Endocrine Abstracts

JOINT2548

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of childbearing age. The mechanisms of this syndrome are due to hormonal imbalance, resulting in excessive production of androgens, particularly testosterone. this case report illustrates a case of renal failure at the hemodialysis stage with sopk.

Observation: 31-year-old patient who has as antecedent: ESRD due to renal amyloidosis at hemodyal stage, cerebral venous thrombosis and IVC thrombosis on anticoagulant of the antivitamin K family presented with moderate hirsutism evolving over the past 4 years, associated with rapidly worsening androgenic alopecia and cycle disorders. clinical examination reveals negative Homans sign, Absence of ancanthosis nigricans, a BMI of 21 kg/m² and a feriman score of 22. External genitalia examination: clitoral hypertrophy prader 1 Creatinine levels were 53 mg/hormonal investigation found Testosterone level =1 .45 ng/ml FSH =4.67 mu/ml LH=27 mu/ml 17 OH PROGESTERONE =1.5 ng/ml D4ANDROSTENDIONE = 5.3 ng/ml SDHEA= 410 ng/ml negative ovarian tumour markers metabolic panel showed dylipidemia with normal glycated hemoglobin Surrenal MRI was normal, and pelvic MRI of enlarged ovaries with multiple follicular formations (greater than 12 follicles/ovary).

Discussion: The management of sopk in the context of end-stage renal failure and thrombosis antcd represents a challenge to the practitioner. Given the multiple contraindications encountered with the usual treatments (oestroprogestogenic contraception, anti-androgenic progestins), therapeutic options will be directed towards 2nd-line treatments, notably spirinolactione, finasteride and flutamide. The data in the literature have demonstrated the possibility of using these treatments in this context, provided that the minimum effective doses are respected and regular monitoring of kalemia, INR and liver function is carried out. In safety studies concerning the use of mineralocorticoid receptor antagonists in hemodialysis patients, spirinolactone caused only a negligible change in baseline kalemia levels. In our patient, the choice of treatment was spironolactone at a dose of 50 mg/day, in in concession with the nephrologists.

Conclusion: The management of sopk in the context of ESRD and thrombosis antecedent remains a challenge for the practitioner, requiring a multidisciplinary approach involving specialists in endocrinology, nephrology and haematology.