Turkiye Klinikleri Journal of Internal Medicine

.: REVIEW
Karmaşık İlişki: D Vitamini, İnsülin Direnci ve Polikistik Over Sendromu
Complex Relationship: Vitamin D, Insulin Resistance and Polycystic Ovary Syndrome
Emre Batuhan KENGERa, Tuğçe ÖZLÜa, Rümeysa GÜRDOĞANa, Kevser ÇELİKa
aBahçeşehir Üniversitesi Sağlık Bilimleri Fakültesi, Beslenme ve Diyetetik Bölümü, İstanbul, TÜRKİYE
Turkiye Klinikleri J Intern Med. 2020;5(1):27-33
doi: 10.5336/intermed.2019-70547
Article Language: TR
Full Text
ÖZET
 Polikistik over sendromu (PKOS); menstrüel düzensizlik, yükselmiş androjen seviyeleri ve polikistik görünümlü overler gibi özellikleri ile üreme çağındaki kadınlarda en sık görülen endokrinopatidir. Kalıtım, obezite, diyabet hastalığı PKOS için başlıca risk faktörlerindendir. Bununla birlikte, mevcut kanıtlar insülin direncinin PKOS patogenezinde merkezi bir role sahip olduğunu ve altta yatan metabolik anormallikleri şiddetlendiren önemli bir faktör olarak öne çıktığını göstermektedir. Gözlemsel çalışmalar D vitamini eksikliğinin de PKOS gelişiminde rol oynayabileceğini düşündürmektedir. PKOS'lu kadınlarda D vitamini eksikliği yaygın görülen bir sorundur. PKOS'lu kadınların %67-85'inin ortalama 25-hidroksi vitamin D (25OHD) düzeyleri 20 ng/mL'nin altındadır. D vitamini eksikliği özellikle obezite, hiperandrojenizm, üreme fonksiyonlarında bozukluk durumlarını daha da ağırlaştırarak PKOS gelişimine zemin hazırlayabilmektedir. Bununla birlikte yapılan çalışmalar D vitamini eksikliğinin, PKOS patogenezinde başlıca rol oynayan insülin direncinin gelişiminde önemli bir rol oynadığını ortaya çıkarmıştır. Yakın geçmişte PKOS tedavisinde D vitamini takviyesinin etkilerini değerlendiren bazı randomize kontrollü çalışmalar dâhil olmak üzere yapılan çeşitli çalışmaların sonuçları ise değişkenlik göstermektedir. Vitamin D takviyesinin PKOS yönetimi için yararlı olabileceği düşünülse de PKOS'lu kadınlarda D vitamini desteğinin insülin direnci ve diğer semptomlar üzerindeki etkileri ve bu etkilerin hangi yolaklarla sağlandığı konuları hâlâ belirsizliğini korumaktadır. Bu çalışmada, D vitamininin PKOS ve insülin direnci patogenezindeki olası etkilerini ve PKOS tedavisindeki rolünü ortaya koymak amaçlanmıştır.

Anahtar Kelimeler: D vitamini eksikliği; insülin direnci; polikistik over sendromu
ABSTRACT
 Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age with features such as menstrual irregularity, elevated androgen levels and polycystic ovaries. Family history, obesity, diabetes are the main risk factors for PCOS. However, current evidence suggests that insulin resistance plays a central role in the pathogenesis of PCOS and appears to be an important factor that compounds underlying metabolic abnormalities. Observational studies suggest that vitamin D deficiency may also play a role in the development of PCOS. Vitamin D deficiency is a common problem in women with PCOS. 67-85% of women with PCOS have 25-hydroxy vitamin D (25OHD) levels below 20 ng/mL. Vitamin D deficiency may aggravate the conditions of obesity, hyperandrogenism and reproductive functions, and may pave the way for the development of PCOS. However, studies have shown that vitamin D deficiency plays an important role in the development of insulin resistance, which plays a major role in PCOS pathogenesis. The results of several recent studies, including some randomized controlled trials evaluating the effects of vitamin D supplementation in PCOS treatment are variable. Although vitamin D supplementation is thought to be beneficial for PCOS management, the effects of vitamin D supplementation on insulin resistance and all other symptoms in women with PCOS and the ways in which these effects are provided remain unclear. In this review, we aimed to investigate the possible effects of vitamin D on the pathogenesis of PCOS and insulin resistance and its role in the treatment of PCOS.

Keywords: Vitamin D defiency; insulin resistance; polycystic ovary syndrome
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