( ) ( 15 ) ( ) ( 45 ) ( ) ( 90 ) ( ) ( 21 7 ) 4,5 PCOS 6 7 三影像學多囊性卵巢 PCOS PCOS 2~8 mm 10 四肥胖和胰島素抗性 50% PCOS 50% PCOS 8 參診斷 PCOS 1990

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1 臨床藥物治療學青春期多囊性卵巢症候群之治療奇美醫院藥劑部藥師陳蓉芳王慧瑜摘要 metformin adolescence polycystic ovary syndrome insulin resistance 壹前言 (Polycystic Ovary Syndrome PCOS) 1 PCOS PCOS (luteining hormone, LH) 2 貳臨床特徵 PCOS PCOS 一高雄性素 Ferriman-Gallwey Scoring System steroid phenytoins diazoxide cyclosporine 3 PCOS PCOS 3 二月經不規則 PCOS PCOS 90 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2 Jun

2 ( ) ( 15 ) ( ) ( 45 ) ( ) ( 90 ) ( ) ( 21 7 ) 4,5 PCOS 6 7 三影像學多囊性卵巢 PCOS PCOS 2~8 mm 10 四肥胖和胰島素抗性 50% PCOS 50% PCOS 8 參診斷 PCOS 1990 National Institutes of Health (NIH) criteria NIH 2003 Rotterdam criteria NIH criteria 2006 Androgen Excess Society (AES) criteria AES criteria 9 肆病理機轉 10 (sex hormone-binding globulin SHBG) SHBG SHBG 11 - (LH) (FSH) 2 PCOS 12 伍治療 PCOS 28 2 Jun 藥學雜誌第 111 冊 91

3 臨床藥物治療學一不規則月經 ng/dl PCOS 150 ng/dl Drospirenone spironolactone Drospirenone Yaz Norgestimate norgestimate ethinyl estradiol (EE) Ortho-Tri- Cyclen FDA ethynodiol diacetat Ethynodiol diacetat EE Zovia ( ) ( ) ( ) progesterone medroxyprogesterone progestins (gonadotropin releasing hormone, GnRH) ( depot leuprolide) GnRH 16 9 二多毛症 2008 Endocrine Society Guidelines cyproterone drosperinone 92 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2 Jun

4 spironolactone cyproterone acetate flutamide finasteride spironolactone flutamide finasteride spironolactone 11 三胰島素抗性 PCOS 13 metformin PCOS metformin metformin PCOS metformin thiazolidinediones metformin Metformin mg/day bid or tid 11 陸結論 PCOS PCOS PCOS 參考資料 : 1. Rosenfield RL: Clinical review: identifying children at risk for polycystic ovary syndrome. J Clin Endocrinol Metab 2007; 92: Chhabra S, McCartney CR, Yoo RY, et al: Progesterone inhibition of the hypothalamic gonadotropin-releasing hormone pulse generator: evidence for varied effects in hyperandrogenemic adolescent girls. J Clin Endocrinol Metab 2005; 90: Martin KA, Chang RJ, Ehrmann DA, et al:evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93: Avvad CK, Holeuwerger R, Silva VC, et al: Menstrual irregularity in the first postmenarchal years: an early clinical sign of polycystic ovary syndrome in adolescence. Gynecol Endocrinol 2001; 15: Van Hooff MH, Voorhorst FJ, Kaptein MB, et al:predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligo-amenorrhoea at age 18 years. Hum Reprod 2004; 19: Apter D, Vihko R. Serum pregnenolone, progesterone, 17-hydroxyprogesterone, testosterone and 5 alpha-dihydrotestosterone during female puberty. J Clin Endocrinol Metab 1977; 45: Apter D, Vihko R. Endocrine determinants of fertility: serum androgen concentrations during follow-up of adolescents into the third decade of life. J Clin Endocrinol Metab 1990; 71: Vural B, Caliskan E, Turkoz E, et al: Evaluation of metabolic syndrome frequency and premature carotid atherosclerosis in young women with polycystic ovary syndrome. Hum Reprod 2005; 20: Badawy A, Elnashar A. treatment options for polycystic ovry syndrome. International Journal of Women's Health 2011: 3: BC, RRL: polycystic ovary snydrome in adolescence. Endocrinol Metab Clin North Am 2005; 34: O j a n i e m i M, Ta p a n a i n e n P, M o r i n - P a p u n e n L:Management of polycystic ovary snydrome in childhood and adolescence. Horm Res Paediatr 2010; 74: Franks S, Gilling-Smith C, Watson H, Willis D: Insulin action on the normal and polycystic ovary. Endocrinol Metab Clin North Am 1999; 28: Patel SM, Nestler JE. Fertility in polycystic ovary syndrome. Endocrinol Metab Clin North Am 2006; 35: Jun 藥學雜誌第 111 冊 93

5 臨床藥物治療學 Polycystic Ovary Syndrome in Adolescents Jung-Fang Chen, Hue-Yu Wang Department of Pharmacy, Chi-Mei Medical Center Abstract Polycystic ovary syndrome (PCOS) in adolescence typical features includes irregular menstrual cycles, acne, hirsutism, and insulin resistance. Treatment of PCOS is symptomatic. Lifestyle changes are a first-line intervention; however, increasing evidence suggests that metformin and estrogen-progestin combination pill maybe beneficial. Several risk factors for PCOS have been identified and clinicians should be alert for this condition already in adolescence. Early intervention and patient counseling might be the key for prevention of comorbidities of PCOS. 94 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2 Jun

Ferriman-Gallwey 資料來源 : 參考資料 ) testosterone 150 ng/dl (5.2 nmol/ L) free testosterone2 ng/dl (0.07 nmol/l) DHEA-S700 mcg/dl (13.6 µmol/l

Ferriman-Gallwey 資料來源 : 參考資料 ) testosterone 150 ng/dl (5.2 nmol/ L) free testosterone2 ng/dl (0.07 nmol/l) DHEA-S700 mcg/dl (13.6 µmol/l 家庭醫業前言及定義病態生理學 F e r r i m a n - G a l l w e y hirsutism scoring system 9 04 Ferriman-Gallwey score8 (hirsutism) hypertrichosis hypertrichosis hirsutism androgen t e s t o s t e r o n e d i h y d r o

( ) ( 15 ) ( ) ( 45 ) ( ) ( 90 ) ( ) ( 21 7 ) 4,5 PCOS 6 7 三 影 像 學 多 囊 性 卵 巢 PCOS PCOS 2~8 mm 10 四 肥 胖 和 胰 島 素 抗 性 50% PCOS 50% PCOS 8 參 診 斷 PCOS 1990

( ) ( 15 ) ( ) ( 45 ) ( ) ( 90 ) ( ) ( 21 7 ) 4,5 PCOS 6 7 三影像學多囊性卵巢 PCOS PCOS 2~8 mm 10 四肥胖和胰島素抗性 50% PCOS 50% PCOS 8 參診斷 PCOS 1990