HIPERPLAZIA ADRENALĂ CONGENITALĂ ŞI SINDROMUL OVARELOR POLICHISTICE: DIAGNOSTIC DIFERENŢIAL LA FEMEI INFERTILE

Abstract

Introducere. Infertilitatea femenina de cauză endocrino-logică la pacientele tinere poate fi determinată de afecţiuni cu fenotip hiperandrogenic comun. Hiperplazia adrenală congenitală cu debut tardiv şi sindromul ovarelor polichi-stice sunt cele mai frecvente cauze, fiind adesea dificil de diferenţiat clinic. Scop. Identificarea parametrilor clinici şi hormonali care permit diferenţierea precisă între hiperpla-zia suprarenală congenitală cu debut tardiv şi sindromul ovarelor polichistice la femeile cu infertilitate. Material şi metode. A fost realizat un studiu retrospectiv pe un lot de 17 paciente cu vârste între 18 şi 35 ani, evaluate pentru infertilitate şi semne de hiperandrogenism. S-au efectuat examinări clinice, ecografie transvaginală, determinări hormonale (testosteron total, DHEAS, 17-hidroxiprogesteron). La valorile >2 ng/mL 17-OHP s-a efectuat testul cu ACTH. Rezultate. Din cele 17 paciente, 2 (11,8%) au fost diagnosticate cu hiperplazie adrenală congenitală (CAH). La una dintre ele, valoarea bazală a 17-hidroxiprogesteronului (17-OHP) s-a situat între 2 şi 10 ng/mL, iar testul de stimulare cu ACTH a evidenţiat o creştere semnificativă peste 15 ng/ mL, confirmând diagnosticul. La cealaltă pacientă, valoarea bazală a 17-OHP a depăşit 10 ng/mL, permiţând stabilirea diagnosticului fără test de stimulare. Sindromul ovarelor polichistice (SOPK) a fost identificat la 11 paciente (64,7%). Restul de 4 paciente (23,5%) au avut profiluri variate, inclusiv o pacientă diagnosticată cu hiperprolactinemie. Concluzii. Determinarea valorii bazale şi stimulate a 17-OHP permite diferenţierea corectă între CAH şi SOPK la paciente infertile. Rezultatele susţin utilitatea profilului hormonal extins în stabilirea diagnosticului corect. Rezultate subliniază importanţa unui profil hormonal complet pentru diagnostic

Introduction. Female endocrine-related infertility in young patients can be caused by disorders with similar hyperan-drogenic phenotypes. Late-onset congenital adrenal hyperplasia and polycystic ovary syndrome are among the most common causes, often difficult to distinguish clinically. Accurate diagnosis is essential. Objective. Identification of clinical and hormonal parameters relevant to the clear differentiation between late-onset congenital adrenal hyperplasia and polycystic ovary syndrome in women with infertility. Material and methods. A retrospective study was conducted on a group of 17 women aged between 18 and 35, evaluated for infertility and signs of hyperandrogenism. Clinical examination, transvaginal ultrasound, and hormonal testing (total testosterone, DHEAS, 17-hydroxyprogester-one) were performed. In cases with 17-OHP values >2 ng/ mL ACTH test was conducted. Results. Out of 17 patients, 2 (11.8%) were diagnosed with congenital adrenal hyperplasia (CAH). One of them had a baseline 17-hydroxyprogester-one (17-OHP) level between 2 and 10 ng/mL, and the ACTH stimulation test showed a significant increase above 15 ng/ mL, confirming the diagnosis. In the second case, the 17-OHP baseline level was above 10 ng/mL, enabling diagnosis without stimulation. Polycystic ovary syndrome was diagnosed in 11 patients (64.7%). The remaining 4 (23.5%) had varied profiles, including one with hyperprolactinemia. Hormonal profiles supported clinical suspicion in all subjects, reinforcing the need for targeted investigation. Conclusion. The determination of both basal and ACTH-stimulated 17-OHP levels enables accurate differentiation between CAH and PCOS in infertile. These findings highlight the importance of a comprehensive hormonal profile for establishing a precise diagnosis and guiding appropriate treatment strategies