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The Effect of Valproic Acid on Ovary of pubertal Child
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KMID : 0391520010090010086
Abstract
¸ñÀû: Valproic acid´Â ¼Ò¾Æ¿Í ¼ºÀÎ ¸ðµÎ¿¡°Ô¼ ±¤¹üÀ§ÇÏ°Ô ¾²À̸ç, Àü½Å ¹ßÀÛ°ú ºÎºÐ ¹ßÀÛ µî ¿©·¯ Á¾·ùÀÇ °æ·Ã¿¡ Ä¡·á È¿°ú¿Í ¾ÈÀü¼ºÀÌ ÀÔÁõµÈ Ç×°æ·ÃÁ¦ÀÌ´Ù. Áö±Ý±îÁö º¸°íµÈ ÈçÇÑ À§Àå°ü°èÀÇ ºÎÀÛ¿ë°ú üÁß Áõ°¡, °£µ¶¼º, ±×¸®°í µå¹°°Ô´Â ½Å°æ°è ºÎÀÛ¿ë ¿Ü¿¡,
¿©¼º¿¡¼ ƯÈ÷ 20¼¼ ÀÌÀüºÎÅÍ valproic acid¸¦ º¹¿ëÇÑ °æ¿ì ¾Èµå·ÎÁ¨°úÀ×Áõ°ú ´Ù³¶¼º ³Æ÷ µîÀÇ ¹ß»ýÀÌ º¸°íµÇ°í ÀÖ´Ù. ÀÌ¿¡ ÀúÀÚ´Â valproic acid°¡ ¼Ò¾Æ¿Í û¼Ò³â±âÀÇ ¿©¾Æµé¿¡¼ »ý½Ä ³»ºÐºñ°è¿¡ ¹ÌÄ¡´Â ¿µÇâ¿¡ ´ëÇØ ¾Ë¾Æº¸±â À§ÇØ, valproic acid¸¦ º¹¿ë ÁßÀÎ
´Ù¾çÇÑ
½Ã±âÀÇ »çÃá±â ¿©¾Æ¸¦ ´ë»óÀ¸·Î üÇü, ³¼ÒÀÇ ÇüÅ ¹× ¼ºÈ£¸£¸ó¿¡ ´ëÇÑ ¿¬±¸¸¦ ½Ç½ÃÇÏ¿´´Ù.
¹æ¹ý: 2000³â 1¿ùºÎÅÍ 7¿ù±îÁö Ãæ³²´ëÇб³º´¿ø ¼Ò¾Æ°ú¿¡¼ °£Áú·Î Áø´Ü¹Þ°í valproic acid¸¦ º¹¿ëÇÏ°í Àִ ȯ¾Æ Áß 8¼¼¿¡¼ 18¼¼±îÁöÀÇ ¿©¾Æ 23·Ê¸¦ ´ë»óÀ¸·Î, °æ·ÃÀÇ ÇüÅÂ¿Í Åõ¿©µÈ valproic acidÀÇ ¿ë·®°ú ±â°£À» Á¶»ç ÈÄ, ½ÅÀå°ú üÁßÀ» ÃøÁ¤ÇÏ¿© Body Mass
Index¸¦
»êÃâÇÏ¿´´Ù. »çÃá±âÀÇ ´Ü°è´Â Tanner stage¿¡ µû¶ó °áÁ¤ÇÏ¿´°í, ÃÊÀ½ÆÄ·Î Á÷ÀåÀ» ÅëÇÏ¿© ³¼Ò ¿©Æ÷¸¦ °üÂûÇÏ¿© ´Ù³¶¼º ³Æ÷¸¦ Áø´ÜÇÏ¿´´Ù. Ç÷Áß ¼ºÈ£¸£¸óÀÇ ³óµµ ÃøÁ¤Àº äÇ÷À» ÅëÇÏ¿© free testosterone, sex hormone-binding globulin(SHBG), luteinizing
hormone(LH),
follicle-stimulating hormone(FSH), estradiol µîÀ» ÃøÁ¤ÇÏ¿´´Ù.
°á°ú: Valproic acid¸¦ Åõ¿© ÁßÀÎ °£Áú ȯ¾Æ 23¸í Áß 5¸íÀº »çÃá±â Àü±â¿´À¸¸ç, 13¸íÀº »çÃá±â¿´°í, 5¸íÀº »çÃá±â Èı⿡ ÇØ´çÇÏ¿´À¸¸ç, ÀÌÁß ºñ¸¸¿¡ ¼ÓÇϴ ȯ¾Æ´Â 2¸íÀ̾ú´Ù. Æò±Õ Ç÷û SHBG, LH, FSH, estradiolÀÇ Ç÷Áß ³óµµ´Â ±âÁØÄ¡¿Í ºñ±³½Ã, »çÃá±âÀü±â,
»çÃá±â,
»çÃá±âÈı⠸ðµÎ¿¡¼ Á¤»ó¿¡ ¼ÓÇÏ¿´´Ù. ±ÔÄ¢ÀûÀÎ ¿ù°æ Áֱ⸦ °®´Â Á¤»ó ¿©¾Æ¿¡¼ÀÇ ´Ù³¶¼º ³Æ÷ÀÇ ¹ß»ýÀ²ÀÌ 9%Àε¥ ºñÇØ, º» ¿¬±¸¿¡¼´Â valproic acid¸¦ º¹¿ëÁßÀÎ 20¸íÀÇ ¿©¾Æ Áß ´Ù³¶¼º ³Æ÷ÀÇ ¹ß»ýÀº 5¸íÀ¸·Î 25%¿¡ ÇØ´çÇÏ¿´´Ù.
°á·Ð: Valproic acid¸¦ Åõ¿© ÁßÀÎ ¿©¾Æ¿¡¼ ±ÔÄ¢ÀûÀÎ ³¼ÒÀÇ ÃÊÀ½ÆÄ °Ë»ç´Â ÇÊ¿äÇÑ °ÍÀ¸·Î »ç·áµÈ´Ù. ÇÏÁö¸¸, ³¼ÒÀÇ ÇüÅÂÇÐÀû º¯È°¡ valproic acid¿¡ ÀÇÇؼ À¯¹ßµÇ´Â ÁöÀÇ ¿©ºÎ¸¦ °áÁ¤Çϱâ À§Çؼ´Â ´õ ±íÀº ¿¬±¸°¡ ÇÊ¿äÇÒ °ÍÀ¸·Î »ç·áµÈ´Ù.
Purpose: Valproic acid is effective and safe in adults and children for the treatment of a variety of seizure types. But, according to the recent reports, this drug induce hyperandrogenism, obesity, and polycystic ovaries, particularly when the
medication is stared before the age of 20. This research was designed to study the effect of valproic acid on ovary of pubertal child.
Methods: The sample group consisted of 23 girls who were diagnosed to epilepsy by our department of pediatrics, and were taking valproic acid from January 2000 to July 2000. They were evaluated reproductive endocrine function with the serum sex
hormones
and ultrasonographic study of ovary.
Results: 1) The mean serum sex hormones concentration of prepubertal, pubertal, and postpubertal girls taking valproic acid were belong to the normal range of reference values of textbook of Nelson and Park's report.
2) The obesity were seen in two of the 23 girls taking valproic acid.
3) The rate of polycystic ovaries in normal girls with regular menstruation has been reported in 9%, but, in our report, polycystic ovaries were seen in five of the 20 girls taking valproic acid(25%).
Conclusion: Ultrasinographic study of ovaries is required for the girls taking valproic acid. If the problems from the polycystic ovary are developed on patients taking valproic acid, the substitution of other anticonvulsant drug for valproic
acid
may
be required. However, further study was needed to clarify whether this ovarian morphologic changes were elicited by valproic acid or not.
Å°¿öµå
Valproic acid; Poly cystic overy; Epilepsy; Pubertal girl;
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