Riscos de infecção por SARS-CoV-2 e COVID-19 em mulheres com síndrome dos ovários policísticos / Risks of SARS-CoV-2 and COVID-19 infection in women with polycystic ovary syndrome

Esta revisão narrativa teve como objetivo avaliar possíveis riscos da associação entre a infecção por SARS-CoV-2 (causa da COVID-19) e as características metabólicas e endócrinas frequentemente encontradas em mulheres com a síndrome dos ovários policísticos (SOP). A COVID-19 é mais grave em indivíduos com obesidade, diabetes mellitus, dislipidemia e hipertensão arterial. Como essas condições são comorbidades comumente associadas à SOP, foi hipotetizado que mulheres com SOP teriam maior risco de adquirir COVID-19 e desenvolver formas clínicas mais graves da doença. Considerando vários estudos epidemiológicos, a presente revisão mostra que mulheres com SOP têm risco 28% a 50% maior de serem infectadas pelo vírus SARS-CoV-2 em todas as idades e que, nessas mulheres, a COVID-19 está associada a maiores taxas de hospitalização, morbidade e mortalidade, especialmente naquelas com alterações no metabolismo de carboidratos e lipídios, hiperandrogenemia e aumento do tecido adiposo visceral. Os mecanismos que explicam o maior risco de infecção por COVID-19 em mulheres com SOP são considerados.(AU)

Fisiopatología del síndrome de ovario poliquístico / Pathophysiology of polycystic ovary syndrome

Introducción: En la génesis del síndrome de ovario poliquístico intervienen múltiples factores sistémicos y locales que tienen una relación multidireccional sobre los que persisten muchas cuestiones aún sin dilucidar y cierta confusión e incertidumbre. Objetivo: Describir el enfoque actual sobre las causas y los mecanismos involucrados en el origen y desarrollo del síndrome de ovario poliquístico. Métodos: Se realizó una revisión bibliográfica tipo estado del arte. Se revisaron alrededor de 250 artículos, que se obtuvieron de las bases PubMed, Medline, SciELO y Google Académico. Se describen los factores y las vías que se proponen para explicar la etiopatogenia y fisiopatología de alteraciones genéticas, ambientales, endocrinas y metabólicas asociadas al síndrome y su expresión clínica. Conclusiones: La fisiopatología del síndrome de ovario poliquístico es compleja. Muchos aspectos permanecen sin esclarecerse, pero se tiene cada vez más conocimiento que aporta luz a los enigmas que aún persisten y a la comprensión de fenómenos previamente desconocidos. Existe el convencimiento creciente de que la alteración central es a nivel ovárico, que el síndrome es heterogéneo en todos sus elementos y que conocer la gran diversidad de factores y mecanismos que intervienen en su etiología y patogenia es fundamental no sólo desde lo científico, sino también por su utilidad práctica(AU)

Introduction: Multiple systemic and local factors are involved in the genesis of polycystic ovary syndrome that have a multidirectional relationship about which many there are questions yet to be clarified and some confusion and uncertainty persist. Objective: To describe the current approach to the causes and mechanisms involved in the origin and development of polycystic ovary syndrome. Methods: A state-of-the-art literature review was performed. The factors and pathways proposed to explain the etiopathogenesis and pathophysiology of genetic, environmental, endocrine and metabolic alterations associated with the syndrome and its clinical expression are described. Conclusions: The pathophysiology of polycystic ovary syndrome is complex. Many aspects remain unclear, but there is increasing knowledge that sheds light on the enigmas that still persist and on the understanding of previously unknown phenomena. There is a growing conviction that the central alteration is at the ovarian level, that the syndrome is heterogeneous in all its elements and that knowledge of the great diversity of factors and mechanisms involved is fundamental, not only from the scientific point of view but also for its practical utility(AU)

Carcinoma corticosuprarrenal virilizante en un niño / Virilizing adrenocortical carcinoma in a child

Introducción: Los tumores suprarrenales en niños son poco frecuentes y el carcinoma suprarrenal representa menos de un 10 %. En el prepúber, la manifestación más típica es el desarrollo de pubertad precoz. Objetivo: Describir las características clínicas, los procederes diagnósticos y terapéuticos de un paciente con carcinoma adrenal en edad pediátrica. Presentación de caso: Paciente de 8 años, masculino y de piel blanca con antecedentes de salud. Acude a la consulta por crecimiento de vello pubiano y aumento del pene en longitud y grosor de aproximadamente 2 años de evolución. En el examen físico se constatan aumento de la velocidad de crecimiento y signos sugestivos de virilización (voz gruesa, vello axilar, vello sexual púbico y genitales externos estadio III de Tanner). Se realizaron estudios hormonales que corroboraron el hiperandrogenismo por secreción endógena autónoma, con niveles de gonadotropinas suprimidas, niveles de testosterona y dehidroepiandrosterona elevados. También se realizaron estudios imagenológicos que evidenciaron edad ósea acelerada y la existencia de un tumor. Se realizó una adrenalectomía izquierda y se confirmó por anatomía patológica el carcinoma corticosuprarrenal virilizante izquierdo en estadío 2. Inició un tratamiento con quimioterapia por dicho diagnóstico y actualmente se mantiene en seguimiento. Conclusiones: Los carcinomas corticosuprarrenales en niños son mayoritariamente funcionantes y constituyen una de las causas de pubertad precoz periférica. Estos son infrecuentes y agresivos, por lo que la realización de estudios genéticos en familias con síndromes hereditarios contribuiría a su diagnóstico precoz para un adecuado tratamiento y mejor pronóstico(AU)

Introduction: Adrenal tumors in children are rare and adrenal carcinoma represents less than the 10 percent. In the prepubescent, the most typical manifestation is the development of early puberty. Objective: Describe the clinical characteristics and diagnostic and therapeutic procedures of a patient with adrenal carcinoma in a pediatric age. Case presentation: 8-year-old male, white-skinned patient with a history of health conditions. He attentds to the consultation due to pubic hair growth and penis enlargement in length and thickness of approximately 2 years of evolution. Physical examination shows increased growth rate and signs suggestive to virilization (deep voice, axillary hair, pubic sexual hair and external genitalia in Tanner's stage III). Hormonal studies were carried out that corroborated hyperandrogenism by autonomic endogenous secretion, with suppressed gonadotropin levels, elevated testosterone and dehydroepiandrosterone levels. Imaging studies were also performed that showed accelerated bone age and the existence of a tumor. A left adrenalectomy was performed and stage 2 left virilizing adrenocrotical carcinoma was confirmed by pathological anatomy studies. He began chemotherapy treatment for this diagnosis and is currently being followed up. Conclusions: Adrenocortical carcinomas in children are mostly functioning and are one of the causes of peripheral early puberty. These are uncommon and aggressive, so genetic studies in families with hereditary syndromes would contribute to their early diagnosis for adequate treatment and better prognosis(AU)

Aumento do risco cardiovascular em mulheres com síndrome do ovário policístico / Increased cardiovascular risk in women with polycystic ovary syndrome

Objetivo: A síndrome dos ovários policísticos (SOP) é uma alteração endócrina comum em mulheres que estão em fase reprodutiva. Essa patologia pode estar relacionada a fatores de risco para o desenvolvimento de complicações cardiometabólicas, o que a torna um tema relevante para discussão, visto sua grande prevalência na população feminina. Trata-se de uma revisão integrativa da literatura com o objetivo de identificar os fatores de risco associados à SOP e verificar se há maior risco cardiovascular para as mulheres com essa síndrome. Fonte de dados: Foi realizada uma busca nas bases de dados Biblioteca Virtual de Saúde, National Library of Medicine, Scientific Eletronic Library Online e EbscoHost, com os seguintes descritores: "Síndrome do ovário policístico e riscos cardiovasculares"; "Mulheres, policístico e riscos cardiovasculares"; "Ovário policístico e riscos" e "Mulheres, ovários policísticos"; "Polycystic ovary and risks"; "Polycystic ovary syndrome and cardiovascular risk" e "Polycystic ovaries and cardiovascular". Seleção de estudos: Foram encontrados 21 artigos, dos quais 15 atenderam aos critérios de inclusão previamente estabelecidos. Foram incluídos os artigos originais e as publicações entre o período de 2014 e 2021 que relacionavam diretamente a síndrome aos riscos cardiovasculares, síndromes metabólicas e alterações lipídicas. Coleta de dados: A estratégia de seleção dos artigos foi realizada mediante busca nas bases de dados selecionadas, leitura dos títulos de todos os artigos encontrados e exclusão daqueles que não abordavam o assunto, leitura crítica dos resumos dos artigos e leitura na íntegra dos artigos selecionados nas etapas anteriores. Síntese de dados: Todos os autores afirmam que a síndrome é um distúrbio ovulatório e metabólico, uma vez que a resistência à insulina e a consequente hiperinsulinemia compensatória podem ser exacerbadas pela coexistência da obesidade, presente em muitas mulheres com SOP. Além disso, foram identificados os fatores de risco tradicionais para o desenvolvimento de doenças cardiovasculares, e 93,33% dos artigos analisados demonstraram que, entre as mulheres com a síndrome, alguns fatores de risco para o desenvolvimento de tais doenças parecem apresentar uma chance maior de estarem presentes. Conclusão: Ao final dessa revisão, foi possível responder à pergunta clínica proposta, pois todos os artigos pesquisados concluíram e trouxeram estudos comprovando que mulheres com a SOP possuem maiores chances de desenvolver algum problema cardiovascular precoce, devido a fatores como o hiperandrogenismo e o aumento da gordura visceral e da resistência insulínica.(AU)

Objective: Polycystic ovary syndrome is an endocrine disorder, common in women who are in the reproductive phase. This pathology may be related to risk factors for the development of cardiometabolic complications, which makes it a relevant topic for discussion, given its high prevalence in the female population. This is an integrative literature review with the aim of identifying the risk factors associated with polycystic ovary syndrome and verifying whether there is a higher cardiovascular risk for women with this syndrome. Data source: A search was performed in the Virtual Health Library databases; National Library of Medicine; Scientific Electronic Library Online and EbscoHost, with the following descriptors: "Polycystic ovary syndrome and cardiovascular risks"; "Women, polycystic and cardiovascular risks"; "Polycystic ovaries and risks" and "Women, polycystic ovaries"; "Polycystic ovary and risks"; "Polycystic ovary syndrome and cardiovascular risk" and "Polycystic ovaries and cardiovascular". Study selection: Twenty-one articles were found, of which 15 met the previously established inclusion criteria. Original articles and publications between the period 2014 and 2021 that directly related the syndrome to cardiovascular risks, metabolic syndromes and lipid disorders were included. Data collect: The article selection strategy was performed by searching the selected databases; reading the titles of all articles found and excluding those that did not address the subject; critical reading of the abstracts of the articles and full reading of the articles selected in the previous steps. Data synthesis: All authors state that the Syndrome is an ovulatory and metabolic disorder, since insulin resistance and consequent compensatory hyperinsulinemia can be exacerbated by the coexistence of obesity, present in many women with polycystic ovary syndrome. In addition, traditional risk factors for the development of cardiovascular diseases were identified, with 93.33% of the articles analyzed showing that, among women with the syndrome, some risk factors for the development of such diseases seem to have a chance greater than being present. Conclusion: At the end of this review, it was possible to answer the proposed clinical question, as all the researched articles concluded and brought studies proving that women with polycystic ovary syndrome are more likely to develop an early cardiovascular problem, due to factors such as hyperandrogenism, the increase in visceral fat and insulin resistance.(AU)

Carcinoma adrenal virilizante en una adolescente: reporte de caso / Virilizing adrenal carcinoma in an adolescent: case report

Los tumores suprarrenales virilizante son infrecuentes y representan 5-6% de los tumores de esas glándulas1. Pueden secretar diferentes andrógenos como dehidroepiandrosterona sulfato (DHEAS), androstenediona y testosterona. Las características clínicas dependen de la edad de presentación; en niños pueden determinar pubertad precoz y en mujeres en edad fértil ocasionar hirsutismo, amenorrea o ciclos oligomenorreicos y diversos grados de virilización2. Los carcinomas adrenocorticales son tumores raros y la incidencia es aproximadamente uno a dos por millón de habitantes/año3,4. Los exámenes de imagen como la tomografía o la resonancia confirman el origen suprarrenal, valoran la presencia de metástasis y definen la conducta terapéutica5. La presentación inicial en pacientes pediátricos mayoritariamente es con virilización6 y aproximadamente el 50% de los pacientes adultos con carcinoma adrenal tienen un estadio de la enfermedad relativamente avanzado7. El tratamiento de elección es la cirugía y sigue siendo la mejor esperanza para la supervivencia a largo plazo8. El pronóstico habitual para el carcinoma adrenocortical es generalmente malo con una supervivencia global a 5 años de 20 a 25%5 en adultos, pero en niños y adolescentes la supervivencia puede llegar al 100%9. Se presenta el caso de una paciente con fenotipo totalmente masculino con diagnóstico de carcinoma adrenal virilizante que comienza en la infancia y se diagnostica en la adolescencia.

Virilizing adrenal tumors are uncommon and represent 5-6% on tumors of these glands1. They can secrete different androgens such as dehydroepiandrosterone sulfate (DHEAS), androstenedione, and testosterone. Clinical features depend on the age of presentation; in children they can determine precocious puberty and in women of childbearing age cause hirsutism, amenorrhea or oligomenorrheic cycles and various degrees of virilization2. Diagnosis consists of clinical evidence of hyperandrogenism, accompanied by an increase in androgens in the blood, especially DHEAS, whose origin is mainly adrenal. Adrenocortical carcinomas are rare and the incidence is approximately one to two per million inhabitants/year3,4. Imaging tests such as tomography or resonance confirm the adrenal origin, assess the presence of metastases and define the therapeutic approach5. In initial presentation in most pediatric patients is with virilization6 and approximately 50% adult's patients with adrenal carcinoma have a relatively advanced stage of the disease7. The treatment of choice is surgery and is the best hope for long-term survival. The usual prognosis for adrenocortical carcinoma is generally poor with a 5-year overall survival of 20 to 25%5 in adults, but in children and adolescent's survival can reach 100%9. We present the case of a patient with a totally male phenotype diagnosed with virilizing adrenal carcinoma that begins in childhood and is diagnosed in adolescence.

Calidad de vida en mujeres con el síndrome de ovario poliquístico, según el cuestionario WHOQOL-BREF / Quality of Life in Women with Polycystic Ovary Syndrome, according to the WHOQOL-BREF Questionnaire

Introducción: El síndrome de ovario poliquístico se caracteriza clínicamente por trastornos menstruales, infertilidad anovulatoria, hiperandrogenismo clínico y bioquímico. Con frecuencia se asocia a diabetes mellitus tipo 2, hipertensión arterial, dislipidemia y riesgo de enfermedad cardiovascular. Objetivo: Evaluar la calidad de vida de mujeres con diagnóstico de síndrome de ovario poliquístico, según el cuestionario WHOQOL-BREF. Métodos: Se realizó un estudio transversal en el periodo de septiembre de 2019 a marzo de 2020, que incluyó a 84 mujeres con diagnóstico del síndrome de menos de tres meses. Se les aplicó el cuestionario para evaluar la calidad de vida denominado WHOQOL-BREF, elaborado por la Organización Mundial de la Salud. Resultados: La valoración de la calidad de vida global para el 20,2 por ciento fue poca, el 15,5 por ciento refiere que es mala y el 8,3 por ciento de los pacientes dijo estar muy insatisfecho con su estado de salud. La media de la puntuación de este ítem fue 2,81. La media de la calidad de vida global de las mujeres estudiadas fue 85,2. De acuerdo con la calidad de vida global categorizada como baja, media o alta, en el primer caso hubo un 14,3 por ciento, el 72,6 por ciento estuvo dentro de la calificación media y solo el 13,1 por ciento tuvo una calidad de vida alta. Conclusiones: El cuestionario demostró una afectación moderada de la calidad de vida en las mujeres con la enfermedad, sobre todo en facetas de la dimensión física. Por tanto, consideramos importante incluir el estudio de los aspectos relacionados con su calidad de vida en aras de tener una atención más integral(AU)

Introduction: Polycystic ovary syndrome is clinically characterized by menstrual disorders, anovulatory infertility, as well as clinical and/or biochemical hyperandrogenism. It is frequently associated with type 2 diabetes mellitus, arterial hypertension, dyslipidemia, and risk of cardiovascular disease. Objective: To assess quality of life of women diagnosed with polycystic ovary syndrome, from their perspective and using a general questionnaire. Methods: A cross-sectional study was carried out in the period from September 2019 to March 2020, which included 84 women with a diagnosis of the syndrome for less than three months. The questionnaire to assess quality of life called WHOQOL-BREF, prepared by the World Health Organization, was applied to them. Results: Assessment of global quality of life for 20.2 percent was low, 15.5 percent refer that it is bad, and 8.3 percent of the patients expressed that they were very dissatisfied with their health status. The mean score for this item was 2.81. The mean value of global quality of life of the women studied was 85.2. Consistent with the global quality of life categorized as low, medium or high, in the first case there was 14.3 percent. 72.6 percent were within the average rating, and only 13.1 percent presented a high value for quality of life. Conclusions: The questionnaire showed a moderate impact on the quality of life in women with the disease, especially in aspects of the physical dimension. Therefore, we consider it important to include the study of aspects related to their quality of life in order to have a more comprehensive care(AU)

Síndrome de ovario poliquístico e infertilidad / Polycystic ovary syndrome and infertility

Una de las manifestaciones del síndrome de ovario poliquístico (SOP) es la infertilidad, y hoy es la primera causa de infertilidad por anovulación, representando aproximadamente el 80% de los casos. Las alteraciones del SOP en su mayoría son tratables y el diagnóstico temprano de las pacientes mejora su pronóstico reproductivo. Pese a su alta incidencia e importancia, los mecanismos fisiopatológicos del SOP aún son relativamente desconocidos. Recientemente se han publicado recomendaciones internacionales basadas en evidencia para su tratamiento.

Infertility is one of the main manifestations of the polycystic ovary syndrome (PCOS), and to day PCOS is the main cause of anovulatory infertility accounting for 80% of the cases. The majority of PCOS causes of infertility are treatable, and early diagnosis improves the patient's fertility outcome. In spite of its incidence and importance, the physiopathological mechanisms of PCOS are still relatively unknown. Recently an international evidence base recommendation for treatment have been published.

Consideraciones en el manejo del adulto con Hiperplasia Suprarrenal congénita clásica por déficit de 21-Hidroxilasa / Management considerations for the adult with congenital adrenal hyperplasia due 21-hydroxylase deficiency

La Hiperplasia Suprarrenal Congénita (HSRC) corresponde a un grupo de defectos genéticos en la síntesis de cortisol. El 95% de ellas son debidas al déficit de 21-hidroxilasa por lo que nos referiremos solo a esta deficiencia. La hiperplasia suprarrenal congénita clásica (HSRC-C) debuta en recién nacidos o lactantes con insuficiencia suprarrenal primaria, diferentes grados de hiperandrogenismo clínico en mujeres y puede coexistir con hipotensión, hiperkalemia e hiponatremia si hay un déficit clínico de aldosterona. El objetivo de este artículo es actualizar el conocimiento y enfoques sugeridos para el manejo de la HSRC-C desde el inicio de sus controles en la etapa adulta. El diagnóstico diferencial en retrospectiva de la HSRC-C y la no clásica (HSRC-NC) a veces resulta difícil ya que esta enfermedad es un espectro fenotípico continuo. La insuficiencia suprarrenal y la dependencia a terapia corticoidal son los eventos principales para diferenciar estas dos patologías que tienen enfoques terapéuticos diferentes. El tratamiento de la HSRC-C en adultos abarca 2 objetivos primarios: la adecuada sustitución de la falla suprarrenal y el control de hiperandrogenismo mediante el uso de corticoides en sus dosis mínimas efectivas. En la mujer existen terapias complementarias para el control del hiperandrogenismo como anticonceptivos y otras que se encuentran en diferentes fases de investigación. Esto permite disminuir las dosis de corticoides en algunos casos. Es importante a la vez abordar tres objetivos secundarios: controlar el riesgo cardiometabólico propio de la enfermedad, evitar el sobre tratamiento corticoidal y manejar la infertilidad. La correcta monitorización del tratamiento en adultos tomando en cuenta los objetivos descritos permite una mejor calidad de vida en estos pacientes. Finalmente el consejo genético debe realizarse en todos los pacientes con HSRC que deseen fertilidad y en sus parejas. El estudio requiere de secuenciación del gen CYP21A2 y debe realizarse en un laboratorio de experiencia.

Congenital Adrenal Hyperplasia (CAH) are a group of genetic defects characterized by impaired cortisol synthesis. 95% of them are due to 21-hydroxylase deficiency. We will discuss only this enzyme's deficiency. Classic congenital adrenal hyperplasia (CAH-C) debuts in newborns or infants with primary adrenal insufficiency, some degree of clinical hyperandrogenism in newborn females, and can coexist with hypotension, hyperkalemia, and hyponatremia if there is a clinical aldosterone deficiency. The objective of this article is to update the knowledge and suggested approaches for the management of CAH-C from the beginning of its controls in the adult stage. The retrospective differential diagnosis of CAH-C and non-classical (CAH-NC) is sometimes difficult because this disease is a continuous phenotypic spectrum. Adrenal insufficiency and dependence on corticosteroid therapy are the main events to differentiate these two pathologies that have different therapeutic approaches. In adults, the treatment of CAH-C must include 2 primary objectives: adequate the replacement of adrenal failure and control of hyperandrogenism, through the use of corticosteroids in their minimum effective doses. In women there are complementary therapies for the control of hyperandrogenism, such as contraceptives and others that are in different phases of research. This makes it possible to reduce the doses of corticosteroids in some cases. It is important at the same time to address three secondary objectives: control the cardiometabolic risk of the disease secondary to corticosteroid treatment, avoid corticosteroid overtreatment and manage infertility. The correct monitoring of treatment in adults and taking in to account the objectives described, allows a better quality of life in these patients. Finally, genetic counseling must be carried out in all patients planning for children, with any type of CAH and in their partners. The study requires sequencing of the CYP21A2 gene and must be performed in a certified laboratory.

Revisión de los criterios diagnósticos para el síndrome de ovario poliquístico / Review of diagnostic criteria for polycystic ovary syndrome

Resumen El síndrome de ovario poliquístico, es la alteración endocrina metabólica más frecuente en mujeres en edad fértil, teniendo implicaciones a nivel reproductivo, metabólico, cardiovascular y psicosocial. Actualmente, su sobrediagnóstico corresponde a una problemática común derivada de la heterogeneidad en la aplicación de los criterios actualmente avalados para su hallazgo, lo que ha contribuido en el incremento de tratamientos innecesarios, así como los efectos negativos en la calidad de vida y el bienestar de las pacientes falsamente calificadas con este trastorno. Se realizó una búsqueda en PubMed-MENDELEY y Ovid entre los meses de Febrero a Abril del 2020, obteniendo 43 artículos relacionados con el tema, publicados en los últimos 10 años. El conocimiento por parte del personal médico capacitado sobre los consensos actuales para la correcta evaluación del síndrome y el estudio individualizado de cada caso, corresponden las medidas más apropiadas para la reducción del sobrediagnóstico. MÉD.UIS.2020;33(3):21-28

Abstract Polycystic ovary syndrome is the most frequent metabolic endocrine disorder in women of childbearing age, having implications at both the reproductive, metabolic, cardiovascular and psychosocial levels. Currently, its overdiagnosis corresponds to a common problem derived from the heterogeneity in the application of the criteria currently endorsed for its discovery, which has contributed to the increase in unnecessary treatments, as well as the negative effects on the quality of life and well-being of falsely rated patients with this disorder. A search was made in PubMed-MENDELEY and Ovid between the months of February to April of 2020, obtaining 43 articles related to the topic, published in the last 10 years. The knowledge on the part of the trained medical personnel about the current consensuses for the correct evaluation of the syndrome and the individualized study of each case, correspond to the most appropriate measures for the reduction of this event. MÉD.UIS.2020;33(3):21-28

O legado das regulações esportivas. Diagnóstico e consentimento na elegibilidade da categoria feminina / The legacy of sports regulations. Diagnosis and consent in the female category eligibility / El reglamento del legado del deporte. Diagnóstico y consentimiento para la elegibilidad de la categoría femenina

Resumo As regulações esportivas para definir a elegibilidade na categoria feminina são políticas antigas, datadas do começo do século XX, que atravessam disputas sobre o corpo, suas inscrições e possibilidades de futuro. De modo que a definição de um diagnóstico, com suas articulações de saúde, doença e cuidado terapêutico, concentram alguns atributos significativos para essa determinação de elegibilidade. Acompanhando um pouco da história da ex-judoca brasileira Edinanci Silva, vamos compreender como tais regulações constituem estratégias normativas de controle do corpo e da população, assim como mobilizam os cenários em que os sujeitos existem, se individualizam e cuidam de si. Essa difícil tarefa de consentir num contexto de crise, de risco e de humilhação diz muito sobre os limites dessas mesmas inclusões pelo esporte. No fim, também vamos entender porque a virilização feminina continua a ser medicalizada e importa mais do que a eficiência do rendimento esportivo propriamente dito.

Abstract The sports regulations to define the eligibility in the female category are old policies, dating from the beginning of the 20th century, which go through disputes over the body, its inscriptions and possibilities for the future. In this sense, the definition of a diagnosis, with its articulations of health, disease and therapeutic care, concentrate some significant attributes for this eligibility. Following a bit of the history of former Brazilian judoka Edinanci Silva, we'll understand how such regulations constitute normative strategies for controlling the body, the population, as well as mobilizing the scenarios in which the subjects exist, individualize and take care of themselves. This difficult task of consenting in a context of crisis, risk and humiliation says a lot about the limits of these same inclusions by sport. In the end, we'll also understand why female virilization continues to be medicalized and matters more than the efficiency of sports performance itself.

Resumen La normativa deportiva para definir la elegibilidad en la categoría femenina son políticas antiguas, fecha del comienzo del siglo 20, que pasan por disputas sobre el cuerpo, sus inscripciones y posibilidades de futuro. De modo que la definición de un diagnóstico, con sus articulaciones de salud, enfermedad y atención terapéutica, concentre algunos atributos significativos para esta determinación de elegibilidad. Siguiendo un poco de la historia de la ex-judoca brasileña Edinanci Silva, entenderemos cómo estas regulaciones constituyen estrategias normativas para controlar el cuerpo y la población, así como movilizar los escenarios en que los sujetos existen, se individualizan y se cuidan. Esta difícil tarea de consentir en un contexto de crisis, riesgo y humillación dice mucho sobre los límites de estas mismas inclusiones para el deporte. Al final, también entenderemos por qué la virilización femenina sigue medicalizada y es más importante que la eficacia del rendimiento deportivo en sí.

Salud sexual y reproductiva en pacientes con hiperplasia adrenal congénita asignadas como femeninas / The Reproductive Future of Female-Assigned Patients with Congenital Adrenal Hyperplasia

RESUMEN Introducción: Si bien en la mujer con hiperplasia adrenal congénita la consecución de una función gonadal y fertilidad normales requiere de una adhesión estricta al tratamiento sustitutivo, no siempre esto es suficiente y, desde la adolescencia, aparece algún grado de hiperandrogenismo ovárico que influye de manera negativa. Objetivos: Describir algunos aspectos relacionados con la sexualidad, la salud sexual y reproductiva en pacientes con hiperplasia adrenal congénita asignadas como femeninas. Métodos: Se realizó un estudio descriptivo transversal y observacional, que incluyó todas las pacientes con diagnóstico de hiperplasia adrenal congénita asignadas como femeninas, que fueron atendidas en el Instituto Nacional de Endocrinología durante el periodo 2000-2019. Exploró aspectos demográficos, historia familiar y aspectos relacionados con la salud sexual y reproductiva. Resultados: La muestra quedó constituida por 47 pacientes, con una media de edad actual de 14,76 ± 7,04 años y una edad promedio de inicio del tratamiento de 5,9 años. Se comprobó un predominio de las formas clínicas clásicas en 25 pacientes (53,19 por ciento), y 22 (46,80 por ciento) formas no clásicas. Presentaron algún grado de virilización genital 22 pacientes, de este grupo 14 (68,1 por ciento) habían recibido cirugía genital, 5(10,6 por ciento) clitoroplastia con una media de edad 2,8 ± 0,8 años y 9 (19,1 por ciento) combinado con vaginoplastia. De las 36 pacientes en edad reproductiva, 11 (37,9 por ciento) refirieron haber iniciado relaciones sexuales a los 17,8 ± 3,9 años, como promedio. Conclusiones: Es importante considerar que la subfertilidad de las mujeres con hiperplasia adrenal congénita tiene su origen desde los años peripuberales, por lo que debe ser de interés permanente del endocrinólogo pediatra para mejorar su futuro reproductivo(AU)

ABSTRACT Introduction: Although in women with congenital adrenal hyperplasia, the achievement of normal gonadal function and fertility requires strict adherence to substitution treatment, this is not always sufficient and some degree of ovarian hyperandrogenism appears with a negative effect, which is evident since adolescence. Objective: To characterize some factors related to sexual and reproductive health in patients with congenital adrenal hyperplasia and assigned as female. Methods: A cross-sectional and observational-descriptive study was carried out, including all female-assigned patients with a diagnosis of congenital adrenal hyperplasia and who were treated at the Institute of Endocrinology from 2000 to 2019. The study explored demographic aspects, family history, as well as aspects related to sexual and reproductive health Results: The sample was made up of 47 patients, with current mean age of 14.76 ± 7.04 years and average age for starting treatment of 5.9 years. Predominance of classic clinical forms was verified in 25 patients (53.19 percent), while 22 patients (46.80 percent) presented nonclassical forms. Some degree of genital virilization manifested in 22 patients; of this group, 13 (59.1 percent) had received genital surgery, four (8.5 percent) received clitoroplasty at mean age of 2.8 ± 0.8 years, and nine (19, 1 percent) received an approach combined with vaginoplasty. Of the 36 patients at reproductive age, 11 (37.9 percent) reported having started sexual intercourse relations at an average age of 17.8 ± 3.9 years old. Conclusions: It is important to consider that subfertility of women with congenital adrenal hyperplasia starts in the peripubertal years, a reason why it should be of permanent interest to the pediatric endocrinologist in order to improve their reproductive future(AU)

Presentación de un caso de síndrome de Cooke-Apert-Gallais / Presentation of a case of Cooke-Apert-Gallais syndrome

Se estudió una paciente de 47 años de edad con antecedentes de buena salud, sin antecedentes atópicos personales ni familiares, que acude a la consulta de endocrinología por presentar aumento del vello corporal con dos años de evolución. Al examen físico se le constató rubicundez facial, escudo pubiano masculino, predominio de la cintura escapular sobre la cintura abdominal e hipertrofia de 3,5 cm del clítoris. Referente a los exámenes complementarios presentó un marcado aumento de la testosterona en sangre así que se le practicó una histerectomía con doble anisectomía y los resultados de la biopsia fueron: un tumor benigno de células de Leydig. Se concluyó que se trataba de un Síndrome de Cooke-Apert-Gallais por un tumor productor de testosterona en el ovario(AU)

A study was conducted of a female 47-year-old patient with a history of good health and no personal or family atopic antecedents, who attends endocrinology consultation due to increased growth of body hair of two years' evolution. Physical examination revealed facial reddishness, a male pubic shield, predominance of the scapular waist over the abdominal waist, and 3.5 cm hypertrophy of the clitoris. Complementary tests found a marked increase in blood testosterone, which led to the performance of hysterectomy with double adnexectomy. The result of the biopsy was benign Leydig cell tumor. The final diagnosis was Cooke-Apert-Gallais syndrome due to a testosterone-producing tumor in the ovary(AU)

Dosages of androgenic hormones in adolescent patients with severe acne

SUMMARY OBJECTIVE Acne vulgaris in female adolescents, when severe or accompanied by other signs of androgenization, may represent a sign of hyperandrogenemia often underdiagnosed, which will have harmful consequences for adult life. The objective of this cross-sectional and retrospective study was to demonstrate the incidence of hormonal changes in the cases of female adolescents with severe or extensive acne, with or without other signs of hyperandrogenism, and propose a hormonal research pattern which should be indicated in order to detect early hyperandrogenemia. METHODS The medical records of 38 female patients aged between 9 and 15 years old with grade II and/or III acne were analyzed. The dehydroepiandrosterone sulfate, dehydroepiandrostenedione, and androstenedione, total testosterone, and dihydrotestosterone sulfate hormones were required prior to initiation of treatment. The hormonal dosages were performed in the serum after at least 3 hours of fasting by means of radioimmunoassay tests. RESULTS Of the 38 patients included, 44.7% presented changes in androgen levels (hyperandrogenemia), and the two most frequently altered hormones were DHEA and androstenedione, with the same incidence (23.6%). CONCLUSIONS The correct and early diagnosis provides an effective and agile approach, including antiandrogen therapy, with the purpose of avoiding the reproductive and metabolic repercussions, besides controlling the inflammatory picture and avoid aesthetic complications.

RESUMO OBJETIVO A acne vulgar em adolescentes do sexo feminino, quando grave ou acompanhada de outros sinais de androgenização, pode representar um sinal de hiperandrogenemia muitas vezes subdiagnosticado, que acarretará consequências danosas para a vida adulta. O objetivo deste estudo transversal e retrospectivo foi demonstrar a incidência das alterações hormonais nos casos de adolescentes do sexo feminino com acne grave ou extensa, acompanhada ou não de outros sinais de hiperandrogenismo e propor um padrão de pesquisa hormonal que deve ser indicado com o intuito de detectar precocemente o quadro de hiperandrogenemia. MÉTODOS Foram analisados os prontuários de 38 pacientes do sexo feminino com idades entre 9 e 15 anos, portadoras de quadro de acne grau II e/ou III. Os hormônios sulfato de dehidroepiandrostenediona, dehidroepiandrostenediona, androstenediona, testosterona total e dehidrotestosterona foram solicitados antes do início do tratamento. As dosagens hormonais foram realizadas no soro após pelo menos 3 horas de jejum por meio de exames de radioimunoensaio. RESULTADOS Das 38 pacientes incluídas, 44,7% apresentaram alterações dos níveis de andrógenos (hiperandrogenemia), sendo que os dois hormônios mais frequentemente alterados foram o DHEA e androstenediona, com a mesma incidência (23,6%). CONCLUSÕES O diagnóstico correto e precoce propicia uma abordagem efetiva e ágil, incluindo a terapia antiandrogênica, com a finalidade de evitar as repercussões reprodutivas e metabólicas, além de controlar o quadro inflamatório e evitar complicações estéticas.

Hirsutismo y estados hiperandrogénicos / Hirsutism and hyperandrogenic states

Este es un artículo de revisión sobre lo que es el hirsutismo. Se expone que la mayor causa está asociada con el ovario poliquístico. Se describe la producción ovárica y suprarrenal de andrógenos en la mujer, las diferentes manifestaciones de hiperandrogenismo, las diversas clasificaciones que hay para el diagnóstico y clasificación clínica del hirsutismo y el papel que juega la 5-alfa-reductasa. Se postulan las principales etiologías, el diagnóstico y el manejo de esta patología.

This es a review article about what is hirsutism. It is exposed that the greatest cause associated is polycystic ovary. Ovarian and adrenal androgen production are described, the different manifestations of hyperandrogenism, the different classification systems for diagnosis and clinical classification of hirsutism and the role of 5-alfa-reductase. The main etiologies are postulated, as well as diagnosis and management of this pathology.

Síndrome dos ovários policísticos: tratamento das manifestações androgênicas / Polycystic ovary syndrome: treatment of androgenic manifestations

A síndrome dos ovários policísticos (SOP) é um distúrbio endócrino-metabólico muito frequente no período reprodutivo. Quando associado ao distúrbio metabólico, as mulheres com SOP podem ter ainda risco acrescido para doença cardiovascular. O objetivo deste manuscrito é descrever as repercussões metabólicas, incluindo quais as principais, como investigar e as consequências desse distúrbio sobre a saúde da mulher. É uma revisão narrativa mostrando a implicação da resistência insulínica, das dislipidemias e da síndrome metabólica sobre o sistema reprodutor e sobre o risco cardiovascular da mulher com SOP, bem como do uso de sensibilizadores de insulina no seu tratamento. Conclui-se que a correção dos distúrbios metabólicos na SOP é benéfica tanto para o sistema reprodutor quanto para o cardiovascular. A primeira linha de tratamento é a mudança de estilo de vida e a perda de peso. Na resposta inadequada, o tratamento medicamentoso está recomendado. Nas mulheres com obesidade mórbida que não tiveram bons resultados com o tratamento clínico, a cirurgia bariátrica é uma opção.(AU)

Level of Betatrophin in PCOS patients

PCOS is known now as an endocrine, metabolic, and chronic inflamatory disorder, with hyperandrogenemia, insulin resistance and obesity being the key factors that influence the expression and symptoms of the condition. Objective: To assess the level of alpha fetoprotein in PCOS women. Patients and method: A case control study conducted at Al-Elwyia. Teaching hospital when 200 women were enrolled in the study and divided into two groups: case group (100) patients with PCOS and control healthy group (100). The patient with PCOS women was diagnosed according to Roterdam criteria. Results: A total of 200 respondents and divided into 2 groups. The mean age of them (27.7 ± 2.3) years, highly significant association (P <0,001) were found between the age group especially (21-30) years in PCOS patients moreover highly significant association were found between the obese patient in PCOS than that in normal group (P<0.001). Betatrophin levels were significantly highly increases in patients than that in control group (P<0.001). Conclusion: the serum betatrophin level was significantly increased in patients with polycystic syndrome (AU)

La esteroidogénesis en el síndrome de ovarios poliquísticos / Steroidogenesis in polycystic ovary syndrome

Resumen El síndrome de ovarios poliquísticos es la enfermedad endocrina más frecuente en la edad reproductiva; se caracteriza por alteraciones menstruales, hiperandrogenismo clínico o bioquímico e identificación ultrasonográfica de quistes ováricos. Las alteraciones neuroendocrinas y metabólicas que lo acompañan implican desensibilización del eje hipotálamo-hipófisis-ovario, esteroidogénesis e hiperandrogenismo. Recientemente se ha explorado el papel de la resistencia a la insulina. Se ha establecido que la principal causa del síndrome de ovarios poliquísticos es el hiperandrogenismo, debido a alteraciones enzimáticas en la vía esteroidogénica, por lo que existe sobreestimulación por parte de la hormona luteinizante a causa de los pulsos rápidos generados por la hormona liberadora de gonadotropinas. Diversos factores de crecimiento y citocinas inhiben la conversión de andrógenos a estrógenos. En la desregulación característica de este síndrome también están involucradas la activina y las prostaglandinas e, incluso, altos niveles de insulina.

Abstract Polycystic ovary syndrome is the most common endocrine disease in reproductive age, characterized by menstrual alterations, clinical or biochemical hyperandrogenism, and ultrasound-identified ovarian cysts. The neuroendocrine and metabolic alterations that accompany this condition involve the desensitization of the hypothalamus-pituitary-ovary axis, steroidogenesis and hyperandrogenism; recently, the role of insulin resistance has been explored. Hyperandrogenism has been established to be the main cause of polycystic ovary syndrome, due to enzymatic alterations in the steroidogenic pathway that cause luteinizing hormone over-stimulation because of quick pulses generated by gonadotropin-releasing hormones. Various growth factors of and cytokines inhibit the conversion of androgens into estrogens; activin and prostaglandins are also involved, even high levels of insulin participate in the characteristic deregulation of this syndrome.

The Modified Ferriman-Gallwey Score and Hirsutism among Filipino Women

BACKGROUND: The modified Ferriman-Gallwey (mFG) score is the gold standard for the clinical evaluation of hirsutism. However, racial variations in terminal hair growth limit this tool. This study aimed to determine the mFG cut-off score among Filipino women and its association with biochemical hyperandrogenism.METHODS: A total of 128 Filipino women were included in this prospective cross-sectional study and were divided into two groups: a polycystic ovary syndrome (PCOS) group (n=28) and a non-PCOS group (n=100). The participants underwent mFG score determination, ovarian ultrasound conducted by a single sonographer, and hormone testing. The mFG cut-off score was determined based on the 95th percentile of the non-PCOS group. Logistic regression was used to analyze the relationship between mFG score and biochemical hyperandrogenism.RESULTS: Although the mFG score was generally low in both the PCOS and non-PCOS groups, the former exhibited a higher mean score than the latter (4.3±3.0 vs. 2.0±2.2, P<0.001). Normal values for the total mFG score ranged from 0 to 7. Using a cut-off score of 7, a higher proportion of hirsute women (mFG score ≥7) was observed in the PCOS group versus the non-PCOS group (17.9% vs. 5.0%, P=0.025). Elevated calculated free testosterone (FT) was also found to be significantly associated with hirsutism (odds ratio, 6.2; 95% confidence interval, 1.2 to 32.4 pmol/L; P=0.030).CONCLUSION: A score of 7 and above constitutes hirsutism in this population of Filipino women. Hirsute women are more likely than non-hirsute women to have elevated calculated FT.