將PCOS定義為高雄激素血癥的標準
《將PCOS定義為高雄激素血癥的標準》內(nèi)容預覽
Angeles, California 90048; University of Palermo (E.C.), 90128 Palermo, Italy; Lille University Hospital (D.D.), 59037 Lille, France; University of Athens Medical School (E.D.-K.), GR-157 84 Athens, Greece; Hospital Ramon y Cajal and University of Alcala´ (H.F.E.-M.), 28801 Madrid, Spain; Mount Sinai School of Medicine (W.F.), New York, New York 10029; University of Essen (O.E.J.), 45131 Essen, Germany; Pennsylvania State University School of Medicine (R.S.L.), Hershey, Pennsylvania 17033; University of Adelaide (R.J.N.), Woodville, South Australia 5005, Australia; Pfizer Global Research and Development (A.E.T.), Groton, Connecticut 06340; and Children’s Hospital of Pittsburgh (S.F.W.), Pittsburgh, Pennsylvania 15213
THE DISORDER THAT eventually would be known as the polycystic ovary syndrome (PCOS) was initially described by Stein and Leventhal in 1935 (1). There is little disagreement that PCOS should be considered a syndrome, i.e. a collection of signs and features, in which no single test is diagnostic. In essence, the whole (or global assessment) is greater than the sum of the individual features. However, establishing a clear, contemporaneous, and evidence-based definition for this syndrome has important clinical and investigational implications. Nonetheless, the definition of PCOS has continued to generate significant controversy (2– 4).
Clinically, diagnosing a woman as having PCOS implies an increased risk for infertility, dysfunctional bleeding, endometrial carcinoma, obesity, type 2 diabetes mellitus, dyslipidemia,hypertension, and possibly cardiovascular disease (5). Furthermore, it has important familial implications, principally, but not exclusively, for her sisters and daughters
(6–8). Finally, a diagnosis of PCOS may mandate life-long treatments, e.g. the use of insulin sensitizers, and may negatively affect her ability to access health care coverage, rincipally in capitalistic markets. Consequently, the diagnosis of PCOS should not be assigned lightly, and diagnostic criteria should be based on robust data.
A judicious definition of PCOS is also essential to guide current and future research. The inclusion of patients whose definition, characterization, and selection criteria are unclear
continues to plague the PCOS scientific literature. This issue is becoming critical as the field moves to the establishment of larger clinical trials and studies of the molecular biology
and genetic nature of the disorder. In addition, definitions not based on clear-cut evidence have the potential effect of discouraging future and needed research into the nature of
the disorder, its breadth, and its phenotype. Consequently, a contemporaneous definition based on what is currently known will benefit future investigation in this area.
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