Puntos de corte de 17-hidroxiprogesterona en la detección de Hiperplasia Suprarrenal Congénita / Cut offs levels of 17-hydroxyprogesterone in screening of Congenital Adrenal Hyperplasia / Pontos de corte da 17-hidroxiprogesterona na detecção de Hiperplasia Adrenal Congênita

El presente estudio investiga la utilidad de determinar puntos de corte ajustados según la edad gestacional y el peso al nacer de neonatos (2-100 días) en la cuantificación de 17-hidroxiprogesterona en muestras de sangre seca en papel de filtro. Se analizaron los resultados de 6.266 determinaciones realizadas en el marco del Programa Nacional de Fortalecimiento de la Detección Precoz de Enfermedades Congénitas. Los datos se dividieron en cuatro grupos; Grupo 1: recién nacido pretérmino con bajo peso; Grupo 2: recién nacido pretérmino con peso normal; Grupo 3: recién nacido a término con bajo peso y Grupo 4: recién nacido a término con peso normal. Se establecieron puntos de corte diferentes a partir del cálculo del percentilo 99 de la distribución de frecuencias. Basado en este análisis se realizó la comparación de la tasa de resultados falsos positivos que se obtuvieron según el punto de corte establecido por el fabricante y los obtenidos en el estudio. Los nuevos puntos de corte obtenidos fueron: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L y 82,38 nmol/L para los grupos 1, 2, 3 y 4 respectivamente. Se evidenció una tasa total de falsos positivos del 1% con los nuevos puntos de corte, significativamente menor a la tasa del 6,2% obtenida al utilizar el punto de corte del fabricante. Esto puso en evidencia que el uso de puntos de corte adecuadamente establecidos para la población en estudio reduce significativamente las complicaciones derivadas de las repeticiones de análisis y eventualmente la tasa de recitaciones, lo cual es una importante contribución a la Salud Pública.

The present work studies the usefulness of determining adjusted cut-offs for the quantification of 17-hydroxyprogesterone in dried blood samples on filter paper, taking into account the gestational age and weight of the neonates. The results of 6266 determinations made within the framework of the National Program of Strengthening Early Detection of Congenital Disease were analysed. Data were divided into groups, Group 1: early established from the calculation of the 99 percentiles of the frequency distribution. New cutoff points were: 217.72 nmol/L, 102.14 nmol/L, 61.62 nmol/L and 82.38 nmol/L for groups 1, 2, 3 and 4 respectively. It showed a total rate of 1% false positives with the new cut-off points, which was significantly lower than the rate of 6.2% obtained using the manufacturer's cutoff. This revealed that the use of properly established cut-offs for the study of population reduces significantly the complications derived fromn analysis repetitions and eventually the recitation rate, which is an important contribution to Public Health.

O presente estudo investiga a utilidade de determinar pontos de corte estabelecidos conforme a idade gestacional e o peso ao nascer de neonatos (2-100 dias) na quantificação da 17-hidroxiprogesterona em amostras de sangue seco em papel filtro. Foram analisados os resultados de 6.266 determinações feitas no âmbito do Programa Nacional de Fortalecimento da Detecção Precoce de Doenças Congênitas. Os dados foram divididos em quatro grupos; Grupo 1: recém-nascido pré-termo com baixo peso, Grupo 2: recém-nascido pré-termo com peso normal, Grupo 3: recém-nascido a termo com baixo peso e Grupo 4: recém-nascido a termo com peso normal e foram estabelecidos pontos de corte diferentes a partir do cálculo do percentil 99 da distribuição de frequências. Com base nesta análise foi realizada a comparação da taxa de resultados falsos positivos obtidos conforme o ponto de corte estabelecido pelo fabricante e os obtidos no estudo. Os novos pontos de corte obtidos foram: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L e 82,38 nmol/L para os grupos 1, 2, 3 e 4, respectivamente. Tornou-se evidente uma taxa total de 1% de falsos positivos, com os novos pontos de corte significativamente menor do que a taxa de 6,2% obtida utilizando o ponto de corte do fabricante. Isto revelou que o uso de pontos de corte de forma adequada estabelecidos para a população em estudo reduz significativamente as complicações decorrentes das repetições de análises e eventualmente a taxa de repetição de novos encontros, o que é uma importante contribuição para a saúde pública.

Comparing intramuscular progesterone, vaginal progesterone and 17 alpha-hydroxyprogestrone caproate in IVF and ICSI cycle

Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. The objective of this study was to compare the efficacy of three types of progesterone on biochemical, clinical and ongoing pregnancy rates and abortion and live birth rates. A prospective randomized study was performed at Royan Institute between March 2008 and March 2009 in women under 40 years old, who use GnRH analog down-regulation. One hundred eighty six patients in three groups were received progesterone in oil [100 mg, IM daily], intravaginal progesterone [400 mg, twice daily] and 17-alpha hydroxyprogestrone caproate [375mg, every three days], respectively. Final statistical analysis after withdrawal of some patients was performed in 50, 50 and 53 patients in group 1, 2 and 3 respectively. No differences between the groups were found in baseline characteristics. No statistical significance different was discovered for biochemical, clinical and ongoing pregnancies. Although the abortion rate was statistically higher in group 1 [p=0.025] the live birth rate was not statistically significant between the three groups. The effects of three types of progesterone were similar on pregnancies rate. We suggest the use of intravaginal progesterone during the luteal phase in patients undergoing an IVF-ET program because of the low numbers of abortions, and high ongoing pregnancy rates

Is there a role for progesterone in preterm labour

To evaluate the role of progesterone in combination with half the usual dose of the beta-sympathomemetic [salbutamol] in treatment of actual preterm labour and to compare it with the full dose of beta-agonist used alone. A randomized, controlled trial done at Baghdad teaching hospital and Al-Kadhimiyah teaching hospital, department of Obstetrics and Gynecology-Baghdad/Iraq, during the period from March 2006 to June 2007. One hundred one pregnant women who presented with actual preterm labour were randomly divided into two groups. Fifty-one patients received 17 hydroxyprogesterone hexanoate in oil [Primolut Depot] 250 mg with half the usual dose of salbutamol [1.25 mg/500 ml 5% dextrose] regarded as the study group and fifty patients received only salbutamol in the full dose [2.5 mg/500 ml 5% dextrose] regarded as the control group. Both groups were compared for the time of delivery within 48 hours, 48 hours - one week, and after one week, for the maternal side effects of salbutamol and progesterone and for neonatal outcome for those delivered within 1 week. There was no significant difference between the control group and the study group regarding treatment-delivery interval within 1[st] 48 hours, 48 hours - one week, and after one week [p=0.6], nor regarding neonatal death or admission to neonatal care unit [p=0.078]. Maternal side effects of beta-agonist were reduced when half the dose of salbutamol in combination with a high dose of progesterone was used. There was a highly significant reduction in tachycardia, hyperglycemia, nausea and vomiting [p=0.000], and a significant reduction in shortness of breath, restlessness, tremor and chest pain [p<0.05] in the study group compared to control group. No significant difference existed between the two groups regarding headache [p=0.93]. No pulmonary edema developed in either group. Progesterone could have a role in the treatment of actual preterm labour when used in combination with a beta-agonist to minimize the potentially life threatening side effects of beta-agonists

Pituitary primary cell culture of Common carp [Cyprinus Carpio] and evaluation of its secretion effect on endocrine activity of incubated ovarian follicles

In this study, five carp pituitary glands were collected and dispersed enzymatically and mechanically. Then, the cells were cultivated as monolayer in MEM [minimum essential medium Eagle]. The culture media were collected after 72 h and frozen at -20°C. Carp ovarian follicles also were separated mechanically and incubated in BSS [basic salt solution] Cortland medium in 24-well microplates for 48 h at 20°C. Then, they were divided into two groups: control group which were incubated in BSS medium and experimental group which subdivided into three subgroups according to treatment with different concentration of collected pituitary secretion [50, 100 and 200 micro 1/ml]. Follicles culture media were collected 24 h later and were analyzed for 17-beta-oestradiol [E[2]] and 17-alpha-hydroxy progesterone [P[4]] content by radioimmunoassay [RIA]. The results showed that adding low concentration [50 micro 1/ml] of collected pituitary secretion [CPS] increased steroid hormones [E[2] and P[4]] secretion of incubated ovarian follicles significantly [P<0.05] but the high concentration of CPS [200 micro 1/ml] significantly decreased the secretion of E[2] and P[4] [P<0.05]. Collected pituitary secretion at the concentration of 100 micro 1/ml had no significant effect on steroid hormones [P>0.05]

Chemical constituents in aerial part of Reineckea carnea / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents in the aerial part of Reineckea carnea.</p><p><b>METHOD</b>The compounds were isolated by extraction, silica gel, gel, and reversed-phase silica gel coloum chromatography, and high-performance liquid chromatography. The structures were identified by various spectroscopic methods including 1D and 2D NMR spectrum, MS, IR, etc.</p><p><b>RESULT</b>Six compounds were isolated and identified as 1alpha, 3beta-dihydroxy-5beta-pregn-16-en-20-one-3-O-beta-D-glucopyranoside (1), syringaresinol-beta-D-glucoside (2), sophoraflavone B (3), stigmast-5, 22-dien-3-O-beta-D-glucopyranoside (4), daucosterol (5), a-D-glucose (6).</p><p><b>CONCLUSION</b>Compound 1 was a new compound, coumpounds 2-6 were obtained from the plant for the first time.</p>

Effects of estradiol-17beta and 17alpha, 20beta-dihydroxy-4-pregnen-3-one on different phospholipids metabolism and histological changes in ovary during reproductive growth in the catfish, Heteropneustes fossilis (Bloch).

Effect of cumulative doses of estradiol -17beta (E2-7, 14 and 28 mg/kg body weight) and 17alpha, 20beta-dihydroxy-4-pregnen-3-one (17alpha,20betaP-7, 14 and 28 mg/kg body weight) on total phospholipids (TP) and various phospholipids- phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylinositol (PI) and phosphatidylethanolamine (PE) on liver plasma and ovary were investigated during the reproductively active preparatory and prespawning phases of the annual reproductive cycle in the freshwater female catfish, H. fossilis. The effect of E2 on TP was generally stimulatory and has pronounced effect than 17alpha,20betaP during both the phases. The levels of PC was promoted high during prespawning phase by E2 comparatively very less than by 17alpha, 20betaP in studied tissues during both the phases. The levels of PS after E2 treatments was maximum in all tissues during prespawning phase whereas 17alpha,20betaP was effective only in liver during this phase. The PI was elevated in liver during preparatory phase but its elevation was in all studied tissues during prespawning phase after E2 treatments. The levels of PI was most effective in ovary during preparatory phase in response to 17alpha,20betaP. The levels of PE was declined in liver but elevated in ovary after E2 treatments during both the phases. Treatments of E2 during preparatory phase showed greater number of vitellogenic oocytes as compared to 17alpha,20betaP treatments. The present finding has demonstrated that estradiol-17beta has more pronounced effects than the 17alpha,20beta P in regulation of different phospholipids and ovarian recrudescence during reproductively active phases and among the phospholipids the PC is the main phospholipids of vitellogenin/ovarian lipids in H. fossilis.

[Comparing 17 alpha - hydroxyprogesterone caproate and progesterone in oil for luteal phase support in IUI cycles]

Luteal phase support is practiced routinely in some medical centers in patients undergoing ovulation induction [OI] and intrauterine insemination [IUI] cycles. The purpose of this study was to compare the effects of progesterone in oil with 17- alpha -hydroxy progesterone caproate [17- HPC] for luteal phase support. This prospective randomized clinical trial was done at Montaserieh Infertility Center in Mashad, Iran, from October 2005 to October 2006. In this study, 162 patients undergoing OI and IUI were randomly treated with either 17-HPC [250 mg/weekly, IM] or progesterone in oil [50mg/daily, IM] until serum beta -hCG was evaluated. In patients with positive beta -hCG results [Biochemical pregnancy], the treatment was continued until the 12th week of gestation. The data were analyzed using t-tests, Chi-squared and Fisher's exact test. P-values <0.05 were considered as the level of significance. The outcomes of IUI in both study groups were compared. No differences were found in the outcome of pregnancies, considering parameters such as biochemical pregnancy [p=0.69], clinical pregnancy [p=0.3] or ongoing pregnancy up to the 20th week [p=0.831]. Complications were significantly lower in 17-HPC group [p=0.002] and the patients' satisfaction was signi-ficantly higher compared to the other group [p=0.003]. The results of this study confirm that 17-HPC has the same effects as oily progesterone for luteal phase support in patients undergoing OI and IUI cycles and it could be used instead of progesterone in oil, although more studies are needed to support this replacement

Studies on the induction and properties of 11-a-hydroxylasse from aspergillus nidulans

The induced cells of Aspergillus nidulans were homogenized with alumina and centrifuged for obtaining 11-alpha-hydroxylase. The results showed that the maximum 11-alpha-hydroxyprogetreone yield [98.5%] was obtained by using phosphate buffer at pH 7, transformation time 2 hr, at 35C, enzyme ratio [1:20] and Km value 6.15 mg/100 ml. The effect of some activators and inhibitors on 11-alpha-hydroxylase activity were also investigated. While, Mg+2, Co+2, Fe+2 and chloramphenicol appeared to be good inducers and Zn+2, Hg+2 and cyclohexamide showed different inhibitory effects. The 11-alpha- hydroxylase enzyme produced by A. nidulans was observed to be NADPH dependent

Insulin alone can lead to a withdrawal of meiotic arrest in the carp oocyte.

Meiotic arrest of oocyte in an Indian carp, Labeo rohita Ham. has been found for the first time to be withdrawn by insulin only. Addition of insulin to oocytes in vitro caused germinal vesicle breakdown (GVBD), one of the first visual markers to determine initiation of the final maturational process. Under the influence of insulin the germinal vesicle (GV) of the oocyte migrated towards the animal pole, reached the micropyle and then dissolved (GVBD). By using different concentrations of insulin i.e., 0.063, 0.63, 6.3 and 12.6 mM, optimum amount required was found to be 6.3 mM. Induction of GVBD by insulin could be blocked by cycloheximide (Chx), a translation inhibitor, while actinomycin D (AcD) had no effect suggesting non-involvement of transcriptional activity in this process. Addition of the maturation-inducing steroid 17alpha,20beta-dihydroxy-4-pregnen-3-one (DHP) stimulated (P<0.01) GVBD of carp oocytes and its combination with insulin showed an additive effect. Gonadotropin (GtH) caused GVBD but its effect was greatly augmented by insulin. Our results demonstrate that not only can insulin alone induce GVBD in carp oocytes, but it also augments the stimulatory effect of DHP or IGF-I or GtH on GVBD. This information will be important in hormonal manipulation during induced breeding of carp.

Serum 17 alpha-hydroxyprogesterone, delta 4-androstenedione and cortisol levels in healthy full-term neonates

Measurement of adrenocortical steroids at birth is of paramount importance especially for early diagnosis and treatment of some grave diseases including congenital adrenal hyperplasia and adrenocortical insufficiency. To determine the serum levels of 17 alpha -hydroxyprogesterone [17 alpha -OHP], 4 delta -androstenedione and cortisol in normal full-term neonates. The level of the above-mentioned corticosteroids were measured at the time of delivery, and 12 and 24 hours after birth in 15 healthy neonates by use of specific radioimmunoassays [RIA]. The present study indicated that there are no significant differences between the adrenocortical steroid levels of the two sexes. The level of each corticosteroid declined in the first 24 hours of life. The mean and standard deviation of the above-mentioned corticosteroids are higher [but not statistically significant] in comparison to studies conducted in different geographical areas, perhaps due to difference in race, consanguinity and high frequency of congenital adrenal hyperplasia in Iran

Hiperplasia adrenal congénita no clásica: deficiencia de 21-hidroxilasa / Non classic congenital adrenal hyperplasia: 21-hydroxylase deficiency

Los síndromes de hiperandrogenismo de diferente grado constituyen un motivo de consulta frecuente en un consultorio de Ginecología Infantojuvenil. Estos cuadros suelen provocar preocupación en las adolescentes tanto por sus manifestaciones estéticas (hirsutismo, acné, alopecía) como por la presencia de alteraciones del ciclo mestrual que puede crearles dudas sobre su fertilidad futura. Una de las causas de hiperandrogenismo, la Hiperplasia Adrenal Congénita No Clásica (HACNC), cobra importancia debido a su origen genético y a que no existen elementos de la clínica que permitan diferenciarla de otras etiologías como síndrome de ovarios poliquísticos. El presente trabajo propone una actualización sobre HACNC, en cuanto a su fisiopatología, aspectos genéticos, clínica, metodología diagnóstica y tratamiento. Se consideran en forma particular sus posibles repercusiones sobre la fertilidad, así como el asesoramiento genético que requieren estas pacientes

Cyclic AMP-mediated control of oocyte maturation in the catfish, Clarias batrachus (Bloch): effects of 17 alpha,20 beta-dihydroxy-4-pregnen-3-one and phosphodiesterase inhibitors.

An increase in the percentage of germinal vesicle breakdown (GVBD) with a corresponding decrease in cAMP was found in the oocytes which were incubated for 36 hr with different concentrations of 17 alpha,20 beta-dihydroxy-4-pregnen-3-one (17 alpha,20 beta-DP). At its highest concentration (1 microgram/ml), 17 alpha,20 beta-DP induced 91.9 +/- 2.3% GVBD and decreased cAMP level to 0.8 +/- 0.1 pmol/oocyte from 2.9 +/- 0.2 pmol/oocyte (control). The two different known inhibitors of phosphodiesterase viz. 3-isobutyl-1-methyl-xanthine (IBMX) and theophylline inhibited GVBD in vitro and promoted the accumulation of cAMP in a dose-dependent manner irrespective of whether the oocytes were treated for a short duration (2 hr) or for a long duration (36 hr). Evaluation of time course response to 1 mM IBMX or 1 mM theophylline revealed that cAMP levels increased at all the time points when compared with their respective controls and blocked maturation. In contrast, 1 microgram/ml 17 alpha,20 beta-DP not only induced oocyte maturation but also caused an immediate decrease in cAMP within the first 2 hr (from 3.2 +/- 1.3 to 1.3 +/- 0.1 pmol/oocyte) of incubation which was maintained till the end of experiment (36 hr). Likewise, a significant inhibition of GVBD and accumulation of cAMP was recorded even in oocytes pre-stimulated with 1 microgram/ml 17 alpha,20 beta-DP for 6 hr and then treated with different concentrations of IBMX or theophylline. Taken together, these data strongly suggest that in C. batrachus a decrease of oocyte cAMP concentration is a prerequisite for the induction of oocyte maturation, and its increase is associated with the maintenance of meiotic arrest.

Biotransformation of progesterone to II alpha-hydroxy-progesterone using the immobilized spores and mycelium of Mucor racemosus NRRL 3639

Immobilized spores and mycelium of M. racemosus NRRL 3639 were used to transform progesterone to II-alpha-hydroxy-progesterone [II- alpha- HP], where different fermentation parameters; namely, alginate concentration, time course, different progesterone levels, progesterone coimmobilization, semi-continuous transformation, pH values of the used buffer and addition of some activators, were investigated. The results showed that good yield of II-alpha-hydroxy- progesterone was obtained by using 3% w/v alginate concentration, 48-hour transformation period and 20 mg progesterone, whereas the optimal progesterone concentration for the immobilized spores was 30 mg/50 ml medium. On the other hand, coimmobilization using 100 mg progesterone/10 g wet mycelium at pH 6 and enhancement by MgSO4.7H2O, FeSO4.7H2O and riboflavin gave better yield of II-alpha-HP

Gonadotropinas y sexoesteroides en mujeres posmenopáusicas del círculo de abuelos

En publicaciones recientes se han evaluado varios factores que pueden influir en las hormonas de la reproducción durante el climaterio. En nuestro medio no existen investigaciones sobre esta problemática, razón por la cual se diseñó este estudio con el objetivo de conocer la relación entre los niveles hormonales posmenopáusicos y la actividad en los círculos de abuelos. Se seleccionó una muestra simple aleatoria de 134 mujeres posmenopáusicas, estratificada según participaran o no en el círculo de abuelos (67 en cada estrato), de un área de salud urbana. Se determinaron por radioinmunoanálisis las siguientes hormonas: FSH, LH, prolactina, testosterona, estradiol 17 beta, androstenediona y 17 hidroxiprogesterona (17 OH-P). La prolactina fue mayor en las mujeres que no participan en las actividades del círculo de abuelos, mientras que la testosterona y la 17 OH-P fueron menores con respecto al grupo que participa en el círculo de abuelos. El resto de las hormonas no mostró diferencias entre los 2 grupos. Según estos resultados, las actividades realizadas por estas mujeres en el círculo de abuelos influyen en los niveles de algunas de las hormonas de la reproducción, lo que pudiera tener efectos favorables para la salud, al disminuir el estrés y en particular sobre la osteoporosis que se desarrolla en esta época de la vida

Efecto de la gonadectomía prepuberal en el síndrome de resistencia parcial a los andrógenos / Effect of prepuberal gonadectomy on partial Resitance to Androgens Syndrome

El síndrome de resitencia a los andrógenos es un padecimiento dominante y recesivo ligado a X con manifestaciones clínicas heterogéneas. Se presenta el caso de un paciente de 17 años con amenorrea primaria y abigüedad genital. Tenía el antecedente de hernioplastía inguinal bilateral y probable gonadectomía a los 14 meses de edad. Su cariotipo fue masculino 46, XY y los exámenes hormonales mostraron la existencia de hipogonadismo hipergonadotrópicos. Se descartó la existencia de hiperplasia suprearrenal congénita (deficiencia de 21 hidroxilasa). En el síndrome de resistencia parcial a los andrógenos, la gonadectomía prepuberal evita la virilización progresiva de los genitales externos. Sin embargo, es necesario administrar terapia estrogénica de reemplazo

Diagnóstico e prevalência da hiperplasia adrenal congênita forma näo clássica em uma amostra de 122 pacientes hirsutas / Diagnosis and prevalence of nonclassical congenital adrenal hyperplasia in 122 hirsute patients

OBJETIVOS: Estabelecer o diagnóstico de HAC-NC e a prevalência desta patologia no nosso meio, em pacientes consultando por hirsutismo. PACIENTES E MÉTODOS: Foram avaliadas do ponto de vista clínico e hormonal 122 pacientes hirsutas. A avaliaçao hormonal incluiu a realizaçao sistemática do teste do ACTH em todas as pacientes. Os dados foram comparados com um grupo controle constituído por 13 mulheres normais, nao hirsutas e com um grupo de 5 heterozigóticas obrigatórias para a deficiência da P45Oc21, maes das pacientes. RESULTADOS: Nove pacientes tiveram o diagnóstico de HAC-NC por déficit na P45O-c21 e 1 por deficiência na P45O-c11. O perfil clínico e hormonal apresentou grande variabilidade entre as 9 pacientes, incluindo os níveis basais de 17-hidroxiprogesterona, que foram normais em 2 delas. A paciente com deficiência na P45O-c11 era normotensa, com acne severa e moderadamente hirsuta, sem outros sinais de virilizaçao. Esta paciente apresentou níveis moderadamente elevados de 17-hidroxiprogesterona em resposta ao ACTH e o diagnóstico foi confirmado pela resposta aumentada do 11 deoxi-cortisol ao estímulo corticotrófico. Na amostra estudada de 122 pacientes hirsutas, a prevalência encontrada para a HAC-NC por deficiência da P45O-c21 foi de 7,4 por cento.

Características generales y hormonas de la reproducción en la mujer posmenopausica / General characteristics and reproduction hormones of post-menopausal women

Se seleccionó una muestra aleatoria triste de 134 mujeres posmenopáusicas de un área de salud urbana, para conocer algunas características generales, así como las concentraciones de la hormonas de la reproducción (gonadotropinas hipofisarias y sexoesteroides), en este período de la vida. Se determinaron por radioinmunoanálisis las siguientes hormonas : FSH, LH, estradiol (E2), testosterona (T), androstenediona (A'd), prolactina (PRL) y el precursor 17 hidroxiprogesterona (17 OH-P). La edad cronólogica media de las mujeres fue de 56,3 años y un promedio de 8,4 años desde la menopausia. La edad de la menopausia fue 48,1 ñ 4,7 años, fue poco frecuente después de los 55 años (2,2 por ciento) y antes de los 40 (7,5 por ciento); no se presentó ningún caso de menopausia precoz. La obesidad y el hábito de fumar son hallazgos comunes en la mujer posmenopáusica, ambos son factores de riesgo de trastornos de alta prevalencia en estas mujeres como son las cardiopatías isquémicas y la hipertensión arterial, por lo cual se obvia la necesidad de insistir e eliminar o disminuir el riesgo. El patrón de las hormonas de la producción en las mujeres posmenopáusicas se caracterizó por niveles elevados de gonadotropinas (FSH y LH), índice LH/FSH normal, niveles disminuidos de E2 y niveles normales de PRL, 17 OH-P y andrógenos (Ty A'd)

O espectro clínico e laboratorial da forma näo clássica de hiperplasia adrenal congênita por deficiência da 21-hidroxilase / The clinical and laboratorial spectrum of the non-classic way of congenital adrenal hyperplasia by 21-hydroxilase deficiency

Foram estudadas 9 pacientes portadoras da forma nao clássica de hiperplasia adrenal congênita por deficiência de 2l-hidroxilase (2l-FNC). O diagnóstico baseou-se na resposta da 17-hidroxiprogesterona (l7-OHP) 60 minutos após estímulo com 250 ug de ACTH sintético por via EV. Em relaçao à reserva de glicocorticóide, observamos somente uma paciente com resposta deficiente de cortisol ao estímulo com ACTH. A concentraçao basal de 17-OHP foi altamente variável, tanto em relaçao a mesma paciente como entre as pacientes. Em duas delas, observamos concentraçao basal de 17-OHP normal, após estímulo com ACTH, observamos uma hiperresposta de 17-OHP, compatível com o diagnóstico de 2l-FNC. As pacientes foram subdivididas em três grupos de acordo com o diagnóstico clínico: Grupo I: Pubarca precoce (n= 1); Grupo II: Hirsutismo com ciclos menstruais regulares e ovulatórios (n= 4); e Grupo III: Hirsutismo com alteraçao menstrual (n= 3). Nao observamos qualquer diferença entre os três grupos tanto em relaçao à reserva de glicocorticóide adrenal e a concentraçao de 17-OHP, basal ou pós-estímulo, nem com relaçao à parâmetros clínicos, como obesidade, menarca ou idade de início do hirsutismo nas pacientes dos grupos II e III, sugerindo que a manifestaçao clínica da 2l -FNC esteja na dependência de fatores extra-adrenais, excetuando-se a pubarca precoce.