Dynnik O. Hormonal and metabolic disorders and their correction in patients with pubertal uterine bleeding.

The thesis is devoted to expanding the concepts concerning pathogenetic mechanisms of pubertal uterine bleeding (PUB), defining the principal risk factors of the disease, and to studying the nature of hormonal and metabolic disorders in patients with PUB. On the basis of the results obtained it was established that insulin and leptin play a significant role in the pathogenesis of PUB. A mathematical model of interrelationships between gonadotropic hormones, prolactin, and energy supplying hormones (insulin and leptin) was developed taking into account different body weight of our patients. Quantitative and qualitative shifts in carbohydrate and lipid metabolisms, characteristic of patients with PUB, as well as certain dependence between the severity and the character of disorders of the carbohydrate and lipid spectra and body weight, against which PUB develops, were revealed in the study. According to the results of the lipid metabolism study a factor model of relationships between lipid profile and BMI was constructed. Basing on the statistical analysis some criteria for predicting insulin resistance in patients with PUB were worked out, and a high effectiveness of the proposed criteria for the prediction was revealed according to the Wald's test (72.5%). It was established that the main risk factors for PUB development were: hereditary load for the reproductive system disorders, bottle-feeding of the baby, mother's bad habits at the time of conception (smoking), pathological course of pregnancy (threatened abortion, gestoses of the second half of pregnancy) in mothers of our patients, destructive family of the sick girl, stress in her mother during pregnancy, as well as traumatic injuries (traumas, fractures, and bruises) in our patient and stress which she experienced at home and at school. Application in the complex treatment of our patients medicinal agents, capable of eliminating metabolic disorders, was scientifically grounded in the work.