Polikistik Over
Dr. Burak Hacıhanefioğlu
polycysticovary.net internet sitesinde yer alan tıp içerikli yazı ve videoların tümü Kadın Hastalıkları ve Doğum Uzmanı Dr. Burak Hacıhanefioğlu tarafından hazırlanmış olup, telif hakları yasal koruma altına alınmıştır. İzinsiz kaynak gösterilerek dahi başka bir yerde yayınlanamaz.
Polikistik over sendromu’nda fazla kilolu veya şişman ya da normal kilolu, hatta zayıf, fakat karın ve bel çevresinde yağ miktarı fazla (erkek tipi yağlanma) olan kadınlarda insülin direnci görülmektedir(1,2,3,4). Sigarada bulunan nikotin de insülin direncine neden olmaktadır. (5,6,7,8,9,10). Sigaranın kilo almayı önleyici etkisi nedeniyle fazla kilolu olmayan bu kadınların bel ve karın bölgesinde insülin direncinin belirtisi olan erkek tipi yağlanma artışı görülmektedir(11). Sigara kullanan polikistik over sendromu olan kadınlarda kilo artışı olmasa bile karın ve bel çevresinde yağ miktarı fazlalığı ve insülin direnci artmaktadır(11,12,13,14,15).
Polikistik over sendromu olan ve sigara içen kadınlarda sigarada bulunan nikotin, erkeklik hormonlarının (testosteron) etkisiz maddelere (metabolit) dönüşerek vücuttan atılmasını engellemektedir(16,17). Bu nedenle sigara kullanan polikistik over sendromu olan kadınlarda testosteron miktarı daha da artmaktadır(18,19,20).
KAYNAKLAR
1-Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Diabetes. 1989 Sep;38(9):1165-74.
2-Prediction models for insulin resistance in the polycystic ovary syndrome. Gennarelli G, Holte J, Berglund L, Berne C, Massobrio M, Lithell H. Hum Reprod. 2000 Oct;15(10):2098-102.
3-Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. carmina E , Lobo RA. Fertil Steril. 2004 Sep;82(3):661-5.
4-Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. DeUgarte CM, Bartolucci AA, Azziz R. Fertil Steril. 2005 May;83(5):1454-60.
5-Smoking induces insulin resistance–a potential link with the insulin resistance syndrome. Attvall S, Fowelin J, Lager I, Von Schenck H, Smith U. J Intern Med. 1993 Apr;233(4):327-32.
6-Insulin resistance and cigarette smoking. Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Lancet. 1992 May 9;339(8802):1128-30.
7-Cigarette Smoking: An Accessory to the Development of Insulin Resistance. Artese A, Stamford BA, Moffatt RJ. Am J Lifestyle Med. 2017 Aug 23;13(6):602-605.
8-Chronic Tobacco Exposure by Smoking Develops Insulin Resistance. Mukharjee S, Bank S, Maiti S. Endocr Metab Immune Disord Drug Targets. 2020;20(6):869-877.
9-Intramuscular lipid metabolism in the insulin resistance of smoking. Bergman BC, Perreault L, Hunerdosse DM, Koehler MC, Samek AM, Eckel RH. Diabetes. 2009 Oct;58(10):2220-7.
10-Novel and reversible mechanisms of smoking-induced insulin resistance in humans. Bergman BC, Perreault L, Hunerdosse D, Kerege A, Playdon M, Samek AM, Eckel RH.Diabetes. 2012 Dec;61(12):3156-66.
11-Cigarette smoking and fat distribution in 21,828 British men and women: a population-based study. Canoy D, Wareham N, Luben R, Welch A, Bingham S, Day N, Khaw KT.Obes Res. 2005 Aug;13(8):1466-75.
12-Circulating levels of adipose products and differences in fat distribution in the ovulatory and anovulatory phenotypes of polycystic ovary syndrome. Carmina E, Bucchieri S, Mansueto P, Rini G, Ferin M, Lobo RA. Fertil Steril. 2009 Apr;91(4 Suppl):1332-5.
13-Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Kirchengast S, Huber J. Hum Reprod. 2001 Jun;16(6):1255-60.
14-Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, Di Fede G, Rini G. J Clin Endocrinol Metab. 2007 Jul;92(7):2500-5.
15-Nicotinic regulation of energy homeostasis. Zoli M, Picciotto MR.Nicotine Tob Res. 2012 Nov;14(11):1270-90.
16-Glucuronidation genotypes and nicotine metabolic phenotypes: importance of functional UGT2B10 and UGT2B17 polymorphisms. Chen G, Giambrone NE Jr, Dluzen DF, Muscat JE, Berg A, Gallagher CJ, Lazarus P.Cancer Res. 2010 Oct 1;70(19):7543-52.
17-Smoking, sex, risk factors and abdominal aortic aneurysm: is it all down to testosterone? Schooling CM. J Epidemiol Community Health. 2015 May;69(5):495.
18-Cigarette smoking and testosterone in men and women: A systematic review and meta-analysis of observational studies. Zhao J, Leung JYY, Lin SL, Mary Schooling C. Prev Med. 2016 Apr;85:1-10.
19-Smoking in infertile women with polycystic ovary syndrome: baseline validation of self-report and effects on phenotype. Legro RS, Chen G, Kunselman AR, Schlaff WD, Diamond MP, Coutifaris C, Carson SA, Steinkampf MP, Carr BR, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Myers ER, Zhang H, Foulds J; Reproductive Medicine Network. Hum Reprod. 2014 Dec;29(12):2680-6.
20-Effect of exposure to second-hand smoke from husbands on biochemical hyperandrogenism, metabolic syndrome and conception rates in women with polycystic ovary syndrome undergoing ovulation induction. Li J, Wu Q, Wu XK, Zhou ZM, Fu P, Chen XH, Yan Y, Wang X, Yang ZW, Li WL, Stener-Victorin E, Legro RS, Ng EH, Zhang H, Mol BWJ, Wang CC; for PCOSAct Study Group. Hum Reprod. 2018 Apr 1;33(4):617-625.