Diagnosis and treatment of benign hyperplastic diseases of the uterus in women with endocrine metabolic disorders

The aim of this study was to optimize the diagnosis and therapy for benign hyperplastic diseases of the uterus in women with endocrine metabolic disorders. The study was carried out in 154 women with endometrial hyperplasia, uterine myoma, adenomyosis, and combinations thereof. The patients were divided into 2 groups. The main group included patients with endocrine metabolic disorders, the reference group consisted of patients without disorders of this kind. Comprehensive clinical, laboratory, and instrumental studies were carried out in all patients. Endocrine metabolic disorders were evaluated, and pathomorphological fi ndings were analyzed. Detection of the clinical, biochemical, and morphological parallels in the studied cohort of patients with metabolic shifts prompted us to distinguish (for the fi rst time) three pathogenetic variants of the endocrine metabolic disorders. The role of leptin resistance in the pathogenesis of uterine myoma, adenomyosis, and endometrial hyperplasia was evaluated more precisely. The fi ndings indicated that hyperleptinemia was a potent endocrine factor of clinical manifestation of uterine myoma, adenomyosis, and endometrial hyperplasia. Measurements of serum leptin can serve as an important laboratory test for predicting the progress of latent benign hyperplastic diseases of the uterus and formation of combined forms of the organ involvement. Based on the results, a pathogenetically-based algorithm for examinations and treatment of patients with benign hyperplastic uterine diseases was created. Metabolic rehabilitation of patients, aimed at leptin resistance and insulin resistance control, body weight and lipid tissue control, was suggested. Early correction of the endocrine and metabolic disorders in accordance with the pathogenetic variants defi ned should be the key component of combined therapy and secondary prevention of benign hyperplastic uterine diseases.