Prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities

Polycystic ovaries are considered to be the most frequent cause of hirsutism with its prevalence of 10% of woman of reproductive age group. Polycystic ovarian syndrome [PCOS] reflects multiple potential etiologies and variable clinical presentations. To investigate the prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities [oligo- or oligohypomenorrhea] and to correlate presence of hirsutism with BMI, polycystic ovaries, ovarian volume and biochemical markers. All patients who presented with oligo- or oligohypomenorrhea or hirsutism either in outpatient clinic of Obstetrics and Gynecology, Shalamar Hospital or a private laser clinic were enrolled in study. Patients who had hirsutism with normal menstrual cycle were excluded from study. Enrolled patients were categorized into two groups on basis of hirsutism, group 1: oligomenorrhea/oligohypomenorrhea with hirsutism and group 2: oligomenorrhea/oligohypomenorrhea without hirsutism. A detailed clinical history, clinical examination, hormonal profile and abdominopelvic ultrasound were done in all patients. SPSS- version 16 was used for statistical analysis. Out of 90 patients who enrolled in the study, 10 did not report back, so were excluded from study. Out of 80 patients with menstrual problem, 55 [68.7%] had hirsutism [group 1] and 25 [31.3%] had no hirsutism [group 2]. Prevalence of polycystic ovaries was 815% among patients with hirsutism and oligo/oligohypomenorrhea [group 1] as compared to 44% in patients with oligo/oligohypomenorrhea without hirsutism [group 2]. Ovarian volume >10ml and BMI were not statistically significant among both groups. Regarding hormonal profile, serum LH/FSH ratio and testosterone levels were significant among patients with hirsutism as compared to without hirsutism. Prevalence of polycystic ovaries by morphology, FSH/LH ratio and serum testosterone are significantly present among patients with oligo/oligohypomenorrhea and hirsutism as compared to those with oligo/oligohypomennorhea without hirsutism. However Ovarian volume and BMI are not statistically significant among both groups

Forma no clàsica de hiperplasia adrenal congénita en la niñez y adolescencia / Non-classic way of congenital adrenal hyperplasia in childhood and adolescence

INTRODUCCIÓN: la hiperplasia adrenal congénita es un trastorno hereditario de la esteroidogénesis suprarrenal, trasmitido por mutaciones genéticas con carácter autosómico recesivo, las cuales afectan las enzimas que intervienen en la biosíntesis del cortisol. La causa la constituye en 90 a 95 por ciento de los casos la deficiencia de la enzima 21 hidroxilasa. OBJETIVO: exponer la experiencia de los autores de este trabajo en la forma no clásica de esta enfermedad. MÉTODOS: se realizó la caracterización de 7 pacientes diagnosticados en la sala de endocrinología pediátrica del Instituto Nacional de Endocrinología, ubicada en el Hospital Pediátrico del Cerro, durante el período 1998-2008. Todos los pacientes pertenecían al sexo femenino. RESULTADOS: los síntomas se iniciaron a una edad promedio de 8,8 años y más de la mitad de los casos presentaron pubarquia precoz. La menarquia se produjo a una edad media de 10,7 años. Se logró el diagnóstico bioquímico al obtenerse valores elevados de 17 hidroxiprogesterona (en condiciones basales). Se emplearon distintas modalidades de tratamiento según la edad de cada paciente y los síntomas predominantes en cada caso. CONCLUSIONES: se corroboró la mayor frecuencia de diagnóstico de esta enfermedad en el sexo femenino, así como la importancia del estudio y el seguimiento ante un paciente con pubarquia precoz(AU)

INTRODUCTION: the congenital adrenal hyperplasia is an inherited disorder of suprarenal esteroidogenesis, transmitted by genetic mutations with a autosomal recessive character affecting the enzymes intervening in cortisol biosynthesis. In the 90 to 95 percent of cases, the cause is a deficiency of Hydroxylase enzyme 21. OBJECTIVE: to show the current paper authors' experience in the non-classic way of this entity. METHODS: we made a characterization of 7 female patients diagnosed in the Children Endocrinology Ward of the National Institute of Endocrinology located in the Children Hospital, Cerro municipality during 1998-2008. RESULTS: symptoms started at a mean age of 8,8 years and more the a half of cases had an early pubarche. Menarche appeared at a mean age of 19,7 years. We made a biochemical diagnosis achieving higher values of 17 hydroxyprogesterone (in basal conditions). Different treatment modalities were used according to each patient and predominant symptoms in each case. CONCLUSIONS: we verified the great frequency of this entity in female sex, as well as the study and follow-up significance in face of a patient presenting early pubarche(AU)

Treatment outcome of hyperprolactinaemic infertility with carbegoline in sub saharan Africa

Hyperprolactinaemia is a known cause of infertility. We explored the efficacy of carbegoline, the long acting dopamine agonist that was recently introduced into our medical practice. Seventy six patients with infertility secondary to hyperprolactinaemia were studied over a period of 20 weeks each. All the patients had carbegoline twice weekly for eight weeks. Two dosage regimen were used based on the pretreatment prolactin level; less than 50ng/ml had 0.25mg twice weekly [n=58] and 50ng/ml and above 0.5mg twice weekly [n=18]. Normalization of prolactin level was achieved in 75 [98.7%] patients. At the end of the study period, there was resumption of menstrual flow in 10 [76.9%] of the 13 patients that were amenorrhoiec and all the 39 [100%] patients that were oligomenorrhoeic had their normal menstrual cycle restored. Resumption of ovulatory cycles occurred in 87.7% of those with anovulatory cycles. Of the 76 patients, 69 [90.8%] got pregnant during the 20 weeks study. However, out of the 69 that got pregnant, 13 [18.8%] got pregnant while on carbegoline therapy. There was no case of carbegoline resistance or discontinuation recorded in this study. Carbegoline is a cost effective first line therapy in the management of infertile women with hyperprolactinaemia

Idiopathic hirsutism or polycystic ovary syndrome

Polycystic ovarian syndrome [PCOS] is a common reproductive disorder, the most important symptoms of which are hirsutism, acne and irregular menstruation. Subjects who had idiopathic hirsutism also suffer from excess hair and have Laboratory results and ultrasound findings, which are similar to PCO. The aim of this study is to find a relationship between idiopathic hirsutism and PCOS. For this reason, PCO were detected using ultrasound imaging in a series of 173 women who presented with significant hirsutism and in some cases with irregular menstruation. Patients were divided in to 3 groups: those with hirsutism and regular menstruation [cycles > 8 per year, group 1, n=96], those with hirsutism and oligomenorrhoea [cycles < 8 per year, group 2, n= 99] and those with hirsutism and amenorrhoea [cycles < 2 per year, group 3, n= 33]. These 3 groups were compared with subjects with normal ovaries and regular cycles of 26-34 days and without hirsutism [n= 29] and also with a group of women with PCO and regular cycles who had no sign of hirsutism [n=90]. PCO were found in 86% of group 1, 97% of group 2 and 94% of women within group 3. The results suggest that the term "idiopathic hirsutim" may not be appropriate. Sensitivity of biochemical tests for PCO amongst women of group 1, 2 and 3 were 100%, 91% and 76% respectively. This was in the case when at least one of these biochemical tests were reported to be abnormal: luteinizing hormone level > 9 U/L, testosterone level > 2.2 nmol/L, sex hormone binding globulin < 32 nmol/L or free androgen index > 4.5

Hiperandrogenismo e irregularidades menstruales en mujeres jóvenes / Hyperandrogenism and menstrual disorders in young women

Objetivos: estudiar a jóvenes con irregularidad menstrual, hirsutismo, acné u obesidad, su incidencia de anovulación y la respuesta de aquellas hiperandrogénicas a bajas dosis de conticoides. Materiales y métodos: en 229 pacientes entre 10 y 25 años se midió TSH, PRL, LH, FSH, TT, TL. La ovulación se caracterizó según el moco cervical y niveles de progesterona séricos y urinarios. En caso de HA se realizó un test de supresión con dexametasona. Resultados: el 44,5 por ciento del total de la población consulta por oligomenorrea y el 66,9 por ciento presenta hiperandrogenismo. El 30 por ciento mostró en forma concomitante hiperprolactinemia, hiper o hipotiroidismo. El 85 por ciento presentó anovulación y el 81 por ciento de las hiperandrogénicas tuvo un test de supresión positivo. Conclusiones: la patología más frecuente en esta población es el hiperandrogenismo, que responde a dexametasona. Las jóvenes con trastornos menstruales deben ser estudiadas precozmente; con un tratamiento adecuado para su patología se prevendrían casos de infertilidad, cáncer y dislipidemia

Adenomas hipofisarios en adolescentes / Pituitary adenomas in adolescence

Presentamos una serie de 48 pacientes (de 14 a 20 años) con adenoma hipofisario. De éstos, 46 (96 por ciento) presentaban tumores secretantes, 3 enfermedad de Cushing, 9 somatotrofinomas y 34 (29 mujeres y 5 hombres) prolactinomas. Treinta casos fueron diagnosticados como adenomas intraselares (62 por ciento) mientras los restantes 18 (38 por ciento) presentaron expansión extraselar. De los 9 pacientes acromegálicos, 7 desarrollaron bioquímica y clínica típica de la enfermedad mientras 2 fueron exclusivamente diagnosticadas con niveles de GH basales normales, pero pruebas dinámicas anormales. Los prolactinomas fueron no invasivos en mujeres y de crecimiento rápido y de mayor tamaño en hombres. Cuarenta y siete pacientes fueron sometidos a cirugía. Cinco de ellos requirieron craneotomía y el resto fueron abordados por víatranseptoesfenoidal (TSE). Se consiguió remisión de la enfermedad de Cushing, acromegalia y prolactinoma intraselar femeninos. Los resultados en tumores mayores tales como los adenomas no secretantes y prolactinomas masculinos fueron malos luego de haber sido tratados mediante una resección subtotal y los disturbios endocrinológicos persistieron. Nuestros hallazgos demuestran que estos tumores son más agresivos en los jóvenes que en los adultos. Como hubo una estrecha relación entre el tamaño del tumor, su invasividad y el resultado final del paciente, concluímos que el diagnóstico temprano y el tratamiento son esenciales. Las frecuentes consultas de adolescentes tales como menstruaciones irregulares, retraso puberal y alteraciones de crecimiento deberían ser investigadas cuidadosamente y no simplemente consideradas como hechos transitorios o funcionales

¿Tiene la oligomenorrea un siginificado patológico?: importancia de este síntoma en medicina interna / Has oligomenorrhea a pathological meaning?: the importance of this symptom in internal medicine

Background: Oligomenorrhea, defined as a menstrual cycle lasting 36 to 90 days, can be a normal condition in the first years after the menarche. When it persists or appears after a period of normal menstrual cycles, an underlying illness must be sought. Aim: To assess ovulation and causes of anovulatory cycles in women with oligomenorrhea, compared with causes of secondary amenorrhea. Patients and methods: One hundred one women of less the 35 years old, presenting with oligomenorrhea persisting 5 years after menarche or lasting more than two years after a period of normal menstrual cycles, were studied. Ovulation was studied measuring serial plasma progesterone during normal or induced (with intramuscular progesterone) menstrual cycles. Results: Eighty nine percent of women had anovulatory oligomenorrhea. The main causes were polycystic ovarian disease in 51percent and hypothalamic dysfunction in 31percent. Thirty percent of women with secondary amenorrhea had polycystic ovarian disease and 14percent had hyperprolactinemia. Women older than 20 years old or with more than 10 years of gynecological age had a higher frequency of polycystic ovarian disease and a lower prevalence of hypothalamic dysfunction. Conclusions: There is a high frequency of anovulatory oligomenorrheas. Therefore, this symptom deserves a thorough endocrinological assessment to uncover underlying diseases. Special attention must be paid to polycystic ovary syndrome, due to its importance in internal medicine as a risk factor for myocardial infarction, high blood pressure, and type 2 diabetes mellitus

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

El factor ovánico endocrino en infertilidad matrimonial / Ovarian-Endocrine Factor In Infertility marriyes

Se realizó un estudio retrospectivo en mujeres con infertilidad de origen ovárico endocrino en el Hospital Arzobispo Loayza entre enero de 1983 y Setiembre de 1991, encontrándose 138 casos que corresponden a una incidencia del 22.4 por ciento de las pacientes infértiles, representando un incremento de dicha patología en nuestro medio. La entidad más frecuente fue la Anovulacián crónica de causa indeterminada con un 31.87 por ciento, seguida por el Sindrome de ovario poliquístico con 18.84%, la Hiperprolactinemia con 18.12 por ciento, y la Fase lútea inadecuada con 17.38 por ciento. Estas tres entidades han aumentado su incidencia a expensas de la Anovulación crónica de causa indeterminada, debido a las mayores facilidades para su diagnóstico. El 61.59 por ciento tuvo irregularidades mestruales, siendo las más frecuentes la oligomenorrea, y la amenorrea, presentes ambas en el 28.26 por ciento de las pacientes. Las causas más importantes de oligomenorrea fueron la Anovulación crónica de causa indeterminada, con 51.28 por ciento, y la poliquistosis ovárica, con 30.77 por ciento, y de amenorrea la Hiperprolactinemia con 35.9 por ciento. El 83.33 por ciento de las pacientes con Fase lútea inadecuada tuvo ciclos clinicamente regulares

Asociación de acromegalia y tiroiditis de Hashimoto / Association of acromegaly and chronic lymphocitic thyroiditis

La tiroiditis de Hashimoto es contrariamente a lo que se aceptaba hace algunos años, una entidad relativamente frecuente en nuestro medio y responsable de un alto porcentaje de bocio e hipotiroidismo, especialmente en mujeres jovenes y de mediana edad. La asociación de esta patología con acromegalia es excepcionalmente rara. Se presenta un caso en el que se desarrolla una tiroiditis linfocítica crónica en una paciente acromegálica. Se discute el proceso diagnóstico y el tratamiento