Clinical and biochemical characteristics of polycystic ovary syndrome in Benghazi- Libya; a retrospective study

Polycystic ovary syndrome [PCOS] is a common endocrine condition affecting women of reproductive age and characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. There are no published data on this syndrome in Libyan patients. To assess the frequency of clinical and biochemical features of PCOS in our patient population, and to compare this with data collected in other parts of the world. A retrospective analysis of patient records at the endocrine clinic in Benghazi was undertaken. Patient inclusion was according to Rotterdam ESHRE/ASRM criteria. Clinical features, associated diseases, family history, hormone levels, and ultrasonography results were analyzed. The mean age of the 318 PCOS patients at presentation was 25.8 years [range 15-44 years], and the majority [67%] were 20-29 years old at presentation. Of all patients, 57% were obese [BMI >/= 30], 93% had oligo- / amenorrhea, 91% were hirsute, and 74% had ultrasound features of polycystic ovaries. Diabetes mellitus was diagnosed in 9% of all PCOS patients and hypertension in 4%. Total serum testosterone was elevated in 26% of the patients, and serum prolactin was elevated in 31%. Thyroid disease was noted among 5.3% of the patients, and a history of diabetes or hypertension among first-degree relatives was seen in [16%] and [8%] of the patients respectively. Chronic anovulation and hirsutism are the dominant features of PCOS in our patient population. More than half were obese, and the prevalence of diabetes, hypertension and thyroid disease in our patients seemed to be underestimated in comparison to other parts of the world

Tumor ovárico de células esteroideas productor de andrógenos: informe de caso / Ovarian steroid cell tummors producing androgens

Los tumores del ovario con repercusión endócrina constituyen 5 por ciento de las neoplasias de este órgano, ocupan el primer término las productoras de estrógenos, las de andrógenos en segundo y son excepcionales las de progesterona, corticosteroides y renina. En la nomenclatura de estos tumores ha existido una serie de sinónimos empleados que indican la confusión acerca de su histogénesis y la dificultad para su manejo en la literatura. Informe del caso. Femenina de 23 años de edad que presentó opsomenorreas de varios años de evolución, amenorrea secundaria, voz grave e hirsutismo rápidamente progresivo. Peso: 98,500 kg, talla: 1.74m. Índice de masa corporal (IMC): 32.61 kg/m2 de supeficie corporal. Vello en cara (barba y bigote), distribución androide en abdomen, antebrazos, muslos y piernas (Ferriman 20), acné e involución mamaria bilateral. Todos los paraclínicos efectuados fueron normales. La cuantificación de gonadotrofina coriónica en orina de 24 horas fue negativa. Imagenología. Ultrasonido de cavidad pélvica y la tomografía axial computada de abdomen demostraron tumoración ovárica derecha. El estudio citogenético fue 46XX. Los estudios endocrinológicos prequirúrgicos fueron: basales hormonales de testosterona libre y total de 14.30 pg/mL y 3.55 ng/mL respectivamente, insulina de 43.3 µU/mL y péptido C de 5.7 ng/mL. La curva de tolerancia oral a la glucosa (CTGO) demostró intolerancia a carbohidratos. Durante el transoperatorio los niveles hormonales de la vena ovárica derecha fueron: testosterona total de 2.70 ng/mL y la libre de 12.70 pg/mL, normalizándose a las 12 horas del postoperatorio. Otras hormonas esteroideas determinadas fueron normales seis meses después del acto quirúrgico la paciente presentaba un puntaje de Ferriman de 10, eumenorreica y con peso: 98,100 kg, CTGO y niveles basles hormonales normales. La ultraestructura mostró datos característicos de tumor productor de esteroides sin cristaloides de Reinke.

Hirsutismo - tratamento / Treatment of hirsutism

O hirsutismo representa uma patologia de grande importância para os médicos ginecologistas, näo só pela sua expressiva incidência e pelo aspecto emocional que envolve as pacientes, mas também pela baixa aderência ao tratamento que deve ser a longo prazo.

Treatment of endometriosis with cyproterone acetate: preliminary report

The objective of this work was to evaluate the efmfectiveness of cyproterone acetate for the treatment of endometriosis. Seven patients with dysmenorrhea due to endometriosis and idiopathic hirsutism were included. Endometriosis was laparoscopically classified as minimal in two cases, mild in two, moderate in two and severe in one patient. Cyproterone acetate was initiated at a daily dose of 10 mg orally for 20 days, followed by 10 days without medication. This sequence was repeated over a period of 6 months. Dysmenorrhea improved in all study subjects. Menstrual disorders were observed in all women, with oligomenorrhea in six patients and spotting in one. At the end of treatment, a second look laparascopy revealed minimal endometriosis in five patients and no evidence of the disease in the other two patients and without changes in the other five. These preliminary data disclose the possible therapeutic use of cyproterone acetate in endometriosis

Psychosocial and biochemical correlates of hirsutism among Egyptian females

Thirty nine hirsute women [mean age 27.3 +/- 6.7] and 40 non-hirsute controls, matched for age, were the subjects of this study. Cases were subjected to history taking, clinical and endocrine assessment as well as abdominal and pelvic sonography. Total and free testosterone levels were measured by radioimmunoassay. Cases and control had a careful psychiatric interview. Taylor anxiety scale and Guilford battery scale were applied to test for anxiety and masculinity/femininity version, respectively. A questionnaire was interviewed for cases to assess reaction of husband, family members and friends, patients' reaction to their problem and any social restrictions practiced by them

Heterogeneity of late-onset adrenal 3ß-ol-hidroxysteroid dehydrogenase deficiency in patients with hirsutism and polycystic ovaries

Nine women clinical features of polycystic ovarian syndrome (PCOS) were studied in order to establish the differential diagnosis with late-onset adrenal hyperplasia (LOAH). Their hirsutism was classified as moderate in five patients and severe in the remainig four cases. All patients had bilateral polycystic ovarian enlargement by ultrasound examination. As a control group five women with normal ovarian function without hirsutism were submitted to the same protocol of study. The patients studied as well as the women of the control group had basal serum determinations of pregnenolone (P5), 17 hydroxypregnenolone (17-OHP5), dehydroepiandrosterone (DHEA), pregesterone (P), 17-hydroxyprogesterone (17-OHP), androstenedione (A), testosterone and cortisol by radioimmunoassay techniques. The basal serum levels of androgens showed no correlation with the severity of hirsutism or with the ultrasound finding. An adrenal stimulation with synthetic adrenocorticotropic hormone (ACTH) to all women performed in order to assess their adrenal responsiveness. The analysis of the ratios between delta 5 and delta 4 steroids demonstrated a partial enzymatic blockade at the level of 3ß-o1-hydroxysteroid dehydrogenase (3-HDS) in three patients. The blockade was particulary in the conversion of P5 to P and 17-OHP5 to 17- OHP. The lack of delta 4 steroid secretion in the presence of normal increase of delta 5 precursors following ACTH was noted. These findings confirm the clinical use of the ACTH stimulation test to reveal the presence of enzymatic alterations in adrenal steroidogenesis in some patients previously considered to have PCOS. Since it was demonstrated that the conversion steps were affected in variable degrees, the presence of different isoenzymes of 3-HSD is suggested

Hirsutismo / Hirsutism

El hirsutismo representa para el médico una posible enfermedad sistemática, sin embargo para la paciente connotaciones emocionales. De una buena comprensión fisiopatológica del problema, resultará un buen diagnóstico y un manejo racional de este importante problema. Se realiza una actualización del tema, enfatizando el rol de la piel como órgano blanco de la acción hormonal

Hirsutismo idiopático / Idiopathic hirsutism

O hirsutismo idiopático é um problema clínico relativamente comum e que pode causar profundos distúrbios emocionais. Säo descritas neste artigo as possíveis causas possíveis causas do hirsutismo idiopático, e também tentou-se elucidar sua fisiopatologia, que ainda é fonte de grande controvérsia

Ansiedade e sídromes androgênicas / Anxiety and androgenic syndromes

Os autores apresentam a avaliaçäo de ansiedade trato e ansiedade estado feita em pacientes ambulatoriais que apresentavam manifestaçöes de síndromes androgênicas ovarianas (síndrome dos ovários policísticos, hipertecose e hirsutismo idiopático). Säo mostradas as diferentas encontradas entre as pacientes e as possíveis relaçöes existentes entre essas sfndromes e o stress. Encontrou-se relaçäo entre os níveis de androstenediona e ansiedade nas pacientes com síndrome dos ovários policísticos e síndromes androgênicas. A presenta de hirsutismo também se relaciona com níveis maiores de ansiedade.

Hirsutismo / Hirsutism

É feita uma revisäo do hirsutismo, discutidos seus conceitos fundamentais e recentes avanços terapêuticos