<\/mark><\/strong>Kan dola\u015f\u0131m\u0131nda bulunan erkeklik hormonlar\u0131n\u0131n bir k\u0131sm\u0131  al\u0131c\u0131lara (androgen receptor) tutunarak etki etmektedir. Erkeklik hormonlar\u0131n\u0131n al\u0131c\u0131lara tutunmas\u0131n\u0131n engellenmesi (androgen receptor antagonist) di\u011fer bir tedavi se\u00e7ene\u011fidir(31,32,33). Bu ama\u00e7la kullan\u0131lan ila\u00e7lar\u0131n (androgen receptor antagonist) do\u011fum kontrol haplar\u0131 gibi hayati tehlikeye sahip yan etkileri (bacak damarlar\u0131n\u0131n p\u0131ht\u0131 ile t\u0131kanmas\u0131 ve ordan kopan p\u0131ht\u0131 par\u00e7as\u0131n\u0131n da akci\u011fer damarlar\u0131n\u0131 t\u0131kamas\u0131 ve meme kanseri) yoktur(34,35,36).<\/p>\n\n\n\n

3-<\/mark><\/strong>Al\u0131c\u0131lara (receptor) tutunarak h\u00fccre i\u00e7ine giren testosteron ile h\u00fccre i\u00e7inde \u00fcretilen testosteron hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu 5- \u03b1 reduktaz (reductase) enzimi taraf\u0131ndan dihidrotestosteron (dhydrotestosterone) hormonuna d\u00f6n\u00fc\u015fmektedir(20,21,22). 5- \u03b1 reduktaz (reductase)enziminin bu etkisinin engellenmesi ( 5- \u03b1  reductase inhibitor) de bir tedavi se\u00e7ene\u011fidir(37,38,39). Bu ama\u00e7la kullan\u0131lan ila\u00e7lar\u0131n ( 5-\u03b1 reductase inhibitor) do\u011fum kontrol haplar\u0131 gibi hayati tehlikeye sahip yan etkileri (bacak damarlar\u0131n\u0131n p\u0131ht\u0131 ile t\u0131kanmas\u0131 ve ordan kopan p\u0131ht\u0131 par\u00e7as\u0131n\u0131n da akci\u011fer damarlar\u0131n\u0131 t\u0131kamas\u0131 ve meme kanseri) yoktur(40).<\/p>\n\n\n\n

4-<\/mark>\u0130leri bir a\u015famaya ula\u015fm\u0131\u015f olan klitoris b\u00fcy\u00fcmesi ila\u00e7 tedavisi ile birlikte yap\u0131lan ameliyat (reduction clitoroplasty) ile k\u00fc\u00e7\u00fclt\u00fclebilmektedir (16). Fakat, ameliyat tedavisinden \u00f6nce altta yatan hormonal sorunun tedavi edilmesi gerekmektedir.<\/mark><\/strong><\/p>\n\n\n\n

Kaynaklar<\/strong><\/p>\n\n\n\n

1-Anatomy of the Clitoris: Revision and Clarifications about the Anatomical Terms for the Clitoris Proposed (without Scientific Bases) by Helen O\u2019Connell, Emmanuele Jannini, and Odile Buisson. Puppo V. ISRN Obstet Gynecol. 2011;2011:261464.<\/p>\n\n\n\n

2-Office gynecology: some facts about the clitoris. Huffman JW.  Postgrad Med. 1976 Nov;60(5):245-7.<\/p>\n\n\n\n

3-The clitoral index: a bioassay of androgenic stimulation. Tagatz GE, Kopher RA, Nagel TC, Okagaki T. Obstet Gynecol. 1979 Nov;54(5):562-4.<\/p>\n\n\n\n

4-Plasma androgens, 17 beta-estradiol, and sex hormone-binding globulin in patients with hirsutism and\/or clitoromegaly. Mathur RS, Holtz G, Baker ER, Moody LO, Landgrebe SC, Rust PF, Williamson HO. Fertil Steril. 1981 Aug;36(2):188-93.<\/p>\n\n\n\n

5-21-Hydroxylase-deficient nonclassic adrenal hyperplasia is a progressive disorder: a multicenter study. Moran C, Azziz R, Carmina E, Dewailly D, Fruzzetti F, Iba\u00f1ez L, Knochenhauer ES, Marcondes JA, Mendonca BB, Pignatelli D,Pugeat M, Rohmer V, Speiser PW, Witchel SF.  Am J Obstet Gynecol. 2000 Dec;183(6):1468-74.<\/p>\n\n\n\n

6-The Presence of Clitoromegaly  in the Nonclassical Form of 21-Hydroxylase Deficiency Could Be Partially Modulated by the CAG Polymorphic Tract of the Androgen Receptor Gene. Moura-Massari VO, Cunha FS, Gomes LG, Bugano Diniz Gomes D, Marcondes JA, Madureira G, de Mendonca BB,Bachega TA. PloS One. 2016 Feb 5;11(2):e0148548.<\/p>\n\n\n\n

7-21-Hydroxylase-deficient nonclassic adrenal hyperplasia is a progressive disorder: a multicenter study. Moran C, Azziz R, Carmina E, Dewailly D, Fruzzetti F, Iba\u00f1ez L, Knochenhauer ES, Marcondes JA, Mendonca BB, Pignatelli D,Pugeat M, Rohmer V, Speiser PW, Witchel SF. Am J Obstet Gynecol. 2000 Dec;183(6):1468-74.<\/p>\n\n\n\n

8-Clitoral and labial sizes in women w\u0131th PCOS. K\u00f6\u015f\u00fc\u015f A, Kamalak Z, K\u00f6\u015f\u00fc\u015f N, Hizli D, Eser A. J Obstet Gynaecol. 2016;36(1):97-101.<\/p>\n\n\n\n

9-Polycystic ovary syndrome: Is obesity a sine qua non? A clinical, hormonal, and metabolic assessment in relation to body mass index. Saxena P, Prakash A, Nigam A, Mishra A. Indian J Endocrinol Metab.<\/a> 2012 Nov;16(6):996-9.<\/p>\n\n\n\n

10-A Case of Unusual Clitoromegaly . Ch\u2019ng TW, Umpaichitra V. J Pediatr Adolesc Gynecol. 2018 Oct;31(5):543-545.<\/p>\n\n\n\n

11-Clinical practice. Hirsutism. Rosenfield RL. N Engl J Med. 2005 Dec 15;353(24):2578-88.<\/p>\n\n\n\n

12-Childhood adrenocortical tumors. Sandrini R, Ribeiro RC, DeLacerda L. J Clin Endocrinol Metab. 1997 Jul;82(7):2027-31.<\/p>\n\n\n\n

13-Juvenile Granulosa Cell Tumor of the Ovary: A Clinicopathologic Study.Wu H, Pangas SA, Eldin KW, Patel KR, Hicks J, Dietrich JE, Venkatramani R. J Pediatr Adolesc Gynecol. 2017 Feb;30(1):138-143.<\/p>\n\n\n\n

14-Clitoromegaly in neurofibromatosis. Sutphen R, Gal\u00e1n-Gom\u00e9z E, Kousseff BG. Am J Med Genet. 1995 Jan 30;55(3):325-30.<\/p>\n\n\n\n

15-Acquired clitoral enlargement. Diagnosis and treatment. Horejs\u00ed J. Ann N Y Acad Sci. 1997 Jun 17;816:369-72.<\/p>\n\n\n\n

16-Primary amenorrhoea and clitoromegaly in a nulliparous woman: successful medical and surgical management. Nigam A, Elahi AA, Varun N, Gupta N. BMJ  Case Rep. 2018 Sep 30; 2018.<\/p>\n\n\n\n

17-Intracrinology. Labrie F. Mol Cell Endocrinol. 1991 Jul;78(3):C113-8.<\/p>\n\n\n\n

18-Endocrine and intracrine sources of androgens in women: inhibition of breast cancer and other roles of androgens and their precursor dehydroepiandrosterone. Labrie F, Luu-The V, Labrie C, B\u00e9langer A, Simard J, Lin SX, Pelletier G. Endocr Rev. 2003 Apr;24(2):152-82.<\/p>\n\n\n\n

19-DHEA and its transformation into androgens and estrogens in peripheral target tissues: intracrinology. Labrie F, Luu-The V, Labrie C, Simard J. Front Neuroendocrinol. 2001 Jul;22(3):185-212.<\/p>\n\n\n\n

20-Sexual hormones in human skin. Zouboulis CC, Chen WC, Thornton MJ, Qin K, Rosenfield R. Horm Metab Res. 2007 Feb;39(2):85-95.<\/p>\n\n\n\n

21-Dihydrotestosterone is a peripheral paracrine hormone. Horton R. J Androl. 1992 Jan-Feb;13(1):23-7.<\/p>\n\n\n\n

22-Tissue distribution and ontogeny of steroid 5 alpha-reductase isozyme expression. Thigpen AE, Silver RI, Guileyardo JM, Casey ML, McConnell JD, Russell DW. J Clin Invest. 1993 Aug;92(2):903-10.<\/p>\n\n\n\n

23-Relative binding affinity of anabolic-androgenic steroids: comparison of the binding to the androgen receptors in skeletal muscle and in prostate, as well as to sex hormone-binding globulin. Saartok T, Dahlberg E, Gustafsson JA. Endocrinology. 1984 Jun;114(6):2100-6.<\/p>\n\n\n\n

24-Origin of plasma androstanediol glucuronide in men. Moghissi E  , Ablan F, Horton R. J Clin Endocrinol Metab. 1984 Sep;59(3):417-21.<\/p>\n\n\n\n

25-Quantitative determination of beta-glucuronidase in sweat gland and other skin components in cystic fibrosis. Gibbs GE, Friffin GD.J Invest Dermatol. 1968 Sep;51(3):200-3.<\/p>\n\n\n\n

26-Inactivation of androgens by UDP-glucuronosyltransferase enzymes in humans. B\u00e9langer A, Pelletier G, Labrie F, Barbier O, Chouinard S. Trends Endocrinol Metab. 2003 Dec;14(10):473-9.<\/p>\n\n\n\n

27-Inactivation by UDP-glucuronosyltransferase enzymes: the end of androgen signaling. Chouinard S, Yueh MF, Tukey RH, Giton F, Fiet J, Pelletier G, Barbier O, B\u00e9langer A. J Steroid Biochem Mol Biol. 2008 Apr;109(3-5):247-53.<\/p>\n\n\n\n

28-Androgen glucuronides, instead of testosterone, as the new markers of androgenic activity in women. Labrie F, B\u00e9langer A, B\u00e9langer P, B\u00e9rub\u00e9 R, Martel C, Cusan L, Gomez J, Candas B, Castiel I, Chaussade V, Deloche C, Leclaire J. J Steroid Biochem Mol Biol. 2006 Jun;99(4-5):182-8.<\/p>\n\n\n\n

29-Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. Cosma M, Swiglo BA, Flynn DN, Kurtz DM, Labella ML, Mullan RJ, Elamin MB, Erwin PJ, Montori VM. J Clin Endocrinol Metab. 2008 Apr;93(4):1135-42.<\/p>\n\n\n\n

30- Treatment Options for Hirsutism: A Systematic Review and Network Meta- Analysis . Barrionuevo P, Nabhan M, Altayar O, Wang Z, Erwin PJ, Asi N, Martin KA, Murad MH. J Clin Endocrinol Metab. 2018 Apr 1;103(4):1258-1264.<\/p>\n\n\n\n

31-The endocrine effects of spironolactone used as an antiandrogen. Young RL, Goldzieher JW, Elkind-Hirsch K. Fertil Steril. 1987 Aug;48(2):223-8.<\/p>\n\n\n\n

32-A systematic review of commonly used medical treatments for hirsutism in women. Koulouri O, Conway GS. Clin Endocrinol (Oxf). May;68(5):800-5.<\/p>\n\n\n\n

33-Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial. Moghetti P, Tosi F, Tosti A, Negri C, Misciali C, Perrone F, Caputo M, Muggeo M, Castello R. J Clin Endocrinol Metab. 2000 Jan;85(1):89-94.<\/p>\n\n\n\n

34-Spironolactone and risk of incident breast cancer in women older than 55 years: retrospective, matched cohort study. Mackenzie IS, Macdonald TM, Thompson A, Morant S, Wei L. BMJ. 2012 Jul 13;345:e4447.<\/p>\n\n\n\n

35-Spironolactone use and risk of incident cancers: a retrospective, matched cohort study. Mackenzie IS, Morant SV, Wei L, Thompson AM, MacDonald TM. Br J Clin Pharmacol. 2017 Mar;83(3):653-663.<\/p>\n\n\n\n

36-Spironolactone use and the risk of breast and gynecologic cancers. Biggar RJ, Andersen EW, Wohlfahrt J, Melbye M. Cancer Epidemiol. 2013 Dec;37(6):870-5.<\/p>\n\n\n\n

37-Hypersecretion of androstenedione by isolated thecal cells from polycystic ovaries. Gilling-Smith C, Willis DS, Beard RW, Franks S. J Clin Endocrinol Metab. 1994 Oct;79(4):1158-65.<\/p>\n\n\n\n

38-Hyperinsulinemia amplifies GnRH agonist stimulated ovarian steroid secretion in women with polycystic ovary syndrome. Tosi F, Negri C, Perrone F, Dorizzi R, Castello R, Bonora E, Moghetti P. J Clin Endocrinol Metab. 2012 May;97(5):1712-9.<\/p>\n\n\n\n

39-Oestradiol feedback stimulation of androgen biosynthesis by human theca cells. Gilling-Smith C, Willis DS, Franks S. Hum Reprod. 1997 Aug;12(8):1621-8.<\/p>\n\n\n\n

40-Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review. Hirshburg JM, Kelsey PA, Therrien CA, Gavino AC, Reichenberg JS. J Clin Aesthet Dermatol. 2016 Jul;9(7):56-62.<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

1- Polikistik over sendromu ve b\u00f6brek \u00fcst\u00fc bezinin fazla \u00e7al\u0131\u015fmas\u0131n\u0131n (Non-Classic Congenital Adrenal Hyperplasia) neden oldu\u011fu klitoris b\u00fcy\u00fcmesinin tedavisi klitoris b\u00fcy\u00fckl\u00fc\u011f\u00fcne ve bu durumun ki\u015finin g\u00fcnl\u00fck hayat\u0131n\u0131 ne kadar etkiledi\u011fine ba\u011fl\u0131 olarak de\u011fi\u015fmektedir. 2- \u0130leri bir a\u015famaya ula\u015fm\u0131\u015f olan klitoris b\u00fcy\u00fcmesi ila\u00e7 tedavisi ile birlikte yap\u0131lan ameliyat (reduction clitoroplasty) ile k\u00fc\u00e7\u00fclt\u00fclebilmektedir (16). Fakat, ameliyat tedavisinden \u00f6nce altta yatan […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7937","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/7937","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/comments?post=7937"}],"version-history":[{"count":23,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/7937\/revisions"}],"predecessor-version":[{"id":13009,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/7937\/revisions\/13009"}],"wp:attachment":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/media?parent=7937"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}