( ) ( 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

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. 30 2012

( ) ( 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. 30 2012 藥 學 雜 誌 第 111 冊 91

臨 床 藥 物 治 療 學 一 不 規 則 月 經 18 21 70-90 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 9 18 21 ( ) ( ) ( ) 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. 30 2012

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 1.5-2.5 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: 787-796. 2. 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: 2810-2815. 3. 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: 1105-1120. 4. 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: 170-177. 5. 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: 383-392. 6. Apter D, Vihko R. Serum pregnenolone, progesterone, 17-hydroxyprogesterone, testosterone and 5 alpha-dihydrotestosterone during female puberty. J Clin Endocrinol Metab 1977; 45: 1039-1048. 7. 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: 970-974. 8. 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: 2409-2413. 9. Badawy A, Elnashar A. treatment options for polycystic ovry syndrome. International Journal of Women's Health 2011: 3: 25-35. 10. BC, RRL: polycystic ovary snydrome in adolescence. Endocrinol Metab Clin North Am 2005; 34: 677-705. 11. 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: 372-375. 12. Franks S, Gilling-Smith C, Watson H, Willis D: Insulin action on the normal and polycystic ovary. Endocrinol Metab Clin North Am 1999; 28: 361-378. 13. Patel SM, Nestler JE. Fertility in polycystic ovary syndrome. Endocrinol Metab Clin North Am 2006; 35: 137-55. 28 2 Jun. 30 2012 藥 學 雜 誌 第 111 冊 93

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. 30 2012