多囊卵巢综合征(PCOS)

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Company Logo,*,多囊卵巢综合征（,PCOS,）,与代谢综合征（,MS,）,病例分享和讨论,时间：,2008,年,7,月,28,日下午,2,：,30,5,：,30,地点：广州市海珠广场华夏大酒店,十一楼国际会议中心,广东省医学会内分泌分会暨妇产科学分会主办,施贵宝公司协办,Company Logo,病例汇报,中山二院妇产科,患者梁, ,，女，,22,岁，,因“月经不规则,10,年”来诊,初潮,12,岁，月经一直不规则，,5-6/23-37,天，量多,近两年体重增加,7kg,爷爷、伯父、父亲均有高血压，外婆有糖尿病,母亲月经规则，父亲无秃顶,病例,1,Company Logo,BP 100/70mmHg,H 160cm Wt 69Kg BMI,27,kg/m,2,WC 89cm HC 100cm WHR,0.89,甲状腺无肿大,乳房,未扪及包块，,无溢乳,颈项部见,轻度黑棘皮征,痤疮评分：,0,分,多毛评分（,F-G,评分）：上唇,1,下颌,0,胸,1,，背上,2,，背下,0,（共,4,分）,上腹,0,，下腹,0,，大腿,0,，上臂,0,妇检未见异常,体格检查,:,Company Logo,阴道,B,超,:,子宫,：,后位,51mm26mm37mm47mm,，肌层回声均匀,内膜,8mm,，,A,型,左卵巢：,45mm22mm26mm,容积：,13.5ml(10ml),内见卵泡约,9,个,最大直径,10mm,右卵巢：,39mm18mm25mm,容积：,9.2ml,内见直径小于,9mm,卵泡约,12,个,(12,个,),Company Logo,性激素,:,PRL 18.32,g/L FSH 3.41 IU/L LH 2.58 IU/L,E,2,9.62 ng/L,T 0.98 nmol/L,雄激素分类,:,F-T 3.63 pg/L DHEA 1512 ng/ml,SHBG,25.61,nmol/L (60-68),17-OHP 0.41 ng/ml TSH,2.50 mIu/L,OGTT,胰岛素释放试验,:,0h 1h 2h,血糖,(mmol/L) 5.9 10.7 4.8,胰岛素,(mIU/L),19.2 162 316,HOMA-IR,5.03,(2.14),血脂,(,mmol/L),:,CHOL,6.44,(6.00),TG,2.52,(1.7 ),HDL-C 1.64 LDL-C,3.89,(3.60),实验室检查,Company Logo,多囊卵巢综合征,(PCOS),胰岛素抵抗,代谢综合征,诊断,Company Logo,患者杨,女, 25,岁,因“月经稀发,8,+,年，淋漓不净,12,天”来诊,17,岁初潮，月经一直稀发，周期,26,个月不等，行经,56,天，量中等。,2008,年,3,月,18,日外院,B,超提示“双侧卵巢呈多囊样改变”。,末次月经,2008,年,5,月,19,日，至今淋漓不净,院外已用倍美力。,已婚,G,1,P,0,A,1,，,2004,年人流一次。,父亲糖尿病、无秃顶,伯父秃顶,母亲月经规则,病例,2,Company Logo,BP,121/79mmHg,H,148cm,Wt,55.5Kg,BMI,25,kg/m,2,WC,84cm,HC,94cm,WHR,0.89,甲状腺无肿大,乳房,未扪及包块，,无溢乳。,无黑棘皮征,痤疮评分：,1,分,散在分布于面部，,10,个,多毛评分（,F-G,评分）：上唇,0,下颌,0,胸,1,，背上,1,背下,0,(,共,3,分） 上腹,0,下腹,1,大腿,0,上臂,0,妇检未发现异常,体格检查,Company Logo,阴道,B,超,:,子宫,:,前位,46mm16mm29mm40mm,内膜,7mm,，,A,型,左卵巢,:30mm16mm27mmmm,容积：,6.8ml,内见卵泡约,13,个,最大直径,6mm,右卵巢,:26mm20mm29mm,容积：,7.9ml,内见卵泡约,12,个,最大直径,7mm,Company Logo,性激素,:,PRL 13.54,g/L,FSH 7.9 IU/L LH 10.79 IU/L,E,2,49.22 ng/L,T 3.99 nmol/L,(2.60,),雄激素分类,:,F-T 6.85 pg/L(6.0),DHEA 2713 ng/ml,SHBG 19.94 nmol/L,(6068),17-OHP 1.18 ng/ml TSH,1.60 mIu/L,OGTT,胰岛素释放试验,:,0h 1h 2h,血糖,(mmol/L) 4.5 9.8,8.0,胰岛素,(mIU/L) 3.3 139,160,HOMA-IR 0.66 (2.14),血脂,(,mmol/L),CHOL 4.58,TG,2.28 (1.7),HDL-C 1.32 LDL-C 2.64,实验室检查,Company Logo,诊断,多囊卵巢综合征（,PCOS,）,糖耐量受损（,IGT,）,高胰岛素血症,高脂血症,Company Logo,患者过,，女，,17,岁，,因“月经稀发,3,年，闭经,2,年”来诊,14,岁初潮，一直月经稀发，周期,5070,天不等，一年,仅有次月经， 行经,5,天，量少。现已闭经,2,年。否,认性生活史，无周期性腹痛。,近,3,年体重增加约,20kg,出现大腿摩擦至外阴皮肤疼痛,出生体重,4kg,一直体重较重,父亲患糖尿病，奶奶高血压；父母均较胖，母亲月经规则,病例,3,Company Logo,BP,131/82 mmHg,Wt 90 kg H,170 cm BMI,31 kg/m,2,WC 102 cm HC,112 cm WHR,0.92,甲状腺无肿大,乳房,Tanner ,期，,未扪及包块，,无溢乳,颈项处见黑棘皮征,痤疮评分：,1,分,面部及肩背部散在分布,10,个,多毛评分（,F-G,评分）,：,上唇,2,下颌,2,胸,1,乳周,1,，背上,1,，背下,2,(,总分,18,） 上腹,2,下腹,3,大腿,3,上臂,1,妇科情况 外阴女性型，,皮肤色素深,阴毛,Tanner,期,女性分布，浓密,体格检查,Company Logo,子宫,:,后位,39mm,27mm,30mm,22mm,，,内膜,5mm,左卵巢：,42mm24mm23mm,内见小卵泡约,15,个,最大直径,8mm,另探及高回声光团：,22mm19mm,考虑畸胎瘤可能,右卵巢：,21mm,17mm,16mm,容积：,2.99ml,内见直径,2-7mm,卵泡约,12,个,直肠,B,超,Company Logo,性激素,:,PRL 12.78,g/L,FSH 5.35 IU/L LH 10.49 IU/L,E,2,42.76 ng/L T,4.00 nmol/,L,(2.60),雄激素分类,:,F-T 3.78 pg/L DHEA 751 ng/ml,SHBG,30.37 nmol/L (6068),17-OHP 0.91 ng/ml,TSH,3.61 mIU/L FT,3,2.29 mIU/L,FT,4,17.6 mIU/L,OGTT,胰岛素释放试验,:,0h 1h 2h,血糖,(mmol/L),5.3 11.2,8.0,胰岛素,(mIU/L),35.10,259,386,HOMA-IR,8.3,(2.14),血脂,(,mmol/L):,CHOL 5.67 TG,2.54,(1.3) LDL-C 3.53,实验室检查,Company Logo,诊断,青春期多囊卵巢综合征,胰岛素抵抗,糖耐量受损,代谢综合征,Company Logo,Company Logo,病例,4,患者陈某,女, 28,岁,因“月经稀发,9,年，无避孕未孕,1,年”来诊,13,岁初潮，既往月经规则，,5-6,天,/30,天，经量较多，,9,年前开始出现月经稀发，,5-6,天,/2-4,月，经量少，常须用,药（,E+P,）来经。,近,7,年体重逐渐增加约,10kg,，伴明显痤疮。,结婚,1,年,无避孕一直未孕。外院予,CC,促排卵示“无卵泡生,长”。造影示双侧输卵管通畅,G,0,P,0,A,0,父亲高血压、无秃顶，母亲糖尿病，月经规则,足月顺产，出生体重,3.1kg,Company Logo,Company Logo,体格检查：,BP 90/60mmHg,H 155cm W 55kg BMI 24kg/m,2,WC,83,cm,(80 ),HC 90cm WHR,0.92(0.85),面部皮肤粗糙,油光明显，痤疮评分,3,分，无黑棘皮征，,甲状腺无肿大,乳房未扪及包块，无溢乳,多毛评分,(FG,评分,):,上唇,2,下颌,0,，胸,1,，上腹,0,，下腹,1,，,(,共,10,分,),上背,1,下背,0,，腿,3,，臂,2,妇科检查未见异常,Company Logo,Company Logo,阴道,B,超,:,子宫,:,后位,37mm26mm42mm37mm,，,肌层回声均匀,.,内膜,4mm,，,A,型,左卵巢：,30mm20mm26mm,V=,7.80,ml,(10),内见直径小于,6mm,卵泡约,19,个,(12),右卵巢：,35mm19mm30mm,V=,9.98,ml,(10),内见直径小于,7mm,卵泡约,15,个,(10),Company Logo,Company Logo,实验室检查：,性激素,: PRL 6.54ug/L FSH 4.98IU/L LH 16.89IU/L,E,2,63.25ng/l T,2.96,nmol/L,(2.60),雄激素分类,: FT,10.28,pg/mL,(6.60),DHEAS,2648,ng/ml,(2170),SHBG,41.29,nmol/L,(60-68),17-OHP:1.21ng/ml TSH,：,2.14mIU/L,血脂,(,mmol/L),:,CHOL 4.20 TG 1.53,HDL-C 1.64,LDL-C 2.13,OGTT-,胰岛素释放试验,:,0h 1h 2h,血糖,(mmol/L) 5.6 10.1,9.4,胰岛素,(mIU/L),17.7,115,185,HOMA-IR,4.42(2.14),Company Logo,诊断,:,多囊卵巢综合征（,PCOS,）,糖耐量受损,(IGT),高胰岛素血症,Company Logo,Company Logo,患者吴某，女，,31,岁。因“月经不调,11,+,年”来诊,20,岁初潮，一直月经稀发，,5-6,天,/2-3,月，经量少，无痛经。,2004,年开始出现不规则出血，,20,+,天,/10,+,天,-3,月，常须用药止血，,2005,年开始出现闭经，用黄体酮后仍无月经来潮,.,2006,年,1,月当地查内分泌示,PRL 10.2ug/L,FSH 3.48IU/L,LH 3.85 IU/L,E,2,0.78ng/l,T 13nmol/L(3),内仅见直径小于,5mm,卵泡,2,个,右卵巢：,28mm15mm27mm,V=5.67ml,内仅见直径小于,9mm,卵泡,3,个,Company Logo,Company Logo,实验室检查：,性激素,: PRL 19.07ug/L FSH 4.25IU/L LH 2.46IU/L,E,2,222.02ng/l T,11.51,nmol/L,(2.60),雄激素分类,: FT 3.76pg/mL,DHEAS,5654,ng/ml,(2170),SHBG 87.59nmol/L,17-OHP,27.2,ng/ml,(3.00),TSH,：,3.24mIU/ml,血脂,(,mmol/L),:,CHOL 3.40 TG 1.26 HDL-C 1.71,LDL-C 2.86,OGTT-,胰岛素释放试验,:,0h 1h 2h,血糖,(mmol/L),4.5,4.8 4.2,胰岛素,(mU/L) 3.09 18.6 12.3,HOMA-IR,0.618(2.14),低剂量地塞米松抑制试验,(,地塞米松,0.75mg,Qd7,天,):,复查,17-OHP 3.27ng/ml,Company Logo,诊断,:,先天性肾上腺皮质增生症,青春期延迟,Company Logo,Company Logo,患者莫某，女，,26,岁,因“月经稀发,9,+,年，经期延长,3,月”来诊,17,岁初潮，以后月经稀发，,6-7,天,/2-3,月，经量中等，无痛经 ，近,3,月开始出现经期延长，,10+,天,/30-40,天。,外院,B,超示“双卵巢呈多囊样改变，弓状子宫”,未婚,有性生活史，,G,0,P,0,A,0,否认糖尿病、高血压、高血脂、肥胖、心血管疾病家族史,母亲月经规则，父亲无秃顶,无生殖道畸形及月经异常家族史。,孕,34,周剖腹产出生，宫内窘迫史，出生体重,2.10kg,病例,6,Company Logo,Company Logo,体格检查：,BP 110/70mmHg,H,153cm,W 45kg BMI 19.22kg/m,2,WC 66cm HC 82cm WHR 0.80,面部皮肤粗糙,痤疮评分,2,分,无喉结,声音较粗,无黑棘皮症,肢体毛发及腋毛粗长。,甲状腺无肿大,乳房达,Tanner IV,期,无溢乳,未扪及包块,.,FG,评分：上唇,3,，下颌,0,，胸,0,，背上,1,，背下,1,，上腹,0,，下腹,1,，,大腿,0,，上臂,0,（共,6,分）,妇科检查：,外阴外观正常,阴毛达,Tanner IV,期,浓密，呈倒三角形分,布，阴蒂未见肥大，阴道通畅，宫颈光滑，子宫前位，,常大，质中，无压痛，双附件区未扪及包块，无压痛。,Company Logo,Company Logo,子宫,:,前位,52mm21mm38mm46mm,，肌层回声均匀,内膜,7mm,，,A,型,左卵巢：,38mm19mm20mm,V=7.22ml,内见直径小于,9mm,卵泡约,12,个,(12),右卵巢：,28mm19mm41mm, V=,10.9,ml,(10),内见直径小于,8mm,卵泡约,13,个,(12),阴道,B,超,:,Company Logo,Company Logo,实验室检查：,性激素,: PRL 14.8ug/L FSH 5.06IU/L LH 12.34IU/L,E,2,95ng/l T,3.1,nmol/L,(2.60),雄激素分类,: FT 2.85pg/mL,DHEAS,2126,ng/ml,(2170),SHBG 92.41nmol/L,17-OHP:5.03ng/ml(3.00),TSH,：,2.17mIU/ml.,血脂,(mmol/L):,CHOL,6.12(6.00),TG 1.62,LDL-C,3.90 (3.60),HDL-C 1.76,OGTT-,胰岛素释放试验,:,0h 1h 2h,血糖,(mmol/L) 4.0 5.8,4.2,胰岛素,(mIU/L),4.5,33.6 14.5,HOMA-IR 0.8(2.14),低剂量地塞米松抑制试验,:,地塞米松,0.75mg,Qd7,天,复查,17-OHP:1.19 ng/ml,Company Logo,诊断,:,迟发性先天性肾上腺皮质增生症,双侧卵巢多囊样改变,高脂血症,Company Logo,Thank You !,Company Logo,