Características clínicas y evolutivas de adenomas hipofisarios incidentales: estudio multicéntrico retrospectivo / Clinical and evolutionary characteristics of incidental pituitary adenomas: retrospective multicenter study

Resumen Introducción : Los incidentalomas hipofisarios (IH) son lesiones halladas fortuitamente en la hipófisis mediante imágenes realizadas por motivos no relacionados con enfermedad hipofisaria. Métodos : Se realizó un estudio transversal, retros pectivo y descriptivo con el objetivo de analizar las características clínicas y evolutivas de una población de pacientes portadores de IH en la ciudad de Córdoba. Resultados : Se incluyeron 67 pacientes, 67% del sexo femenino, con una mediana de edad al diagnóstico de 44 años. Entre los motivos que llevaron a solicitar la primera imagen, la cefalea crónica o recurrente fue el más prevalente (34%). La mediana del tamaño tumoral fue de 12 mm. El 58% fueron macroincidentalomas. Los hombres tuvieron lesiones significativamente más grandes (p = 0.04). Al diagnóstico, considerando ambos sexos, el 30% evidenció extensión extraselar y el 45% invasión a senos cavernosos. Se detectó compromi so neurooftalmológico en el 21%. Se halló correlación positiva entre la edad al momento del diagnóstico y el tamaño tumoral (r = +0.31, p = 0.001). El 91% fueron tumores no funcionantes y en su presentación, el 21% de los pacientes presentaron una o más deficiencias hormonales. El 26% del total requirió cirugía. La ma yoría de aquellos que continuaron sin tratamiento no evidenciaron cambios en el tamaño tumoral al final del seguimiento (mediana 42 meses). Conclusión : Destacamos la elevada frecuencia de macroincidentalomas en nuestra serie, siendo los de fectos del campo visual y el hipopituitarismo frecuentes al diagnóstico. Si bien la mayoría de los IH no operados permanecieron estables, existió una alta frecuencia de lesiones clínicamente significativas.

Abstract Introduction : Pituitary incidentalomas (PIs) are le sions found incidentally in the pituitary on imaging performed for reasons unrelated to pituitary disease. Methods : A cross-sectional, retrospective and descrip tive study was carried out with the aim of analyzing the clinical and evolutionary characteristics of a population of patients with PIs in the city of Córdoba. Results : A total of 67 patients were included, 67% fe male, with a median age at diagnosis of 44 years. Among the reasons that led to requesting the first image, chron ic or recurrent headache was the most prevalent (34%). The median tumor size was 12 mm. Fifty-eight percent were macroincidentalomas. Men had significantly larger lesions (p = 0.04). At diagnosis, including both sexes, 30% showed extrasellar extension and 45% invasion of the cavernous sinuses. Neuro-ophthalmological compromise was detected in 21%. A positive correlation was found between age at diagnosis and tumor size (r= +0.31, p = 0.001). Ninety-one percent were non-functioning tumors and at presentation, 21% of patients had one or more hormonal deficiencies. Of the total, 26% required surgery. Most of those who continued without treatment showed no change in tumor size at the end of follow-up (median 42 months). Conclusion : We highlight the high frequency of mac roincidentalomas in our series, with visual field defects and hypopituitarism being frequent at diagnosis. Al though most non-operated PIs remained stable, there was a high frequency of clinically significant lesions.

Principales disruptores endocrinos vinculados con salud reproductiva femenina: bases biológicas de su asociación / Main endocrine disruptors related to female reproductive health: biological basis of their association

Resumen Se denominan disruptores endocrinos (DEs) a aquellas sustancias químicas capaces de interferir con la homeostasis hormonal, alterando la síntesis, función, almacenamiento y/o metabolismo de las hormonas. Estas sustancias se encuentran en el ambiente y en una amplia variedad de productos de uso diario, por lo que la exposición humana es permanente. Experimentos con animales han confirmado la capacidad de los DEs para inducir desórdenes reproductivos, por lo que se ha sugerido que podrían ser un factor importante como causa de subfertilidad humana. El bisfenol A, los ftalatos y los compuestos orgánicos persistentes son tres tipos de DEs presentes en el medio ambiente y asociados con alteraciones reproductivas. Consultando las bases de datos MEDLINE y PubMed, en la presente revisión, se reúne bibliografía de los últimos 20 años donde se evalúan los efectos provocados por la exposición a los DEs mencionados en mujeres durante la vida adulta. Se resumen los efectos sobre marcadores de reserva ovárica y los resultados de tratamientos de fertilización in vitro. Por otro lado, se evalúa la evidencia a nivel molecular de los efectos provocados por los DEs sobre la fisiología reproductiva en estudios in vitro e in vivo.

Abstract Endocrine disruptors (EDs) are those chemical substances capable of interfering with hormonal homeostasis, altering the synthesis, function, storage and / or metabolism of hormones. These substances are found in the environment and in a wide variety of products for daily use, so human exposure is permanent. Animal experiments have confirmed the capacity of EDs to induce reproductive disorders, which is why it has been suggested that they could be an important factor in causing human subfertility. Bisphenol A, phthalates and persistent organic compounds are three types of EDs present in the environment and associated with reproductive disorders. Consulting the MEDLINE and PubMed databases, in this review, a bibliography of the last 20 years is gathered where the effects caused by exposure to the mentioned EDs in women during adult life are evaluated. The effects on ovarian reserve markers and the results of in vitro fertilization treatments are summarized. On the other hand, the evidence at the molecular level of the effects caused by EDs on reproductive physiology is evaluated in in vitro and in vivo studies.

Hyperandrogenism produced by ovarian tumors in women at different life stages / Hyperandrogenism produced by ovarian tumors in women at different life stages.

OBJECTIVE: to evaluate the different presentations of hyperandrogenism produced by ovarian tumors in women at different life stages DESIGN: case report. SETTING: academic institutions. PATIENT(S): 3 patients at different life stages, with increased androgen levels. INTERVENTION(S): review of hospital records. MAIN OUTCOME MEASURE(S): clinical and biochemical features, treatment and follow-up. RESULT(S): a 10 year-old girl with Leydig cell tumor presented with hyperandrogenemia, virilization and changes in social behavior. Another patient, at reproductive age, with a tumor>10 cm, presented with signs of virilization and abdominal mass, whose pathologic analysis disclosed a carcinoid tumor of the ovary associated with stromal hyperplasia. The third patient was a postmenopausal woman with severe alopecia, who presented a steroid cell tumor, rare at that age. CONCLUSION(S): the evaluation of women with signs and symptoms of virilization should include a detailed clinical record, thorough physical examination and an appropriate hormonal dosage, especially when images are inconclusive.

Síndrome de ovario poliquístico: revisión de su fisiopatogenia / [Polycystic ovary syndrome: physiopathology review].

Polycystic ovary syndrome (PCOS), the most common gynecological endocrinopathy in women of reproductive age, is characterized by hyperandrogenism, chronic anovulation and /or polycystic ovaries. Although the cause of PCOS is still unknown, there are several hypotheses attempting to explain the primary defect; the most commonly accepted is insulin resistance. Due to its high prevalence, the patients have increased risk of developing metabolic and cardiovascular alterations. The compensatory hyperinsulinemia contributes to hyperandrogenism in different ways: by stimulating ovarian androgen synthesis and inhibiting hepatic production of sex hormone binding globulin. From the study of the intrauterine environment in recent years it has been suggested that PCOS may have an origin in utero associated with prenatal exposure to androgens. The aim of this paper is to review the main mechanisms proposed to cause the syndrome.

Evaluación de parámetros endócrino metabólicos en los nuevos fenotipos diagnósticos de pacientes con síndrome de ovario poliquístico / Evaluation of endocrine metabolic parameters in new phenotypes diagnoses of patients with polycystic ovary syndrome

Introducción: el síndrome de ovario poliquístico (SOP), la endocrinopatía ginecológica mßs frecuentes en mujeres en edad fértil, se caracteriza por hiperandrogenismo, anovulación crónica y/u ovarios poliquísticos. Debido a su asociación con la insulino resistencia las pacientes tienen mayor riesgo de padecer alteraciones metabólicas. En la actualidad no existe un único criterio diagnóstico universalmente aceptado para definir SOP, estando en vigencia dos: los formulados en 1990 por el Instituto Nacional de Salud de Estados Unidos (Criterios NIH) y el mßs reciente, publicado en 2004 por la Sociedad Americana de Medicina Reproductiva y la Sociedad Europea de Reproducción Humana y Embriología (Criterios de Rotterdam). El hiperandrogenismo y la anovulación crónica son los elementos cardinales de ambas definiciones, siendo el patrón ecogrßfico de ovario poliquístico el tercer elemento incorporado en el último consenso. Así, aplicando los Criterios de Rotterdam, el diagnóstico se realiza con dos de los tres elementos mencionados; generando cuatro fenotipos de mujeres con SOP: 1- hiperandrogenismo, disfunción ovulatoria y morfología de ovario poliquístico [SOP clßsico tipo I con ovarios poliquísticos], 2- hiperandrogenismo y disfunción ovulatoria pero con ecografía normal [SOP clßsico tipo II con ovarios normales], 3- hiperandrogenismo y ovario poliquístico pero con ciclos ovulatorios [SOP ovulador] y 4- disfunción ovulatoria y ovario poliquístico pero sin hiperandrogenismo [SOP normoandrogénico]. Los nuevos criterios han incrementado la prevalencia, la heterogeneidad y también la controversia; siendo prematuro asumir que todos los fenotipos tienen el mismo riesgo de desarrollar complicaciones metabólicas...

ABSTRACT: Background: Polycystic ovary syndrome (PCOS), the most common gynecological endocrinopathy in women of childbearing age, is characterized by hyperandrogenism, chronic anovulation and / or polycystic ovaries. Because of its association with insulin resistance patients have increased risk of metabolic disorders. At present there is no single universally accepted diagnostic criteria to define PCOS, being in effect two: those made in 1990 by the National Institute of Health USA (NIH criteria) and the most recent, published in 2004 by the American Society of Reproductive Medicine and European Society of Human Reproduction and Embryology (Rotterdam criteria). Hyperandrogenism and chronic anovulation are the cardinal elements of both definitions, with the ultrasonographic pattern of polycystic ovary the third element incorporated in the last consensus. Thus, using the Rotterdam criteria, the diagnosis is made with two of the three elements, generating four phenotypes of women with PCOS: 1- hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology [PCOS classic type I with polycystic ovaries], 2- hyperandrogenism and ovulatory dysfunction but with normal ultrasound [PCOS classic type II with normal ovaries], 3- and polycystic ovarian hyperandrogenism but with ovulatory cycles [PCOS ovulating] and 4- ovulatory dysfunction and polycystic ovaries without hyperandrogenism [PCOS normoandrogenic]. The new criteria have increased the prevalence, diversity and controversy. It is still premature to assume that all phenotypes have the same risk of developing metabolic complications...