{"id":7985,"date":"2025-09-27T19:57:46","date_gmt":"2025-09-27T19:57:46","guid":{"rendered":"https:\/\/polikistikover.net\/yeni\/?page_id=7985"},"modified":"2025-11-21T02:27:16","modified_gmt":"2025-11-21T02:27:16","slug":"polikistik-over-sendromunda-meme-gelisimi","status":"publish","type":"page","link":"https:\/\/polikistikover.net\/yeni\/polikistik-over-sendromunda-meme-gelisimi\/","title":{"rendered":"Polikistik Over Sendromu\u2019nda Meme Geli\u015fimi"},"content":{"rendered":"\n

Gen\u00e7 k\u0131zlarda ergenlik d\u00f6neminin \u00e7o\u011funlukla ilk belirtisi olan meme geli\u015fimi 8 ile 13 ya\u015flar\u0131 aras\u0131nda ba\u015flamaktad\u0131r. Meme geli\u015fimi genellikle 18 ya\u015f\u0131na kadar tamamlanmakla birlikte bazen 20 li ya\u015flara kadar devam etmektedir.<\/mark><\/strong><\/p>\n\n\n\n

Meme geli\u015fimini ve b\u00fcy\u00fcmesini (h\u00fccre \u00e7o\u011falmas\u0131) b\u00fcy\u00fck oranda iki temel fakt\u00f6r belirlemektedir;<\/strong><\/p>\n\n\n\n

1-<\/mark><\/strong>Genetik (Ailesel); Aile hikayesi polikistik over sendromu olmayan ki\u015filerde meme geli\u015fimi ve b\u00fcy\u00fckl\u00fc\u011f\u00fc \u00fczerine olduk\u00e7a fazla belirleyici etkiye sahiptir. Fakat, polikistik over sendromu\u2019nda genetik etkilerle birlikte erkeklik hormonlar\u0131 (testosteron, dihidrotestosteron) da meme geli\u015fimi ve b\u00fcy\u00fcmesini etkilemektedir.<\/p>\n\n\n\n

2-<\/mark><\/strong>Hormonlar; Ergenlikle birlikte yumurtal\u0131klarda daha fazla miktarda \u00fcretilmeye ba\u015flanan \u00f6strojen hormonu meme dokusunda bulunan \u00f6strojen al\u0131c\u0131lar\u0131na (ER\u03b1) ve progesteron hormonu progesteron al\u0131c\u0131lar\u0131na tutunarak meme geli\u015fimini ve b\u00fcy\u00fcmesini sa\u011flamaktad\u0131r(1,2,3,4,16).<\/p>\n\n\n

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\"\"<\/figure>\n<\/div>\n\n\n

Meme;<\/strong> S\u00fct kesecikleri (alveoli), s\u00fct kanallar\u0131 ve onlar\u0131 \u00e7evreleyen destek dokusu<\/strong><\/em><\/p>\n\n\n\n

Erkeklik hormonlar\u0131 (testosteron ve dihidrotestosteron) meme dokusunda bulunan erkeklik hormonu al\u0131c\u0131lar\u0131na (resept\u00f6r) tutunarak \u00f6strojen hormonuna ters bir etki g\u00f6sterip meme geli\u015fimini ve b\u00fcy\u00fcmesini engellemektedir(5,6,13,14,15,17). \u00d6strojen (Estradiol) ve erkeklik hormonlar\u0131n\u0131n miktarlar\u0131nda meydana gelen art\u0131\u015f veya azal\u0131\u015flar meme geli\u015fimi ve b\u00fcy\u00fcmesinde de\u011fi\u015fikliklere neden olurlar.<\/mark><\/strong><\/p>\n\n\n

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\"\"<\/figure>\n<\/div>\n\n\n

Yumurtal\u0131klar\u0131n ve b\u00f6brek \u00fcst\u00fc bezlerinin kan dola\u015f\u0131m\u0131nda ve h\u00fccre i\u00e7inde (deride k\u0131l k\u00f6kleri ve ya\u011f bezleri) bulunan testosteron miktarlar\u0131na olan katk\u0131lar\u0131<\/em><\/strong><\/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 deri ve meme ve ya\u011f dokusu 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)(18,19).<\/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. Kad\u0131nlarda testosteron hormonunun b\u00fcy\u00fck k\u0131sm\u0131n\u0131n \u00fcretildi\u011fi meme, deri, ya\u011f dokusu gibi organlardan ancak k\u00fc\u00e7\u00fck bir miktar (%10) testosteron kan dola\u015f\u0131m\u0131na girmektedir(20).<\/p>\n\n\n\n

Kan dola\u015f\u0131m\u0131na girmeyen testosteron hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu ise 5-\u00a0\u03b1 reduktaz (reductase) enzimi taraf\u0131ndan dihidrotestosteron (dhydrotestosterone) hormonuna d\u00f6n\u00fc\u015fmektedir(21,22,23). Dihidrotestosteron hormonu testosteron hormonundan 10 kat daha g\u00fc\u00e7l\u00fc bir etkiye sahiptir(24). Dihidrotestosteron hormonunun da testosteron hormonu gibi b\u00fcy\u00fck \u00e7o\u011funlu\u011fu (%90) kan dola\u015f\u0131m\u0131na girmemektedir(23). Meme, deri ve ya\u011f h\u00fccresinde \u00fcretilen\u00a0dihidrotestosteron (DHT) hormonunun b\u00fcy\u00fck \u00e7o\u011funlu\u011fu UGT- enzimi ile herhangi bir hormon etkisi olmayan \u00fcr\u00fcnler\u00a0(metabolit) olan 3\u00a0\u03b1- androstanediol glucuronide (3\u03b1 diol G) ve androsterone Glucuronide (ADT-G) d\u00f6n\u00fc\u015ferek meme, deri ve ya\u011f h\u00fccresinden kan dola\u015f\u0131m\u0131na girmektedir(25,26,27,28,29). Kan dola\u015f\u0131m\u0131na kat\u0131lan 3\u00a0\u03b1- androstanediol glucuronide (3\u03b1 diol G) ve androsterone Glucuronide (ADT-G) idrar yolu ile v\u00fccuttan at\u0131lmaktad\u0131r(25,26,27,28,29).<\/p>\n\n\n

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\"\"<\/figure>\n<\/div>\n\n\n

Erkeklik hormonlar\u0131 testosteron ve DHT (dihidrotestosteron) (dihydrotestosterone), erkeklik hormonlar\u0131n\u0131n hammaddesi DHEA (dehidroepiandrosteron)(dehydrotestosterone) ve erkeklik hormonlar\u0131n\u0131n y\u0131k\u0131m \u00fcr\u00fcnlerinin ADT-G (androsterone glucuronide) ve 3 \u03b1-diol-G ( 3 \u03b1-androstanediol glucuronide) kan dola\u015f\u0131m\u0131nda ve h\u00fccre i\u00e7inde (meme, deri ve ya\u011f dokusu) bulunan miktarlar\u0131n\u0131n da\u011f\u0131l\u0131m\u0131. Testosteron ve Dihidrotestosteron hormonlar\u0131n\u0131 g\u00f6steren mavi ve sar\u0131 dikd\u00f6rtgenlerin y\u00fckseklikleri bu maddelerin miktarlar\u0131 ile orant\u0131l\u0131d\u0131r.<\/em><\/p>\n\n\n\n

1-<\/mark><\/strong>\u00dcreme \u00e7a\u011f\u0131ndaki kad\u0131nlarda adet d\u00f6ng\u00fcs\u00fcn\u00fcn ortas\u0131na do\u011fru olan d\u00f6nemde testosteron ve \u00f6strojen hormonlar\u0131 fazla miktarda \u00fcretilir, fakat yumurtlama sonras\u0131 (luteal faz) d\u00f6nemde testosteron hormonu miktar\u0131 azalmaya ba\u015flarken, \u00f6strojen hormonu miktar\u0131 fazla miktarda \u00fcretilmeye devam eder (7). Bu nedenle meme b\u00fcy\u00fcmesi (h\u00fccre \u00e7o\u011falmas\u0131) en fazla yumurtlama sonras\u0131 d\u00f6nemde (luteal) g\u00f6r\u00fclmektedir(8). \u00d6strojen hormonu miktar\u0131n\u0131n en az oldu\u011fu buna kar\u015f\u0131l\u0131k testosteron hormonunun fazla oldu\u011fu yumurtlama \u00f6ncesi d\u00f6nem i\u00e7inde (folik\u00fcler faz) meme geli\u015fimi durmakta ve hatta meme k\u00fc\u00e7\u00fclmesi (apoptosis) olmaktad\u0131r(7).<\/p>\n\n\n\n

2-<\/mark><\/strong>Menopoz sonras\u0131nda \u00f6strojen miktar\u0131 testosteron miktar\u0131na g\u00f6re \u00e7ok daha fazla azalmaktad\u0131r(7). Testosteron hormonu miktar\u0131n\u0131n \u00f6strojen hormonu miktar\u0131ndan fazla olmas\u0131 menopoz sonras\u0131nda meme dokusunun k\u00fc\u00e7\u00fclmesine (atrofi) neden olmaktad\u0131r.<\/p>\n\n\n\n

3-<\/mark><\/strong>\u0130<\/mark>ste\u011fe ba\u011fl\u0131 olarak erkeklik hormonu i\u00e7eren ila\u00e7lar\u0131n\u0131n kullan\u0131lmas\u0131 nedeniyle kad\u0131n sporcular (atletler) ve cinsiyet de\u011fi\u015ftirenler (erkek cinsiyeti tercih eden kad\u0131nlar) de meme dokusunda k\u00fc\u00e7\u00fclme ortaya \u00e7\u0131kmaktad\u0131r(9,10,11). <\/p>\n\n\n\n

4-<\/mark><\/strong>Genetik olarak (Do\u011fu\u015ftan) erkeklik hormonu al\u0131c\u0131lar\u0131 olmayan erkeklerde (Androgen insensitivity syndrome) erkeklik hormonlar\u0131 \u00e7al\u0131\u015fmamaktad\u0131r. Bu nedenle \u00f6strojen hormonunun meme b\u00fcy\u00fct\u00fcc\u00fc etkisine kar\u015f\u0131 koyacak erkeklik hormonu etkisi olmad\u0131\u011f\u0131 i\u00e7in bu erkeklerde meme geli\u015fimi ve b\u00fcy\u00fckl\u00fc\u011f\u00fc kad\u0131nlarda oldu\u011fu gibi tam olarak olu\u015fmaktad\u0131r (12).<\/p>\n\n\n\n

Polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131nda (grup A ve C) \u00f6zellikle meme geli\u015fimi ve b\u00fcy\u00fcmesine etki eden erkeklik hormonlar\u0131 (testosteron ve dihidrotestosteron) ergenlik d\u00f6neminde fazla miktarda \u00fcretilmektedir.<\/p>\n\n\n\n

Polikistik over sendromu olan kad\u0131nlar\u0131n bir k\u0131sm\u0131 ergenlik d\u00f6neminde meme geli\u015fimi ve b\u00fcy\u00fcmesi s\u0131ras\u0131nda \u00f6strojen hormonuna kar\u015f\u0131 fazla miktarda erkeklik hormonuna maruz kalmaktad\u0131r. Bu kad\u0131nlarda maruz kald\u0131klar\u0131 erkeklik hormonu miktar\u0131na paralel olarak meme geli\u015fimi ve b\u00fcy\u00fcmesi yava\u015flamaktad\u0131r. Hatta bu ki\u015filerde erkeklik hormonu miktar\u0131n\u0131n ne kadar fazla \u00fcretildi\u011fine ba\u011fl\u0131 olarak meme b\u00fcy\u00fcmesi durabilmektedir.<\/mark><\/strong><\/p>\n\n\n\n

<\/p>\n\n\n\n

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

Polikistik over sendromu\u2019nun meme geli\u015fimi ve b\u00fcy\u00fcmesi s\u00fcreci tamamlanmadan daha \u00f6nce erken te\u015fhis edilmesi ve tedaviye ba\u015flan\u0131lmas\u0131 fazla miktarda \u00fcretilen erkeklik hormonlar\u0131n\u0131n meme \u00fczerine olan olumsuz etkilerini engellemektedir.<\/mark><\/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.<\/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(30,31). \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(30,31).<\/p>\n\n\n\n

2-<\/mark><\/strong>Kan dola\u015f\u0131m\u0131nda bulunan erkeklik hormonlar\u0131n\u0131n bir k\u0131sm\u0131 meme h\u00fccresinde bulunan 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(32,33,34). 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(35,36).<\/p>\n\n\n\n

3-<\/mark><\/strong>Al\u0131c\u0131lara (receptor) tutunarak meme h\u00fccresi 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). 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(38).<\/p>\n\n\n\n

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

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2-Form and function: how estrogen and progesterone regulate the mammary epithelial hierarchy. Arendt LM, Kuperwasser C. J Mammary Gland Biol Neoplasia. 2015 Jun;20(1-2):9-25.<\/p>\n\n\n\n

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4-Pattern of distribution of cells positive for estrogen receptor alpha and progesterone receptor in relation to proliferating cells in the mammary gland. Russo J, Ao X, Grill C, Russo IH. Breast Cancer Res Treat. 1999 Feb;53(3):217-27.<\/p>\n\n\n\n

5-Differential effects of exogenous androgen and an androgen receptor antagonist in the peri- and postpubertal murine mammary gland. Peters AA, Ingman WV, Tilley WD, Butler LM. Endocrinology. 2011 Oct;152(10):3728-37.<\/p>\n\n\n\n

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8-Estrogens, progestogens, normal breast cell proliferation, and breast cancer risk. Pike MC, Spicer DV, Dahmoush L, Press MF. Epidemiol Rev. 1993; 15(1):17-35.<\/p>\n\n\n\n

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10-An immunohistochemical study of the long-term effects of androgen administration on female-to-male transsexual breast: a comparison with normal female breast and male breast showing gynaecomastia. Burgess HE, Shousha S. J Pathol. 1993 May;170(1):37-43.<\/p>\n\n\n\n

11-Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Grynberg M, Fanchin R, Dubost G, Colau JC, Br\u00e9mont-Weil C, Frydman R, Ayoubi JM. Reprod Biomed Online 2010 Apr;20(4):553-8.<\/p>\n\n\n\n

12-Molecular biology of androgen insensitivity. J\u00e4\u00e4skel\u00e4inen J. Mol Cell Endocrinol. 2012 Apr 16;352(1-2):4-12.<\/p>\n\n\n\n

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14-Cloning of human androgen receptor complementary DNA and localization to the X chromosome. Lubahn DB, Joseph DR, Sullivan PM, Willard HF, French FS, Wilson EM. Science. 1988 Apr 15;240(4850):327-30.<\/p>\n\n\n\n

15-Characterization and expression of a cDNA encoding the human androgen receptor. Tilley WD, Marcelli M, Wilson JD, McPhaul MJ Proc Natl Acad Sci U S A. 1989 Jan;86(1):327-31.<\/p>\n\n\n\n

16-Sequence and expression of human estrogen receptor complementary DNA. Greene GL, Gilna P, Waterfield M, Baker A, Hort Y, Shine J. Science. 1986 Mar 7;231(4742):1150-4.<\/p>\n\n\n\n

17-Androgen receptor inactivation resulted in acceleration in pubertal mammary gland growth, upregulation of ER\u03b1 expression, and Wnt\/\u03b2-catenin signaling in female mice. Gao YR, Walters KA, Desai R, Zhou H, Handelsman DJ, Simanainen U. Endocrinology. 2014 Dec;155(12):4951-63.<\/p>\n\n\n\n

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

19-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

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21-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

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

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24-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

25-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

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Gen\u00e7 k\u0131zlarda ergenlik d\u00f6neminin \u00e7o\u011funlukla ilk belirtisi olan meme geli\u015fimi 8 ile 13 ya\u015flar\u0131 aras\u0131nda ba\u015flamaktad\u0131r. Meme geli\u015fimi genellikle 18 ya\u015f\u0131na kadar tamamlanmakla birlikte bazen 20 li ya\u015flara kadar devam etmektedir. Meme geli\u015fimini ve b\u00fcy\u00fcmesini (h\u00fccre \u00e7o\u011falmas\u0131) b\u00fcy\u00fck oranda iki temel fakt\u00f6r belirlemektedir; 1-Genetik (Ailesel); Aile hikayesi polikistik over sendromu olmayan ki\u015filerde meme geli\u015fimi ve b\u00fcy\u00fckl\u00fc\u011f\u00fc […]<\/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-7985","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/7985","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=7985"}],"version-history":[{"count":28,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/7985\/revisions"}],"predecessor-version":[{"id":10380,"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/pages\/7985\/revisions\/10380"}],"wp:attachment":[{"href":"https:\/\/polikistikover.net\/yeni\/wp-json\/wp\/v2\/media?parent=7985"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}