Turakulov Republican Specialized Scientific and Practical Medical Center of Endocrinology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan
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Abstract
Background. Cushing’s syndrome is a severe neuro-endocrine pathology, which for many years has been under the scrutiny of many different specialists due to the diversity of its complications. Hyperandrogenism and menstrual irregularities, such as amenorrhea and oligomenorrhea, complement the clinical picture of Cushing’s syndrome. The purpose of the study was to assess the state of fertile function and hormonal profile in female patients with Cushing’s syndrome. Materials and methods. Under supervision, there were 163 patients of reproductive age with Cushing’s syndrome during the period from 2000 to 2019. Their average age was 27.58 ± 3.40 years (from 17 to 49 years), the duration of the disease was 4.2 ± 0.2 years. Twenty healthy women of the corresponding age made up the control group. Results. Patients with Cushing’s syndrome were distributed as follows: the first group with ACTH-dependent Cushing’s syndrome — 130 (79.7 %), the second group with ACTH-independent Cushing’s syndrome — 30 (18.4 %), and the third group with ACTH-ectopic Cushing’s syndrome — 3 (1.8 %) people. Among various reproductive disorders in patients with Cushing’s syndrome, menstrual disorders and secondary amenorrhea dominated. A significant decrease in basal levels of luteinizing and follicle-stimulating hormones, a reduction in ovarian hormones (estradiol, progesterone) against the background of hyperandrogenemia and a significant increase in blood cortisol levels, as well as increase in ACTH were characteristic of patients from the first group on the 14th day of the menstrual cycle. Hyperplasia of both adrenal glands was diagnosed in 110 (84.6 %) people with ACTH-dependent Cushing’s syndrome, nodular hyperplasia of both adrenal glands — in 13 (10 %), incidentaloma — in 3 (2.3 %), and nodular hyperplasia of one adrenal gland — in 2 (1.5 %). Conclusions. Reproductive disorders were observed in patients with Cushing’s syndrome: menstrual irregularities — in 32.9 %, secondary amenorrhea — in 20.4 % individuals. Most of the menstrual irregularities were found in the group of patients with ACTH-dependent Cushing’s syndrome. Menstrual irregularities manifested in the form of oligomenorrhea (30 % of cases), amenorrhea (35 %), polymenorrhea (7.5 %) and cycle variability (7.5 %).
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