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SlNDROMA POLIKISTlKOVARIUM
Dr. Lenny M. Lisal, SpOG
SUB.BAGIAN FERTILITAS ENDOKRIN REPRODUKSIBAGIAN OBSTETRI & GINEKOLOGI FAKULTAS
KEDOKTERAN UNIVERSITAS HASANUDDINMAKASSAR
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Pendahuluan
Sinonim:
sindrom S!"in#L"$"n!%' o$ri(m
)oi*is!i*' o$ri(m s*"ro*is!i*')"n+*i!)oi*is!i* o$ri(m' no$(si
d"n,n %i)"rndro,"nism"
P"r!m *i di*"m(**n S!"in#L"$"n!%-/012
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B(*n )"n+*i! m"in*n *(m)(n
,"3
P"n+"44 )s!i 4"(m di*"!%(i' dimn
o$ri(m m"m4"sr dn m"m)(n+i
4n+* *n!on, !( *is! +n, 4"risi
5irn
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1#61 7 8ni! )d r"n!n, m"nrs#
)"rim"no)(s" *n m"n,mi si*(s
+n, !d* 4"ro$(si
91 7 dri si*(s +n, !id* 4"ro$(si i!(4"r*"m4n, m"n3di no$(si *ronis
dm 4"n!(* o$ri(m )oi*is!i*
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; 7 dri *"inn o$ri(m )oi*is!i* inis"5r *inis !m)i s"4,i )"n+*i!
o$ri(m )oi*is!i*
Pd 1#; 7 8ni! (si r")rod(*si')"n+*i! o$ri(m )oi*is!i* ini *n
4"r,"3 I"n,*) s"4,i sindrom
o$rin )oi*is!i*
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Er! *i!nn+ d"n,n )"ris!i8 no$(si'
s"%in,, s"!i) *ondisi !( *"dn +n,
d)! m"n+"44*n !"r3din+ no$(si*roni* *n m"n+"44*n !"r3din+
sindrom o$ri(m )oi*is!i*
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Insiden K"inn "ndo*rin +n, (m(m )d
8ni! (si )rod(*!i
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Patofosiologi
>ni! d"n,n o$ri(m )oi*is!i*' *dr
LH !in,,i dn FSH r"nd%.
Ini !"r3di *i4! m"*nism" (m)n 4i*
"s!ro,"n +n, !in,,i m"n+"44*n s"*r"si
LH dn s()r"si FSH.
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Po ,ondo!ro)in -LH !in,,i don FSHr"nd%2 !"r3di *r"n )"nin,*!n
s"*r"si GnRH
K"ni*n GnRH dis"44*n o"% !on(sO)ioid s"n!r m"n(r(n -O)ioid
%i)o!m(s d% in%i4i!or2.
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Ton(s o)ioid +, *(rn, dis"44*n o"%
*dr r"nd% )ro,"s!"ron +n, m"n"!).
H ini 4"r%(4(n,n d"n,n )"nin,*!n
)d m)i!(d dn
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A*i4! *dr FSH m"n(r(n' P"r!(m4(%n( !id* !(m4(% )"n(%' r"n!n, %id()
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Foi*" ini di*"iin,i s" !"* %i)"r)s!i*'+, m"n,mi (!"nissi *rn LH !in,,i
A*(m(si 3rin,n
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Kondisi ini 4"r3n !"r(s' *"!i*
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Foi*" !r"!i* *n m"n,"(r*nndros!"n"dion dn !"s!os!"ron
A*i4!n+ !im4( in,*rn s"!n' dimn
ndro,"n +, m"nin,*! m"nim4(*nms% "8! *on$"rsi "*s!r ,nd("r
dn %m4!n sin!"sis SHBG'
m"n+"44*n "s!ro,"n m"nin,*!
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Hin,n+
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K)s( s*"ro!i* +, !"4 ini 4"r!ind*
s"4,i )"n,%n, m"*ni* !"r3din+
o$(si. Kons") +n, "4i% *(r! d o$ri(m
)oi*is!i* %si dri *ons"*8"nsi no$(si
)"rsis!"n dn *"dn +, steady state
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Kr"*!"ris!i* o$ri(m )oi*is!i*
m"n5"rmin*n *ondisi dis
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?m
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K"!"4n s!rom *or!"*s m"nin,*! 0; 7'
s!rom s(4*or!i* m"nin,*! 1 *i.P"nin,*!n s!rom dis"44*n *i4!%+)"r)si s" !%"* dn )"m4"n!(*n
s!rom 4r( +, 4"rs dri
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P"r(4%n o$ri(m )oi*is!i* m"n3disindrom o$ri(m )oi*is!i* d%
,n,,(n
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Kons"*("nsi *inis +, )o!"nsi *i4! s"*r"si
%ormon +n, m"n"!) )d sindrom o$ri(m
)oi*is!i* d %+)"rins(in"mi 4"r() %is(!ism",(*os !"r,n,,( sm)i di4"!"s m"i!(s'
%+)"rndro,"nism" 4"r() %is(!ism"' o)"si
dn 3"r8!' in
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Ms% dis
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M"(i
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Ms% ini s"s(i d,n m"n(r(nn+
*!i
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S" ,rn(os o$ri(m )oi*is!i* s,!
s"nsi!i< )d FSH s"dn, s" ,rn(os
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A*i4! in dri )"nin,*!n ndro,"n
d% m"n5",% )"r*"m4n,n
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D"n,n d"mi*in' ,4rn >si* o$ri(m
)oi*is!i* :d 4n+*
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Retensi Insulin
B4r) )"n"i!in r"sis!"nsi ins(in )d
sindrom o$ri(m )oi*is!i* s"5r
")id"mioo,is !"rd)! )"nin,*!n
r"si*o DM !+)" II dn )"n+*i!*rdio$s*("r )d 8ni! d,n sindrom
o$ri(m )oi*is!i* r"sis!"nsi ins(in
!"r3di *i4! )"r(4%n i)id dn)ros"s
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Ad 4"4"r) m"*nism" r"sis!"nsi
ins(in )d sindrom )oi*is!i* o$ri(m'
d% :
# R"sis!"nsi 3rin,n !r,"! di )"ri
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Pr"s"n!si Kinis )si"n d"n,n r"sis!"nsi
ins(in -To"nrnsi ,(*os !"r,n,,( !(
di4"!"s m"i!(s2 !"r,n!(n, )d
*"mm)(n *om)"nssi )n*r"s d"n,nr"sisi!"nsi 3rin,n !r,"! ins(in.
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Hiperandrogenisme
T"rd)! *or"si n!r d"r3!%i)"rins(in"mi d"n,n %i)"rndro,"nism".
Pd *dr +n, I"4i% !in,,i' ins(in m"n,i*!
receptor IGF tipe I (yang strukturnya serupadengan receptor insulin ). ?di 3i* r"5")!orins(in di%m4! !( 3(m% r"5")!or !id*5(*()' d)! di%r)*n ins(in *n m"n,i*!
r"5")!or IGF ri)" I.
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M"n,in,! 4%8 "
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Ge#ala klinis
Hi)"rndro,"nism"
no$(si
Gn,,(n %id -oi,om"nor" m"nor"2
Disi)id"mi
Hi)"r!"nsi
P?K
In
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Sindrom S!"in#L"$"n!%
# O4"si!s
# Hirs(!ism"
# Gn,,(n m"ns!r(si
# S(4
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Diagnosis
Am"nor"' oi,om"nor"' in
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L)ros*o)i Kdr FSH' PRL' dn E norm
LH s"di*i! m"nin,,i -nis4% LHFSH02.
Sin!"sis T di o$ri(m m"nin,*!
S!rom o$ri(m m"n"4 -%i)"r!i*osis2.
Kdr T +n, !in,,i m"m4(!
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Penanganan
Belum menginginkan anak- pilkontrasepsi
Hirsutismus - androgen mis.Siproteronasetat (SPA) atau pilkontrasepsi yang mengandung SPA
Spironolakton 2 : 50 mg!ari
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Menginginkan anak
# P"mi5( o$(si mis. *omi
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Pembedahan widereseksi tidak
dilakukan lagi
Laparaskopi - dilakukan "driling pada ovarium
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Komplikasi
1. Infertilitas
2. Gangguan menstruasi
3. Hirsutisme, alopesia,akne
4. Peningkatan risiko kankerendometrium
5. Peningkatan risiko penyakit
kardiovaskuler. Peningkatan risiko dia!etes mellitius
pada pasien dengan resisitensi insulin
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TERIMA KASIH
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