At the age of 25, why repeated acne, the truth is often not simple

Preface

Recently, a patient diagnosed with obesity and acne was admitted to our hospital.

Case history

The patient, female, 25 years old, unmarried, came to our hospital because of "irregular menstruation for 1 year"

History of present illness: The patient has irregular menstruation in one year without obvious inducement, usually once every 2-3 months, heavy menstrual flow, no blood clots, no dysmenorrhea, no special discomfort, no attention, and no menstruation for 3+ months.

Past history: In 2020, the patient visited the dermatology department of the outside hospital for repeated refractory acne on the face

General physical examination: general conditions are okay, mild acne, no increase in body hair, no pigmentation

Initial diagnosis: menstrual disorders, acne

Related laboratory results and inspections:

The results showed that the patient's testosterone increased, and the patient's repeated refractory acne was a manifestation of excessive androgen, and abnormal androgen metabolism was an important cause of the onset of polycystic ovary syndrome

Four-dimensional ultrasound: changes in bilateral ovarian polycystic ultrasound

Clinical analysis: Most patients with polycystic ovary syndrome will have insulin resistance, which is also another important factor in the onset of disease and is closely related to long-term metabolic complications

The insulin release test indicated that the results were significantly increased, and hyperinsulinemia had appeared

Final diagnosis: polycystic ovary syndrome, insulin resistance

Re-diagnosis: The patient gradually began to lose weight, taking short-acting contraceptives regularly for 3 months, and menstrual cramps regularly during the medication

case analysis

Polycystic ovary syndrome is the most common gynecological endocrine disease in women of childbearing age whose clinical manifestations are highly heterogeneous due to the combined effects of genetic and environmental factors

Clinical manifestations:

1.

2.

3.

4.
Metabolism-related diseases: Research and investigation have shown that at least half of PCOS patients are obese, and most patients have hyperinsulinemia and insulin resistance ^[1-2]
.

Laboratory inspection:

Serum sex hormones: serum total testosterone levels are normal or slightly elevated, but serum free testosterone can better reflect the real role of androgens in the body
.
Most patients with polycystic ovary syndrome have LH/FSH≥2, and about one-third of PCOS patients also have a mild increase in prolactin ^[2]
.

Anti-Müllerian hormone: PCOS patients often have follicular maturation disorders, and serum AMH levels are significantly higher than normal
.

Metabolic-related check: OGTT test; insulin release test; lipids, blood glucose levels; liver function, kidney function tests
.

Other related hormone tests: mainly used to rule out the diagnosis
.
According to individual differences in patients, physical examination results and clinical manifestations, thyroid function, cortisol, adrenal cortex hormone releasing hormone, etc.
can be selected
.

Pelvic ultrasound examination: Sex hormone drugs should be stopped for at least one month before the examination, and polycystic ovaries can also be seen in some normal women, such as the use of contraceptives and amenorrhea [2]
.

Related diagnostic criteria:

Up to now, international experts have put forward 3 consensuses, namely the NH standard proposed by the National Institutes of Health in 1990, the Rotterdam standard jointly proposed by ESHRE and ASRM in 2003, and the AES standard proposed by AE-PCOS in 2006 ^[3]
.
my country's 2018 Polycystic Ovary Syndrome Diagnosis and Treatment Guidelines continue to use the 2011 Chinese PCOS diagnosis and treatment standards, and propose "suspected PCOS" and require that other similar diseases must be excluded, including

Hyperandrogenemia or symptoms of hyperandrogen:

(1) Cushing syndrome;

(2) Non-classical congenital adrenal hyperplasia;

(3) Tumors that secrete androgens from the ovaries or adrenal glands;

(4) Other;

Ovulation disorders:

(1) Functional hypothalamic amenorrhea; (2) Thyroid-related diseases; (3) Hyperprolactinemia; (4) Early-onset ovarian insufficiency ^[2]
.

In adolescent women, the development of the hypothalamic-pituitary-gonadal axis is not fully mature, and many similar symptoms may be temporary, so the diagnosis of PCOS in adolescent women is more difficult and strict
.

Treatment principles:

At present, the etiology and pathogenesis of PCOS are still unclear.
Patients of different ages have different treatment goals and clinical manifestations are highly heterogeneous.
Most of the clinical treatment is individualized symptomatic treatment
.
include:

Adjust living habits: control diet, reduce total calorie intake, suitable and regular exercise, reduce body fat rate, improve metabolic level, which can prevent and treat long-term complications in a timely and effective manner and improve the quality of life
.

Adjust menstrual cycle

Decrease the body's androgen levels

Adjust metabolism

Improve fertility

Psychological guidance: Let patients and their family members have a basic understanding of the disease, physical health and recovery, and maintain a positive and optimistic attitude
.
Don't put too much pressure on the patient by family members and yourself, which may cause the progression of PCOS patients to accelerate
.

Summarize

Polycystic ovary syndrome (PCOS) is a relatively common endocrine disease among women of the right age, with a prevalence of up to 15 %
.
At present, the pathogenesis of the disease has not been studied.
The clinical features mainly include the following two or more: increased AMH, increased androgen, and ultrasound showing polycystic ovary
.

PCOS is related to various metabolic diseases, including hyperinsulinemia and hyperlipidemia, obesity, etc.
These factors may lead to type II diabetes, atherosclerosis and various cardiovascular diseases in later life
.

Hyperandrogenism and obesity can cause cardiometabolic dysfunction and chronic inflammation in women with polycystic ovary syndrome
.
The degree of increased cardiovascular events The incidence of women with polycystic ovary syndrome remains to be studied
.
Children born to mothers with polycystic ovary syndrome may show an increased risk of heart disease.
It is reported that these children will have endocrine abnormalities (such as hyperandrogenemia, hyperinsulinemia) and endothelial dysfunction
.

PCOS is a more common gynecological endocrine disease involving multiple systems in women of childbearing age.
The high heterogeneity of clinical manifestations requires individualized treatment and long-term health management for each patient.
At present, symptomatic treatment is the main focus
.
Therefore, the early integrated analysis of clinical symptoms and laboratory diagnosis are particularly important
.