References

medalphabet

Медицинский алфавит

Medical alphabet

2078-56312949-2807

ООО «Альфмед»

10.33667/2078-5631-2021-26-8-13

medalphabet-2173

Research Article

СОВРЕМЕННАЯ ГИНЕКОЛОГИЯ

MODERN GYNECOLOGY

Основные принципы диагностики и лечения заболеваний в составе синдрома гиперандрогении

Basic principles of diagnosis and treatment of diseases as part of hyperandrogenic syndrome

https://orcid.org/0000-0001-5541-3767

Кузнецова

И. В.

Kuznetsova

I. V.

Кузнецова Ирина Всеволодовна, доктор медицинских наук, профессор, советник директора

Москва

Kuznetsova Irina V., DM Sci, professor, director’s advisor

Moscow

ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава РоссииРоссияNational Medical Research Centre for Obstetrics, Gynecology and Perinatology n.a. academician V.I. KulakovRussian Federation

2021

24092021

026

Современная гинекология (2)

813

2021

Кузнецова И.В.

Kuznetsova I.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-alphabet.com/jour/article/view/2173

Заболевания (состояния), связанные с избыточной продукцией андрогенов в женском организме или повышением чувствительности к ним гормонозависимых органов, объединяются понятием «синдром гиперандрогении» (СГА). Варианты СГА распределяются от изолированных поражений кожи и ее производных до системных заболеваний, сопровождающихся высоким риском нарушений менструального цикла, бесплодия, метаболических расстройств, сердечно-сосудистой патологии, канцерогенеза. Ведением больных с гиперандрогенизмом занимаются гинекологи, эндокринологи, дерматологи, терапевты общей практики, но в реальной жизни взаимодействие между представителями отдельных медицинских специальностей, ксожалению, наблюдается редко. Врезультате лечение пациентов с гиперандрогенизмом грешит полипрагмазией, неправомерными назначениями и игнорированием текущих потребностей женщин. Ситуация усугубляется тем, что лекарственных средств, аннотированных для терапии внешних проявлений гиперандрогенизма, практически нет, а число препаратов, способных оказать многоплановое действие, невелико. Одной из стратегий, позволяющих уменьшить лекарственную нагрузку и решить сразу несколько задач по компенсации андрогензависимых дермопатий и сохранению здоровья у пациенток с гиперандрогенизмом, является назначение комбинированной гормональной контрацепции. Определяющими факторами выбора гормонального контрацептива для женщин с гиперандрогенизмом должны быть наличие антиандрогенного эффекта прогестина в составе лекарственного средства и безопасность длительного применения препарата.

Diseases (conditions) associated with excess production of androgens in the female body or an increase in the sensitivity of hormone-dependent organs to them are united by the concept of ‘hyperandrogenic syndrome’. Its variants range from isolated skin lesions and its derivatives to systemic diseases accompanied by a high risk of menstrual irregularities, infertility, metabolic disorders, cardiovascular pathology, and carcinogenesis. The management of patients with hyperandrogenism is carried out by gynecologists, endocrinologists, dermatologists, general practitioners, but in real life, interaction between representatives of certain medical specialties, unfortunately, is rarely observed. As a result, the treatment of patients with hyperandrogenism is sinning with polypharmacy, inappropriate prescribing and ignoring the current needs of women. The situation is aggravated by the fact that there are practically no drugs annotated for the treatment of external manifestations of hyperandrogenism, and the number of drugs that can have a multifaceted effect is small. One of the strategies that can reduce the drug load and solve several problems at once to compensate for androgen-dependent dermopathies and maintain health in patients with hyperandrogenism is the appointment of combined hormonal contraception. The determining factors in the choice of a hormonal contraceptive for women with hyperandrogenism should be the presence of the antiandrogenic effect of the progestin in the composition of the drug and the safety of long-term use of the drug.

гиперандрогенизмсиндром поликистозных яичниковгирсутизмакнеалопециякомбинированные оральные контрацептивыантиандрогенные прогестиныхлормадинона ацетат

hyperandrogenismpolycystic ovary syndromehirsutismacnealopeciacombined oral contraceptivesantiandrogenic progestinschlormadinone acetate

References1

Churchill SJ, Wang ET, Pisarska MD. Metabolic consequences of polycystic ovary syndrome. Minerva Ginecol. 2015; 67 (6): 545–555. PMID: 26372304.

Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018; 132 (2): 321–336. DOI: 10.1097/AOG.0000000000002698.

Escobar-Morreale H. F. Polycystic ovary syndrome: treatment strategies and management. Expert Opin Pharmacother 2008; 9 (17): 2995–3008.

Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018; 110 (3): 364–379. DOI: 10.1016/j.fertnstert.2018.05.004.

Unluhizarci K, Kaltsas G, Kelestimur F. Non polycystic ovary syndrome-related endocrine disorders associated with hirsutism. Eur J Clin Invest. 2012; 42 (1): 86–94. DOI: 10.1111/j.1365–2362.2011.02550.x.

Rachoń D. Differential diagnosis of hyperandrogenism in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes. 2012; 120 (4): 205–9. DOI: 10.1055/s0031–1299765.

Carmina E, Dewailly D, Escobar-Morreale HF, Kelestimur F, Moran C, Oberfield S, et al. Non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency revisited: an update with a special focus on adolescent and adult women. Hum Reprod Update. 2017; 23 (5): 580–599. DOI: 10.1093/humupd/dmx014.

Lause M, Kamboj A, Fernandez Faith E. Dermatologic manifestations of endocrine disorders. Transl Pediatr. 2017 Oct; 6 (4): 300–312. DOI: 10.21037/tp.2017.09.08. PMID: 29184811; PMCID: PMC5682371.

Matheson E, Bain J. Hirsutism in Women. Am Fam Physician. 2019; 100 (3): 168–175. PMID: 31361105.

Augustin M, Herberger K, Hintzen S, Heigel H, Franzke N, Schäfer I. Prevalence of skin lesions and need for treatment in a cohort of 90880 workers. Br J Dermatol. 2011; 165 (4): 865–873. DOI: 10.1111/j.1365–2133.2011.10436.x.

Starace M, Orlando G, Alessandrini A, Piraccini BM. Female Androgenetic Alopecia: An Update on Diagnosis and Management. Am J Clin Dermatol. 2020; 21 (1): 69–84. DOI: 10.1007/s40257–019–00479-x.

Saei Ghare Naz M, Ramezani Tehrani F, Behroozi Lak T, Mohammadzadeh F, Nasiri M, Kholosi Badr F, Ozgoli G. Quality of Life and Emotional States of Depression, Anxiety and Stress in Adolescents with Polycystic Ovary Syndrome: A Cross-Sectional Study. Psychol Res Behav Manag. 2020; 13: 203–209. DOI: 10.2147/PRBM.S241192.

Greenwood EA, Pasch LA, Cedars MI, Legro RS, Huddleston HG; Eunice Kennedy Shriver National Institute of Child Health and Human Development Reproductive Medicine Network. Association among depression, symptom experience, and quality of life in polycystic ovary syndrome. Am J Obstet Gynecol. 2018; 219 (3): 279. e1–279.e7. DOI: 10.1016/j.ajog.2018.06.017.

Naumova I, Castelo-Branco C, Kasterina I, Casals G. Quality of Life in Infertile Women with Polycystic Ovary Syndrome: a Comparative Study. Reprod Sci. 2021; 28 (7): 1901.-1909. DOI: 10.1007/s43032–020–00394–1.

Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017; 32 (5): 1075–1091. DOI: 10.1093/humrep/dex044.

Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016; 31 (12): 2841–2855. DOI: 10.1093/humrep/dew218.

Hillebrand JJ, Wickenhagen WV, Heijboer AC. Improving Science by Overcoming Laboratory Pitfalls with Hormone Measurements. J Clin Endocrinol Metab. 2021; 106 (4): e1504–e1512. DOI: 10.1210/clinem/dgaa923.

Mimoto MS, Oyler JL, Davis AM. Evaluation. and Treatment of Hirsutism in Premenopausal Women. JAMA. 2018; 319 (15): 1613–1614. DOI: 10.1001/jama.2018.2611.

Al Kindi MK, Al Essry FS, Al Essry FS, Mula-Abed WA. Validity of serum testosterone, free androgen index, and calculated free testosterone in women with suspected hyperandrogenism. Oman Med J. 2012; 27 (6): 471–474. DOI: 10.5001/omj.2012.112.

Bienenfeld A, Azarchi S, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR. Androgens in women: Androgen-mediated skin disease and patient evaluation. J Am Acad Dermatol. 2019; 80 (6): 1497–1506. DOI: 10.1016/j.jaad.2018.08.062.

Lizneva D, Gavrilova-Jordan L, Walker W, Azziz R. Androgen excess: Investigations and management. Best Pract Res Clin Obstet Gynaecol. 2016; 37: 98–118. DOI: 10.1016/j.bpobgyn.2016.05.003.

Panico A, Messina G, Lupoli GA, Lupoli R, Cacciapuoti M, Moscatelli F, et al. Quality of life in overweight (obese) and normal-weight women with polycystic ovary syndrome. Patient Prefer Adherence. 2017; 11: 423–429. DOI: 10.2147/PPA.S119180.

Iamsumang W, Leerunyakul K, Suchonwanit P. Finasteride and Its Potential for the Treatment of Female Pattern Hair Loss: Evidence to Date. Drug Des Devel Ther. 2020; 14: 951–959. DOI: 10.2147/DDDT.S240615.

Boztosun A, Açmaz G, Ozturk A, Müderris II. Clinical efficacy of low dose flutamide plus Diane 35 in the treatment of idiopathic hirsutism and polycystic ovary syndrome. Ginekol Pol. 2013; 84 (4): 258–262. DOI: 10.17772/gp/1573.

Gao X, Xie C, Wang Y, Luo Y, Yagai T, Sun D, et al. The antiandrogen flutamide is a novel aryl hydrocarbon receptor ligand that disrupts bile acid homeostasis in mice through induction of Abcc4. Biochem Pharmacol. 2016; 119: 93–104. DOI: 10.1016/j.bcp.2016.08.021.

Brahm J, Brahm M, Segovia R, Latorre R, Zapata R, Poniachik J, et al. Acute and fulminant hepatitis induced by flutamide: case series report and review of the literature. Ann Hepatol. 2011; 10 (1): 93–98.

Generali JA, Cada DJ. Flutamide: hirsutism in women. Hosp Pharm. 2014; 49 (6): 517–520. DOI: 10.1310/hpj4906–517.

Fraison E, Kostova E, Moran LJ, Bilal S, Ee CC, Venetis C, Costello MF. Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome. Cochrane Database Syst Rev. 2020; 8 (8): CD005552. DOI: 10.1002/14651858.CD005552.pub3.

Morley LC, Tang T, Yasmin E, Norman RJ, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2017; 11 (11): CD003053. DOI: 10.1002/14651858.CD003053.pub6.

Ibáñez L, Diaz M, Sebastiani G, Sánchez-Infantes D, Salvador C, Lopez-Bermejo A, de Zegher F. Treatment of androgen excess in adolescent girls: ethinylestradiol-cyproteroneacetate versus low-dose pioglitazone-flutamide-metformin. J Clin Endocrinol Metab. 2011; 96 (11): 3361–3366. DOI: 10.1210/jc.2011–1671.

van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. Interventions for hirsutism (excluding laser and photoepilation therapy alone). Cochrane Database Syst Rev. 2015; 2015 (4): CD010334. DOI: 10.1002/14651858.CD010334.pub2.

Балан В. Е., Зайдиева Я. З., Тихомирова Е. В. Эффективное лечение кожных и метаболических проявлений гиперандрогении – комплексное улучшение качества жизни. Медицинский совет. 2019; 7: 45–50. Balan V.E., Zaydieva Ya.Z., Tikhomirova E.V. Effective treatment of skin and metabolic manifestations of hyperandrogenism – a comprehensive improvement in the quality of life. Medical Advice. 2019; 7: 45–50.

de Medeiros SF. Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome. Reprod Biol Endocrinol. 2017; 15 (1): 93. DOI: 10.1186/s12958–017–0313-y.

Bozdag G, Yildiz BO. Combined oral contraceptives in polycystic ovary syndrome– indications and cautions. Front Horm Res. 2013; 40: 115–127. DOI: 10.1159/000341823.

Hohl A, Ronsoni MF, Oliveira Md. Hirsutism: diagnosis and treatment. Arq Bras Endocrinol Metabol. 2014; 58 (2): 97–107. DOI: 10.1590/0004–2730000002923.

Barrionuevo P, Nabhan M, Altayar O, Wang Z, Erwin PJ, Asi N, et al. Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab. 2018; 103 (4): 1258–1264. DOI: 10.1210/jc.2017–02052.

de Melo AS, Dos Reis RM, Ferriani RA, Vieira CS. Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits. Open Access J Contracept. 2017; 8: 13–23. DOI: 10.2147/OAJC.S85543.

Podfigurna A, Meczekalski B, Petraglia F, Luisi S. Clinical, hormonal and metabolic parameters in women with PCOS with different combined oral contraceptives (containing chlormadinone acetate versus drospirenone). J Endocrinol Invest. 2020; 43 (4): 483–492. DOI: 10.1007/s40618–019–01133–3.

Kerscher M, Reuther T, Krueger N, Buntrock H. Effects of an oral contraceptive containing chlormadinone acetate and ethinylestradiol on hair and skin quality in women wishing to use hormonal contraception. J Eur Acad Dermatol Venereol. 2013; 27 (5): 601–608. DOI: 10.1111/j.1468–3083.2012.04497.x.

Jaisamrarn U, Santibenchakul S. A comparison of combined oral contraceptives containing chlormadinone acetate versus drospirenone for the treatment of acne and dysmenorrhea: a randomized trial. Contracept Reprod Med. 2018; 3: 5. DOI: 10.1186/s40834–018–0058–9.

McCartney CR, Marshall JC. CLINICAL PRACTICE. Polycystic Ovary Syndrome. N Engl J Med. 2016; 375 (1): 54–64. DOI: 10.1056/NEJMcp1514916.

Yanes Cardozo LL, Romero DG, Reckelhoff JF. Cardiometabolic Features of Polycystic Ovary Syndrome: Role of Androgens. Physiology (Bethesda). 2017; 32 (5): 357–366. DOI: 10.1152/physiol.00030.2016.

Cai WY, Gao JS, Luo X, Ma HL, Ge H, Liu N, et al. Effects of metabolic abnormalities, hyperandrogenemia and clomiphene on liver function parameters among Chinese women with polycystic ovary syndrome: results from a randomized controlled trial. J Endocrinol Invest. 2019; 42 (5): 549–555. DOI: 10.1007/s40618–018–0953–6.

Mu L, Li R, Lai Y, Zhao Y, Qiao J. Adipose insulin resistance is associated with cardiovascular risk factors in polycystic ovary syndrome. J Endocrinol Invest. 2019; 42 (5): 541–548. DOI: 10.1007/s40618–018–0949–2.

Zhang L, Fang X, Li L, Liu R, Zhang C, Liu H, et al. The association between circulating irisin levels and different phenotypes of polycystic ovary syndrome. J Endocrinol Invest. 2018; 41 (12): 1401–1407. DOI: 10.1007/s40618–018–0902–4.

Harris HR, Terry KL. Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: a systematic review. Fertil Res Pract. 2016 Dec 5; 2: 14. DOI: 10.1186/s40738–016–0029–2. PMID: 28620541; PMCID: PMC5424400.

Dokras A, Sarwer DB, Allison KC, Milman L, Kris-Etherton PM, Kunselman AR, et al. Weight Loss and Lowering Androgens Predict Improvements in Health-Related Quality of Life in Women With PCOS. J Clin Endocrinol Metab. 2016; 101 (8): 2966–2974. DOI: 10.1210/jc.2016–1896.

Helvaci N, Yildiz BO. Oral contraceptives in polycystic ovary syndrome. Minerva Endocrinol. 2014; 39 (3): 175–187. PMID: 25003228.

The authors declare that there are no conflicts of interest present.