Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
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The polycystic ovary syndrome

다낭성 난소 증후군

Min, Eung-Gi
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  • Published : 2008.08.15
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Abstract

The polycystic ovary syndrome (PCOS) is a heterogeneous disorder that is characterized principally by oligomenorrhea or amenorrhea with clinical or laboratory evidence of hyperandrogenemia. Furthermore, it is now recognized that a significant proportion of overweight women with PCOS have hyperinsulinemia. Three features are generally recognized to compose this syndrome, including androgen excess, ovulatory dysfunction, and polycystic ovaries. Because its etiology and natural history are poorly understood, there is controversy about the diagnostic criteria and clinical evaluation of the syndrome. But the diagnosis of PCOS entails two principal steps: (a) to determine whether features suggestive of PCOS are present and (b) to exclude related androgen excess or ovulatory disorders. The PCOS results in a number of immediate and long-term morbidities that are associated with a significant impact on quality of life and on economic costs. Immediate morbidities include menstrual dysfunction and abnormal uterine bleeding, subfertility and infertility, and androgen excess-related dermatologic abnormalities including hirsutism, acne, and androgenic alopecia, and an increased risk of obstetrical complications such as pregnancy-induced hypertension and gestational diabetes. However, PCOS is also associated with an increased risk of various other long-term complications or morbidities including cancer, type 2 diabetes mellitus, the metabolic syndrome, and possibly cardiovascular disease. For the management of PCOS, we should consider not only immediate but also the long-term morbidities.

다낭성 난소 증후군이란 여러 가지의 증상과 징후들이 복합적으로 나타나는 가임기 여성들에게 비교적 흔한 내분비 질환의 하나로서, 그 특징적인 소견으로는 안드로겐 (androgen)의 과다, 배란장애 및 불임, 무월경 혹은 희소월경, 비만, 다모증, 다낭 성 소견의 난소 양상 등이다. 또한 다낭성 난소 증후군을 가진 비만 여성들의 많은 비율에서 고인슐린혈증을 동반하는 것으 로 인식되고 있다. 다낭성 난소 증후군은 그 병인이 불명확한 기능적 질환으로서, 원인이 명확하게 밝혀질 수 있는 안드로겐 과다나 배란 장애 등을 제외하면서 순차적으로 진단에 이르게 된다. 일반적으로 본 질환은 이질성의 세가지 특징적인 양상 이 나타나는데 그것이 안드로겐 과다 (hyperandrogenism), 배란 장애 및 다낭성 난소 (PCO: polycystic ovary) 소견이다. 지금까 지로서는 3가지의 진단적 기준이 제안되었는 바, 1990년도의 NIH (National Institutes of Health) 기준과 2003년도의 ESHRE (European Society for Human Reproduction and Embryology) 및 ASRM (American Society for Reproductive Medicine)의 기준 그리고 2006년도의 AES (Androgen Excess Society) 기준이다. 다낭성 난소 증후군은 월경 장애, 부정 자궁출혈, 불임, 안드로겐 과다에 의한 다모증, 여드름, 탈모 등과 더불어 임신성 고혈압 이나 임신성 당뇨증 등 산과적 합병증을 일으킬 뿐만 아니라, 장기적으로 안드로겐 과다와 인슐린 저항성, 고에스트로겐혈증 등에 노출됨으로 인해서 암, 당뇨증 (type 2), 대사증후군 (metabolic syndrome), 심혈관 질환 등이 발생 위험성이 정상인에 비해서 높을 수 있다는 것을 염두에 두어야 한다. 따라서 다낭성 난소 증후군의 치료는 환자 개개인의 조건과 요구에 따라 다르겠으며, 현재 나타나고 있는 증상과 징후 등에 대한 치료적 접근은 물론 장기적인 관리 또한 매우 중요하다. 기본적으로 안드로겐 과다에 대한 치료, 임신을 위한 배란장애 개선, 비만이나 다모증, 여드름 등에 대한 치료, 만성적인 고에스트로겐혈증으로 인한 장기적인 자궁내막이나 유방의 자극에 대한 고려, 심혈관질환이나 당뇨병의 위험에 대한 대비 등 개인에 맞는 맞춤치료를 하여야 한다.

Keywords

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