内分泌学的PCO症例の臨床的背景およびbromocriptineの効果に関する研究

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Present study was performed to elucidate the clinical features and the treatment of so-called endocrinological polycystic ovarian disease (PCO). 36 cases out of 189 infertile patients who had various ovulatory disturbances were subjected during past four years. They were selected by the definitions as follows; 1) serum LH levels?30mIU/ml and serum FSH levels?15mIU/ml, 2) hyper-response of LH secretion by LH-RH (100μg) loading test; maximum values?250mIU/ml. Serum androstenedione (ASD), dehydroepiandrosterone-sulfate (DHA-S), estrone (E1), estradiol (E2), progesterone (P, in the mid-luteal phase) and testosterone (T) levels were examined by RIA method for the purpose of the evaluation of the endocrinological background of the PCO in Japanese women. The same examinations were also done in 8 volunteer women who had normal ovulatory menstrual cycles for the control study. In 6 cases of the PCO patients who showed biphasic BBT charts, the endometrial biopsy was done in the midluteal phase at the same time of the blood sampling. And the correlation between various serum hormone levels and the endometrial morphology in the PCO patients was also discussed. Then bromocriptine (5mg/day) was administered in these patients for more than 30 days and the effect of the treatment was investigated.<BR>Serum ASD levels in the PCO patients were significantly higher than those in the control (2.52±1.30 vs. 1.43±1.21ng/ml, M±S. D., p<0.05), while serum E2 and P levels in the patients were significantly lower than those in the control (E2: 118.6±39.5 vs. 192.5±53.9pg/ml, p<0.005. P: 7.26±5.08 vs. 12.4±4.6ng/ml, p<0.005, respectively). There were no significant differences in serum levels of the other hormones. By the administration of bromocriptine, serum ASD levels decreased (1.62±1.34ng/ml, p<0.05), and E2 (177.9±48.6pg/ml, p<0.025) and P (11.8±4.3ng/ml, p<0.005) levels increased significantly into the levels of the control. Serum LH levels of the patients were also suppressed by the treatment of bromocriptine (42.5±13.7 vs. 27.4±12.0mIU/ml, p<0.005), however there was no change in serum FSH levels.<BR>In the dating of the endometrium, the time lag with more than 2 days were observed in 5 out of 6 patients with PCO (83.3%), in whom endometrium showed atypical secretory phase with the irregular ripening of the endometrial glands. After the treatment of the bromocriptine, these abnormal findings were improved into those of the normal secretory phase and the time lag of the endometrial dating also became within 2 days.<BR>23 cases out of 36 PCO patients became ovulatory only by the administration of bromocriptine, and the other 8 and 3 cases recovered ovulatory cycles, in addition to bromocriptine, with clomiphene citrate and HMG, respectively (total 34 cases, 94.4%). And 12 cases (33.3%) were conceived.<BR>These results indicate that the endocrinological features of PCO in Japanese women are elevated serum LH and ASD levels, and the treatment with bromocriptine is effective not only for the correction of these abnormal serum hormone levels, but also for the normalizing of the endometrium, probably through the mechanism of the improvement of hypothalamic dopamine turnover.
一般社団法人日本内分泌学会の論文

内分泌学的PCO症例の臨床的背景およびbromocriptineの効果に関する研究

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