Das polyzystische Ovarsyndrom – eine Indikation zu bariatrischen Eingriffen?

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund: Mit einer Häufigkeit von 6–10 % bei prämenopausalen Frauen stellt das polyzystische Ovarsyndrom (PCOS) die häufigste Ursache der Infertilität und darüber hinaus die häufigste endokrine Erkrankung dar. Vor allem die metabolischen und kardiovaskulären Folgen bedeuten ein erhebliches Gesundheitsproblem. Im Mittelpunkt der Pathophysiologie steht die viszerale Adipositas und nachfolgend die Insulinresistenz. Dies unterstreicht die Bedeutung von Maßnahmen zur Reduktion der abdominellen Adipositas. Methoden: Zwischen Februar 1995 und Oktober 2006 unterzogen sich 204 Patienten am SRH Wald-Klinikum Gera bariatrischen Eingriffen. Hiervon waren 75 % der Patienten weiblich. Drei Patientinnen hatten ein PCO-Syndrom assoziiert mit Veränderungen des metabolischen Syndroms. Ergebnisse: Nach laparoskopischem Gastric Banding hatten diese drei Patientinnen eine Excess-Body-Weight-Loss (EBWL) von 49, 67 bzw. 41 % ihres Übergewichts bei einer mittleren postoperativen Nachbeobachtungszeit von 104 Monaten. Die diabetische Stoffwechsellage bildete sich hierbei vollständig zurück. Eine Patientin wurde nach erfolgreicher Gewichtsreduktion schwanger. Fazit: Bei Vorliegen des PCO-Syndroms sind bariatrische Eingriffe eine Therapiemöglichkeit zur Gewichtsreduktion. Hieraus resultiert auch eine Reduktion der Komorbiditäten, der Insulinresistenz und eine Verbesserung des metabolischen Syndroms sowie der Fertilität.

Abstract

Background: The polycystic ovary syndrome (PCOS) is the most frequent cause of female infertility with an estimated prevalence of 6–10 % in premenopausal women. Due to its long-term metabolic and cardiovascular consequences, it poses a severe health problem. Visceral obesity and subsequent insulin resistance represent the core pathophysiology of PCOS, clearly suggesting that measures to reduce abdominal obesity should be pursued. Methods: Between February 1995 and October 2006, 204 patients underwent bariatric surgery in the SRH Hospital of Gera. 75 % of the patients were female and three of them were suffering preoperatively from polycystic ovary syndrome and metabolic syndrome. Results: 104 months after laparoscopic adjustable gastric banding, the excess body weight loss (EBWL) was 49, 67 and 41 % in these three patients, respectively. Glucose levels normalised completely. One patient became pregnant after weight reduction. Conclusions: In PCOS with metabolic syndrome, bariatric surgery is an option to reduce weight and to treat associated metabolic disorders. Surgery should be performed based on the body mass index, the metabolic disorders, and the wish of the patient to become pregnant.

Literatur

• 1 Archard C, Thiers J. Le virilisme pilaire et son association a'l'insufficiance glycolytique (diabete des femes a'barbe).  Bul Acad Natl Med. 1921;  86 66-71
  PubMedGoogle Scholar
• 2 Book C B, Dunaif A. Selective insulin resistance in the polycystic ovary syndrome.  J Clin Endocrinol Metab. 1999;  84 3110-3116
  CrossrefPubMedGoogle Scholar
• 3 Buchwald H. A Bariatric surgery algorithm.  Obes Surg. 2002;  12 733-746
  CrossrefPubMedGoogle Scholar
• 4 Buchwald H, Avidor Y, Braunwald E et al. Bariatric Surgery. A systematic review and meta-analysis.  JAMA. 2004;  14 1724-1737
  PubMedGoogle Scholar
• 5 Carmina E, Lobo R A. Polycystic ovary syndrome (PCOS); arguably the most common endocrinopathy is associated with significant morbidity in women.  J Clin Endocrinol Metab. 2001;  84 1897-1899
  PubMedGoogle Scholar
• 6 Conn J J, Jacobs H S, Conway G S. The prevalence of polycystic ovaries in women with type 2 diabetes mellitus.  Clin Endocrinol. 2000;  37 119-125
  PubMedGoogle Scholar
• 7 Dunaif A. Insulin resistance and polycystic ovary syndrome: mechanism and implications for pathogenesis.  Endocr Rev. 1997;  18 774-800
  CrossrefPubMedGoogle Scholar
• 8 Ehrmann D A. Polycystic ovary syndrome.  N Engl J Med. 2005;  352 1223-1236
  CrossrefPubMedGoogle Scholar
• 9 Ehrmann D A, Barnes R B, Rosenfield R L et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome.  Diabetes Care. 1999;  22 141-146
  CrossrefPubMedGoogle Scholar
• 10 Ek I, Arner P, Ryden M et al. A unique defect in the regulation of visceral fat cell lipolysis in the polycycstic ovary syndrome as an early link to insulin resistance.  Diabetes. 2002;  51 484-492
  CrossrefPubMedGoogle Scholar
• 11 Escobar-Morreale H F, Botella-Carretero J I, Alvarez-Blasco F et al. The polycystic ovarian syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery.  J Clin Endocrinol Metab. 2005;  90 6364-6369
  CrossrefPubMedGoogle Scholar
• 12 Fleming R, Hopkinson Z E, Wallace M et al. Ovarian function and metabolic features in women with oligomenorrhae treated with metformin in randomized double-blind placebo-controlled trial.  J Clin Endocrinol Metab. 2002;  87 569-574
  CrossrefPubMedGoogle Scholar
• 13 Glueck C J, Wang P, Kobayashi S et al. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome.  Fertil Steril. 2002;  77 520-525
  CrossrefPubMedGoogle Scholar
• 14 Iuorno M J, Nestler J E. Insulin-lowering drugs in polycystic ovary syndrome.  Obstet Gynecol Clin North Am. 2001;  28 153-164
  CrossrefPubMedGoogle Scholar
• 15 Knowler W C, Barrett-Conner E, Fowler S E. Reduction in the incidence of type II diabetes with life style intervention or metformin.  N Engl J Med. 2002;  346 393-403
  CrossrefPubMedGoogle Scholar
• 16 Lord J M, Flight I H, Norman R J. Metformin in polycystic ovary syndrome: systematic review and meta-analysis.  BMJ. 2003;  327 951-953
  PubMedGoogle Scholar
• 17 Norman R J, Masters L, Milner C R et al. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome.  Hum Reprod. 2001;  16 1995-1998
  CrossrefPubMedGoogle Scholar
• 18 Peppard H R, Marfori J, Iurno M J et al. Prevalence of polycystic ovary syndrome among premenopausal women with type 2 diabetes.  Diabetes Care. 2001;  24 1050-1052
  PubMedGoogle Scholar
• 19 Pierpoint T, McKeigue P M, Isaacs A J et al. Mortality of women with polycystic ovary syndrome at long-term-follow-up.  J Clin Epidemiol. 1998;  51 581-586
  CrossrefPubMedGoogle Scholar
• 20 Porte D, Baskin D G, Schwartz M W. Insulin signaling in the central nervous system: a critical role in metabolic homeostasis and disease from C. elegans to humans.  Diabetes. 2005;  54 1264-1276
  CrossrefPubMedGoogle Scholar
• 21 Sauerland S, Angrisani L, Belachew M et al. Evidence-based guidelines of the European Association for Endoscopic Surgery (E.A.E.S.).  Surg Endosc. 2005;  19 200-221
  CrossrefPubMedGoogle Scholar
• 22 Schöfl C, Horn R, Schill T et al. Circulating grhelin levels in patients with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2002;  87 4607-4610
  CrossrefPubMedGoogle Scholar
• 23 Solomon C G, Hu F B, Dunaif A. Menstrual circle irregularity and risk of future cardiovascular disease.  J Clin Endocrinol Metab. 2001;  87 2013-2017
  PubMedGoogle Scholar
• 24 Stroh C, Hohmann U, Schramm H et al. Langzeitergebnisse nach Gastric Banding.  Zentralbl Chir. 2005;  130 410-418
  Article in Thieme ConnectPubMedGoogle Scholar
• 25 Strowitzki T, Halser B, Dermant T. Body fat distribution, insulin sensitivity, ovarian dysfunction and serum lipoproteins in patients with polycystic ovary syndrome.  Gynecol Endocrinol. 2002;  16 45-51
  CrossrefPubMedGoogle Scholar
• 26 The Rotterdam ESHRE / ASRM-Sponsored PCOS consensus workshop group . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).  Hum Reprod. 2004;  19 41-47
  CrossrefPubMedGoogle Scholar

Dr. C. Stroh

Departement für Allgemein- und Visceralchirurgie · SRH Wald-Klinikum Gera gGmbH

Straße des Friedens 122

07548 Gera

Phone: 03 65 / 8 28 31 01

Fax: 03 65 / 8 28 31 02

Email: Christine.Stroh@wkg.srh.de