Screening patients with polycystic ovary syndrome for cushing's syndrome

SEZGİN, Hacer; GÜR USLU, Emine; AYAZ, Teslime; ilkkilic, kadir; ALGÜN, Ekrem; ŞAHİN BAYDUR, Serap

Screening patients with polycystic ovary syndrome for cushing's syndrome

Serap ŞAHİN BAYDUR, (Recep Tayyip Erdoğan Üniversitesi, Tıp Fakültesi, Endokrinoloji ve Metabolizma Anabilim Dalı, Rize, Türkiye)

Hacer SEZGİN, (Recep Tayyip Erdoğan Üniversitesi, Tıp Fakültesi, Aile Hekimliği Anabilim Dalı, Rize, Türkiye)

Teslime AYAZ, (Recep Tayyip Erdoğan Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Rize, Türkiye)

Emine GÜR USLU, (Recep Tayyip Erdoğan Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Rize, Türkiye)

Kadir İLKKILIÇ, (Recep Tayyip Erdoğan Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Rize, Türkiye)

Ekrem ALGÜN (Recep Tayyip Erdoğan Üniversitesi, Tıp Fakültesi, Endokrinoloji ve Metabolizma Anabilim Dalı, Rize, Türkiye)

İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi

5 0

Yıl: 2014 Cilt: 21 Sayı: 3 Sayfa Aralığı: 215 - 219 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Screening patients with polycystic ovary syndrome for cushing's syndrome

Öz:

Amaç : Polikistik over sendromu (PKOS) ve Cushing sendromu hirsutizm, menstrual düzensizlik, obezite, glukoz intoleransı, dislipidemi gibibirçok ortak klinik bulguya sahiptir. Bu çalışmanın amacı hirsutizm ve/veya menstrual düzensizlik nedeniyle başvuran ve PKOS tanısıkoyduğumuz hastaları Cushing sendromu açısından taramaktır.Gereç ve Yöntemler: Çalışmaya PKOS tanısı koyduğumuz, yaşları 14-35 arasında değişen 109 hasta dahil edildi. Tüm hastalardaantropometrik, hormonal ve metabolik ölçümler yapıldı. Cushing sendromu açısından tüm hastalara 1 mg- deksametazon supresyon testi(DST) uygulandı.Bulgular : Hastaların ortalama beden kitle indeksi ölçümleri 35.6± 9.5 kg/m 2 olup, hastaların %75.2sini obez grup oluşturuyordu. Hastalarınortalama Ferriman- Gallwey skoru 12.6 ± 3.7 olup, %61.1inde menstrual düzensizlik mevcuttu. Hastaların ortalama açlık plazma glukozdüzeyleri 96.5 ± 12.8 mg/dl iken, ortalama HOMA-IR değerleri 3.2± 1.9 olarak saptandı. Hastaların %52.3ünde HOMA-IR>2.7 olarakbulundu. Hastalar 1 mg DST ile tarandığında; sadece 3 hastada kortizol düzeylerinde supresyon olmadı. Daha sonra üç hastaya da 2 gün 2mg DST uygulandı ve her üç hastada da kortizol düzeylerinin 1.8 μg/dlnin altına indiği görüldü. Ciddi hirsutizmi olan hastalarda (n=34)ortalama1-mg DST değeri 0.73 ± 0.7 mg/dL idi; fakat hafif ya da orta düzeyde hirsutizmi olan hastalarda bu değer 0.64 ± 0.4 mg/dL olaraksaptandı (p=0.427).Sonuç: Polikistik over sendromu tanısı koyduğumuz genç kadınların hiçbirinde Cushing sendromu saptanmadı.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Polikistik over sendromu tanılı hastaların cushing sendromu açısından taranması

Öz:

Objective: Polycystic ovary syndrome (PCOS) and Cushing s syndrome share several clinical features such as hirsutism, irregular menses,obesity, glucose intolerance and dyslipidemia. The aim of this study was to investigate the presence of Cushing s syndrome in patients whowere admitted with the complaints of hirsutism and/or irregular menses and were diagnosed with PCOS.Material and Methods: One hundred nine patients with PCOS (aged 14-35 years) were included in the study. We evaluatedanthropometric, hormonal, and metabolic parameters. All the patients were evaluated with 1-mg dexamethasone suppression test (DST)for Cushing s syndrome.Results: The mean body mass index of the patients was 35.6 ± 9.5 kg/m 2 and 75.2% of the patients were obese. The mean Ferriman-Gallwey score of the patients was 12.6 ± 3.7 and 61.1% of them had menstural irregularities. While the mean fasting plasma glucose levelof the patients was 96.5 ± 12.8 mg/dl, mean value of HOMA-IR was 3.2 ± 1.9. We observed HOMA-IR>2.7 in 52.3% of the patients. Threepatients failed to suppress plasma cortisol following1 mg- dexamethasone administration. Then, we performed 2-day 2 mg DST andobserved that all the three patients suppressed cortisol levels to less than 1.8 μg/dl. In patients with severe hirsutism (n=34) the average 1-mg DST result was 0.73 ± 0.7 mg/dL in patients with mild and moderate hirsutism (n=75), however, this value was 0.64 ± 0.4 mg/dL(p=0.427).Conclusion: We did not observe Cushing s syndrome in the young women who were diagnosed with PCOS.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-9.
2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:1925.
3. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril 2002;77:1095-105.
4. Wild RA. Long-term health consequences of PCOS. Hum Reprod Update 2002;8:231-41.
5. Legro RS. Polycystic ovary syndrome and cardiovascular disease: a premature association? Endocr Rev 2003;24:302- 12.
6. Trivax B, Azziz R. Diagnosis of polycystic ovary syndrome. Clin Obstet Gynecol 2007;50:168-77.
7. Pall ME, Lao MC, Patel SS, Lee ML, Ghods DE, Chandler DW et al. Testosterone and bioavailable testosterone help to distinguish between mild Cushing's syndrome and polycystic ovarian syndrome. Horm Metab Res 2008;40:813- 8.
8. Huang J, Ni R, Chen X, Huang L, Mo Y, Yang D. Metabolic abnormalities in adolescents with polycystic ovary syndrome in south China. Reprod Biol Endocrinol 2010;8:142.
9. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. Clin Endocrinol Metab 2008;93:1526-40.
10. Friedman TC, Ghods DE, Shahinian HK, Zachery L, Shayesteh N, Seasholtz S et al. High prevalence of normal tests assessing hypercortisolism in subjects with mild and episodic Cushing's syndrome suggests that the paradigm for diagnosis and exclusion of Cushing's syndrome requires multiple testing. Horm Metab Res 2010;42:874-81.
11. Ness-Abramof R, Nabriski D, Apovian CM, et al. Overnight dexamethasone suppression test: a reliable screen for Cushings syndrome in the obese. Obes Res 2002;10:1217- 21.
12. Etxabe J, Vazquez JA. Morbidity and mortality in Cushing disease: an epidemiological approach. Clin Endocrinol(Oxf) 1994;40:47984.
13. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome. Fertility and Sterility 2004;81:19-25.
14. Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961;21:14407.
15. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:4129.
16. Gokcel A, Ozsahin AK, Sezgin N, Karakose H, Ertorer ME, Akbaba M. et al. High prevalence of diabetes in Adana, a southern province of Turkey. Diabetes Care 2003; 26:3031- 4.
17. Lindholm J, Juul S, Jørgensen JO, Astrup J, Bjerre P, Feldt- Rasmussen U et al. Incidence and late prognosis of Cushing's syndrome: a population-based study. J Clin Endocrinol Metab 2001;86:117-23.
18. Glintborg D, Henriksen JE, Andersen M, Hagen C, Hangaard J, Rasmussen PE et al. Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 Caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 2004;82:1570-9.
19. Karaca Z, Acmaz B, Acmaz G, Tanriverdi F, Unluhizarci K, Aribas S ve ark. Routine screening for Cushing's syndrome is not required in patients presenting with hirsutism. Eur J Endocrinol 2013;168:379-84.
20. Kaltsas GA, Korbonits M, Isidori AM, Webb JA, Trainer PJ, Monson JP et al. How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing's syndrome? Clin Endocrinol (Oxf) 2000;53:493-500.
21. Tiryakioglu O, Ugurlu S, Yalin S, Yirmibescik S, Caglar E, Yetkin DO ve ark. Screening for Cushing's syndrome in obese patients. Clinics (Sao Paulo) 2010;65:9-13.
22. Sahin M, Kebapcilar L, Taslipinar A, Azal O, Ozgurtas T, Corakci A ve ark. Comparison of 1 mg and 2 mg overnight dexamethasone suppression tests for the screening of Cushing's syndrome in obese patients. Intern Med 2009;48:33-9.
23. Invitti C, Pecori Giraldi F, Dubini A, De Martin M, Cavagnini F. Increased urinary free cortisol and decreased serum corticosteroid-binding globulin in polycystic ovary syndrome. Acta Endocrinol (Copenh). 1991;125:28-32.
24. Putignano P, Bertolini M, Losa M, Cavagnini F. Screening for Cushing's syndrome in obese women with and without polycystic ovary syndrome. J Endocrinol Invest 2003;26:539- 44.
25. Invitti C, De Martin M, Delitala G, Veldhuis JD, Cavagnini F. Altered morning and nighttime pulsatile corticotropin and cortisol release in polycystic ovary syndrome. Metabolism 1998;47:143-8.

APA	ŞAHİN BAYDUR S, SEZGİN H, AYAZ T, GÜR USLU E, ilkkilic k, ALGÜN E (2014). Screening patients with polycystic ovary syndrome for cushing's syndrome. , 215 - 219.
Chicago	ŞAHİN BAYDUR Serap,SEZGİN Hacer,AYAZ Teslime,GÜR USLU Emine,ilkkilic kadir,ALGÜN Ekrem Screening patients with polycystic ovary syndrome for cushing's syndrome. (2014): 215 - 219.
MLA	ŞAHİN BAYDUR Serap,SEZGİN Hacer,AYAZ Teslime,GÜR USLU Emine,ilkkilic kadir,ALGÜN Ekrem Screening patients with polycystic ovary syndrome for cushing's syndrome. , 2014, ss.215 - 219.
AMA	ŞAHİN BAYDUR S,SEZGİN H,AYAZ T,GÜR USLU E,ilkkilic k,ALGÜN E Screening patients with polycystic ovary syndrome for cushing's syndrome. . 2014; 215 - 219.
Vancouver	ŞAHİN BAYDUR S,SEZGİN H,AYAZ T,GÜR USLU E,ilkkilic k,ALGÜN E Screening patients with polycystic ovary syndrome for cushing's syndrome. . 2014; 215 - 219.
IEEE	ŞAHİN BAYDUR S,SEZGİN H,AYAZ T,GÜR USLU E,ilkkilic k,ALGÜN E "Screening patients with polycystic ovary syndrome for cushing's syndrome." , ss.215 - 219, 2014.
ISNAD	ŞAHİN BAYDUR, Serap vd. "Screening patients with polycystic ovary syndrome for cushing's syndrome". (2014), 215-219.

APA	ŞAHİN BAYDUR S, SEZGİN H, AYAZ T, GÜR USLU E, ilkkilic k, ALGÜN E (2014). Screening patients with polycystic ovary syndrome for cushing's syndrome. İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi, 21(3), 215 - 219.
Chicago	ŞAHİN BAYDUR Serap,SEZGİN Hacer,AYAZ Teslime,GÜR USLU Emine,ilkkilic kadir,ALGÜN Ekrem Screening patients with polycystic ovary syndrome for cushing's syndrome. İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi 21, no.3 (2014): 215 - 219.
MLA	ŞAHİN BAYDUR Serap,SEZGİN Hacer,AYAZ Teslime,GÜR USLU Emine,ilkkilic kadir,ALGÜN Ekrem Screening patients with polycystic ovary syndrome for cushing's syndrome. İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi, vol.21, no.3, 2014, ss.215 - 219.
AMA	ŞAHİN BAYDUR S,SEZGİN H,AYAZ T,GÜR USLU E,ilkkilic k,ALGÜN E Screening patients with polycystic ovary syndrome for cushing's syndrome. İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi. 2014; 21(3): 215 - 219.
Vancouver	ŞAHİN BAYDUR S,SEZGİN H,AYAZ T,GÜR USLU E,ilkkilic k,ALGÜN E Screening patients with polycystic ovary syndrome for cushing's syndrome. İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi. 2014; 21(3): 215 - 219.
IEEE	ŞAHİN BAYDUR S,SEZGİN H,AYAZ T,GÜR USLU E,ilkkilic k,ALGÜN E "Screening patients with polycystic ovary syndrome for cushing's syndrome." İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi, 21, ss.215 - 219, 2014.
ISNAD	ŞAHİN BAYDUR, Serap vd. "Screening patients with polycystic ovary syndrome for cushing's syndrome". İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi 21/3 (2014), 215-219.