迟发性先天性肾上腺增生或早发性多囊卵巢综合征:一个临床困境

Q4 Medicine
P. Jain, Anuja Bhalerao, Sakshi Aggarwal, J. Malhotra
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引用次数: 0

摘要

目的:鉴别13岁女童的非典型性先天性肾上腺皮质增生症(NCCAH)与多囊卵巢综合征(PCOS)。简介:多毛和男性化是卵巢和肾上腺雄激素过多的结果。它对生活质量有明显的心理和社会影响。约75%的绝经前女孩有多囊卵巢综合征引起的雄激素分泌过多,但不能排除迟发性CAH,这使临床医生在诊断和治疗方面处于两难境地。病例报告:1例131 / 2岁女童,近2个月来表现为面部毛发过多、声音嘶哑、肘窝变黑,病情加重。该患者尚未达到月经初潮,但已在1年前阴部。检查发现棘皮增生,乳房发育不全,阴蒂肿大(30cm)。17-羟孕酮水平正常,但刺激后报告的水平较高。空腹胰岛素水平也很高。开始适当的治疗,患者的症状得到改善。结论:PCOS与NCCAH有明显的重叠,应根据激素分析准确诊断,及早采取适当治疗。临床意义:早期治疗可预防不孕和后期雄激素并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Late-onset Congenital Adrenal Hyperplasia or Early-onset Polycystic Ovarian Syndrome: A Clinical Dilemma
Aim: To differentiate nonclassical congenital adrenal hyperplasia (NCCAH) from polycystic ovarian syndrome (PCOS) in a 13-year-old girl. Introduction: Hirsutism and virilization are effects of hyperandrogenism by ovaries and adrenal glands. It has a marked psychological and social impact affecting the quality of life. About 75% of premenarchal girls have hyperandrogenism due to PCOS but late-onset CAH cannot be ruled out, and this leaves the clinician in a quandary regarding the diagnosis and management. Case report: A 131⁄2-year-old girl presented with excessive facial hair, hoarseness of voice, and darkening of elbow pits since past 2 months, which was increasing in severity. The patient had not yet attained menarche but had pubarche 1 year earlier. Examination revealed presence of acanthosis, underdeveloped breasts, and clitoromegaly >3 cm. Levels of 17-hydroxyprogesterone were normal but higher levels were reported poststimulation. Fasting insulin levels were also high. Appropriate treatment was started, which led to improvement in patient’s symptoms. Conclusion: There is significant overlapping between PCOS and NCCAH, which warrants accurate diagnosis based on hormonal analysis to institute early and appropriate therapy. Clinical significance: Early therapy can prevent infertility and androgenic complications later in life.
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来源期刊
Journal of SAFOG
Journal of SAFOG Medicine-Obstetrics and Gynecology
CiteScore
0.40
自引率
0.00%
发文量
135
期刊介绍: Journal of South Asian Federation of Obstetrics and Gynaecology is the aim of this journal to provide platform for members to have access to scientific and peer-reviewed clinically oriented guidelines for practice and professional updating of subject of obstetrics and gynecology. The scope of South Asian Federation of Obstetrics and Gynaecology (SAFOG) journal is to cover the broad subject of obstetrics and gynecology and give out articles, information, and practice guidelines. The journal has fixed format of review articles, presentations as original studies by members and readers, operative skill reviews, case reports, and midwifery peer-reviewed practice guidelines. In addition, call upon experts and clinical authorities among member countries of SAFOG region to give out editorials on policy formulating topics such as maternal mortality, abortions, contraceptives, reproductive health preservation of women, etc. As well as to tabulate reproductive health country specific data to create awareness regarding the enormity of maternal and neonatal problems. To give out reader specific information for forthcoming professional events in the region. It remains a platform for better communication and exchange of reproductive indices among member countries. Also to amalgamate with world bodies, recommendations for practice guidelines for members. Brief of the journal: The SAFOG journal is the official organ and publication of South Asia Federation of Obstetrics and Gynecology. This is a scientific and peer-reviewed platform of exchange of professional activities, clinical practice guidelines, operative skill updates, and nursing midwifery practices among member countries.
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