Функціональний стан осі «гіпофіз — ​гонади» у жінок із синдромом полікістозних яєчників

Background. The polycystic ovary syndrome (PCOS) is the most frequent form of endocrine pathology and occurs in 5–10 % women of reproductive age and makes up 80 %, and according to some data, even 90 % of all forms of hyperandrogenism. The information about pathogenesis of PCOS is contradictory. The main step of the SPCO pathogenesis is hyperproduction of LH of by the hypophysis, revealed in 40–80 % patients. According to one of numerous theories, an increase secretion results in the increase of LH by the hypothalamus of the gonadotropin-releasing hormone (GRH), secreted in the discrete mode under control sexual steroid hormones, monoamines and opioid peptides. The aim of the investigation is to study the functional status of hypophysis — gonads axis for women with SPCO. Material and methods. In the department of neuroendocrinology of the Center of Endocrinology of Health Ministry of the Republic of Uzbekistan in a period from September 2015 till July 2016 120 outpatients of fertile age with PCOS were inspected. Mean age of patients was 25.5 ± 4.3 years. The duration of the disease hesitated from 7 months to 9 years. 20 healthy women of corresponding age made a control group. The complex of researches, including clinical, biochemical (glycemia, glucose tolerance test), hormonal (LH, FSH, prolactin, estradiol, progesterone, dehydroepiandrostendion (ДGEA), 17-oxyprogesterone, аntimuller hormone (АМH), insulin) was performed in all patients, ultrasonic examination of uterus and ovaries (transabdominal and transvaginal) on the 14th day of cycle with folliculometria in dynamics, and also magnetically-resonant tomography of hypophysis and questionnaire of patients were carried out. Results. Patients were divided into two groups: with primary sterility (94 cases) and with secondary sterility (26 cases). In the first group of patients with primary sterility the reliable decline of both pituitary and ovarian hormones was determined on a background of hyperandrogenemia and hyperprolactinemia. So, as compared to the group of control on the 14th day of cycle LH, FSH, and estradiol, progesterone, while free testosterone, DGEA were enhanced as compared to control data. In the second group of patients the reliable decline of pituitary hormones was also educed on a background of hyperandrogenemia and hyperprolactinemia while an ovarian function was within the normal limits. So, as compared to the group of control on the 14th day of cycle the LH, FSH, here free testosterone, DGEA and АМH levels were enhanced as compared to control data. The neuroimaging of hypophysis in patients with PCOS educed hyperplasia (adenomatosis) of hypophysis in 49 from 120 (40.8 %), that can be explained by ovarian insufficiency in these patients. On the second place by incidence there was the syndrome of the empty sella (26 cases, 21.6 %), and on the third — the microadenoma of hypophysis in 16 persons (13.3 %). Conclusions. In the first group of patients with primary sterility the reliable decline of both pituitary and ovarian hormones was marked on a background of hyperandrogenemia and hyperprolactinemia. In the second group of patients the significant decline of pituitary hormones was also educed on a background of hyperanrogenemia and hyperprolactinemia, while an ovarian function was within the normal limits. In both groups of patients hypogonadotropinemia occurred combined with moderate hyperprolactinemia and hyperandrogenemia. Thus, the most expressed violations of the system of pituitary — ovarian function were found out in the first group of patients with PCOS with primary sterility, at that the significant decline of the functional status of pituitary — gonads axis was marked, namely decline of LH, FSH, estradiol and progesterone levels on the 14th day of menstrual cycle, that was confirmed by ultrasouns examination of uterus and ovaries by impoverishment of follicle vehicle of ovaries, anovulation signs. Thus, the most expressed violations of the system of pituitary-ovarial function were found out in the first group of patients with PCOS with primary sterility, at that the significant decline of the functional state of hypophysis-gonads was marked, namely decline of LH, FSH, estradiol and progesterone levels that was confirmed by ultrasound investigation of uterus and ovaries.