Polimorfismos de la metilenotetrahidrofolato reductasa C677T como factor de riesgo para el síndrome de ovario poliquístico en una muestra de mujeres jordanas / Methylenetetrahydrofolate Reductase C677T Polymorphisms as a Risk Factor for Polycystic Ovarian Syndrome in a Sample of Jordanian Women

Antecedentes: el síndrome de ovario poliquístico (SOP) es un trastorno endocrino reproductivo común, se puede identificar por hiperandrogenismo, oligomenorrea o anovulación y ovarios poliquísticos en la ecografía. Los polimorfismos de la metilentetrahidrofolato reductasa (MTHFR) C677T asociados con la hiperhomocisteinemia se encuentran entre los factores de riesgo del síndrome de ovario poliquístico. Objetivo: El presente estudio de casos y controles tiene como objetivo explorar la relación entre los polimorfismos C677T de la metilenotetrahidrofolato reductasa (MTHFR) como factor de riesgo y el síndrome de ovario poliquístico entre los pacientes jordanos que padecen esta enfermedad. Métodos: Se inscribieron en el estudio 306 sujetos (146 pacientes con SOP y 160 sujetos sanos como grupo de control). Se extrajo ADN de una muestra de sangre venosa extraída de cada participante para analizar los polimorfismos de MTHFR C677T utilizando la reacción en cadena de la polimerasa (PCR) en combinación con digestión con enzima de restricción (PCRRFLP). Posteriormente, los productos de PCR-RFLP se digirieron con la enzima HinfI, luego se sometieron a electroforesis en un gel de agarosa al 2%, se tiñeron y se examinaron bajo luz ultravioleta. Los niveles de homocisteína en plasma se analizaron utilizando el método ELISA. Resultados: Se observó una diferencia significativa en los niveles plasmáticos de homocisteína entre los pacientes con SOP frente a los sujetos de control y entre los diferentes polimorfismos de los pacientes con SOP. No se detectaron diferencias significativas en la distribución y frecuencia alélica de los polimorfismos MTHFR C677T en pacientes con SOP en comparación con los controles. El genotipo 677 / TT y el alelo T se asociaron con un aumento de 1,54 y 1,46 veces en la susceptibilidad al síndrome de ovario poliquístico. Conclusión: El estudio ha demostrado que el polimorfismo MTHFR T677T y el alelo T son posibles factores de riesgo de SOP entre las mujeres jordanas y pueden desempeñar un papel en la patogenia de la enfermedad

Background: Polycystic ovary syndrome (PCOS) is a common endocrine reproductive disorder, it can be identified by hyperandrogenism, oligomenorrhea or anovulation and polycystic ovaries on ultrasound. Methylenetetrahydrofolate Reductase (MTHFR) C677T polymorphisms associated with hyperhomocysteinemia are among the risk factors for PCOS. Objective: The present case control study aims to explore the relationship between Methylenetetrahydrofolate Reductase (MTHFR) C677T polymorphisms as a risk factor and PCOS among Jordanian patients suffering from this disease. Methods: 306 subjects (146 PCOS patients and 160 healthy subjects as a control group) were enrolled in the study. DNA was extracted from venous blood sample withdrawn from each participant for analyzing MTHFR C677T polymorphisms using Polymerase Chain Reaction (PCR) in combination with restriction enzyme fragment length polymorphism (PCR-RFLP). Later, PCR-RFLP products were digested with hinfI enzyme, then, electrophoresed on a 2% agarose gel, stained and examined under UV light. Plasma homocysteine levels were assayed using ELISA method. Results: A significant difference was observed in plasma homocysteine levels among PCOS patients versus the control subjects and in between the different polymorphisms of PCOS patients. No significant difference was detected in the distribution and allelic frequency of MTHFR C677T polymorphisms in PCOS patients compared to the controls. 677/TT genotype and T allele were associated with 1.54 and 1.46 folds increase in the susceptibility for PCOS. Conclusion: The study has shown that MTHFR T677T polymorphism and T allele are possible risk factors for PCOS among Jordanian women and may play a role in the pathogenesis of the disease.

Características fenotípicas y factores de riesgo de síndrome de ovario poliquístico en estudiantes enfermeras / Phenotype characteristics and risk factors of polycystic ovarian syndrome among nursing students

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine condition that occurs in women and is associated with problems such as menstrual irregularities; hirsutism; obesity; insulin resistance; acne; and later life with diabetes mellitus and uterine cancer. The study aim was to assess phenotype characteristics and risk factors of polycystic ovarian syndrome among nursing students. Cross sectional study (descriptive) included a sample of 400 females from Faculty of Nursing, Zagazig University, Egypt.Tools were used for data collection; structured-interviewing questionnaire sheet, data related to anthropometric measures, risk factors about PCOS and observational check list about phenotype characteristics of PCO. The results showed that, (6%) of the studied student females had family history of PCO, nearly half of them had fast food, more than half of studied student females had hirsutism, more than one quarter had acne, (14.5%) had menstrual irregularity and one third of them had continuous abnormal weight gain. Also, this study showed that lack of awareness were found among majority of girls about PCOS. Therefore, it could be concluded that, family history of PCOS, obesity and fast food diet habits are found to be the predisposing factors for development of PCOS. The risk of PCOS increases with presence of one or more identified predisposing factors. Most of the factors tested as predisposing factors in our study are interlinked to each other and are mostly modifiable Although that PCOS is prevalent endocrine disorder, there was poor knowledge among student females in Faculty of Nursing Zagazig University. The study recommended screening program from ministry of health for early detection of predisposing factors of PCOS including the secondary school students and faculties students through educational programs and messages through the counseling, brochures, to increase student's awareness about PCOS symptoms. Further research on larger sample size to identify how the problem is risky and how to deal it. Including the problem in social media and healthy channels. K

Melatonin may prevent or reverse polycystic ovary syndrome in rats

SUMMARY OBJECTIVE To evaluate the ovarian effects of melatonin (Mel) in a rat model of polycystic-ovary-syndrome (PCOS) before and after permanent estrus induction. METHODS Thirty-two adult-female rats with regular estrous cycle were equally divided into four groups: 1) GCtrl - at estrous phase. 2) GPCOS - at permanent-estrous phase. 3) GMel1 - treated for 60 days with Mel (0.4 mg/Kg) during permanent estrus induction and 4) GMel2 - rats with PCOS and treated for 60 days with Mel. After that, the animals were euthanized, and the ovaries were removed and processed for paraffin embedding. Sections were stained with H.E. for histomorphometry or subjected to immunohistochemistry for Ki-67 and cleaved caspase-3 (Casp-3) detections. RESULTS The GPCOS showed lack of corpus luteum and several ovarian cysts, as well as interstitial-like cells. The presence of corpus luteum and a significant increase in primary and antral follicles were observed in Mel-treated groups, which also showed a decrease in the number of ovarian cysts and in the area occupied by interstitial-like cells. These results were more evident in GMel1. The percentage of Ki-67-positive cells was significantly higher in the Mel-treated groups, mainly in the GMel2, as compared to GPCOS. On the other hand, the percentage of Casp-3-positive cells was significantly lower in granulosa cells of GMel1, whereas it was significantly higher in the interstitial-like cells of GMel2, in comparison to GPCOS. CONCLUSION Melatonin administration prevents the permanent estrus state in the PCOS rat model. This effect is more efficient when melatonin is administered before permanent estrus induction.

RESUMO OBJETIVO Avaliar os efeitos ovarianos da melatonina (Mel) em ratas com síndrome dos ovários policísticos (SOP) antes e após a indução do estro-permanente. MÉTODOS Trinta e duas ratas com ciclos estrais regulares foram igualmente divididas em quatro grupos: 1) GCtrl - fase de estro. 2) GSOP - fase de estro-permanente. 3) GMel1 - tratadas por 60 dias com Mel (0,4 mg/kg) durante a indução do estro-permanente e 4) GMel2 - ratas com SOP e tratadas com Mel. Após eutanásia dos animais, os ovários foram processados para inclusão em parafina. Cortes foram corados com H.E ou submetidos à imuno-histoquímica para detecção de Ki-67 e caspase-3 clivada (Casp-3). RESULTADOS O GSOP mostrou ausência de corpos lúteos e vários cistos ovarianos, além de inúmeras células intersticiais. A presença de corpos lúteos e o aumento significativo dos folículos primários e antrais foram observados nos grupos tratados com Mel, os quais também mostraram diminuição no número de cistos ovarianos e na área ocupada pelas células intersticiais. Esses resultados foram mais evidentes no GMel1 do que no GMel2. A porcentagem de células Ki-67 positivas foi significativamente maior no GMel1 e no GMel2, sendo mais evidente no GMel2, em comparação ao GSOP. Por outro lado, a porcentagem de células positivas à Casp-3 foi menor nas células da granulosa do GMel1 e maior nas células intersticiais do GMel2, em comparação ao GSOP. CONCLUSÃO A administração de melatonina previne o estado de estro-permanente em ratas com SOP. Esse efeito é mais eficiente quando a melatonina é administrada após indução do estado de estro-permanente.

Immunohistochemical evaluation of proliferation, apoptosis and steroidogenic enzymes in the ovary of rats with polycystic ovary / Avaliação imunoistoquímica de proliferação, apoptose e enzimas esteroidogênicas no ovário de ratas com síndrome dos ovários policísticos

Objective: to evaluate the immunohistochemical expression of proliferative, apoptotic and steroidogenic enzyme markers in the ovaries of rats with polycystic ovary syndrome (PCOS). Methods: twenty rats were divided into two groups: GCtrl - estrous phase, and PCOS - with polycystic ovaries. The GCtrl animals were subjected to a lighting period from 7 am to 7 pm, while the animals with PCOS group remained with continuous lighting for 60 days. Subsequently, the animals were anesthetized, the ovaries were removed and fixed in 10% formaldehyde, prior to paraffin embedding. Sections were stained using H.E. or subjected to immunohistochemical methods for the detection of Ki-67, cleaved caspase-3, CYP11A1, CYP17A1 and CYP19A1. The results were analyzed using Student's t-test (p < 0,05). Results: morphological results showed evidence of interstitial cells originating from the inner theca cells of degenerating ovarian cysts in PCOS. Immunoexpression of Ki-67 was higher in the granulosa cells in GCtrl, and the theca interna cells in PCOS, while cleaved caspase-3 was higher in granulosa cells of ovarian cysts from PCOS and in the theca interna cells of GCtrl. Immunoreactivity of CYP11A1 in the theca interna, granulosa and interstitial cells was similar between the two groups, while CYP17A1 and CYP19A1 were higher in the granulosa and interstitial cells in the PCOS group. Conclusion: the results indicate that the interstitial cells are derived from the theca interna and that enzymatic changes occur in the theca interna and interstitial cells in ovaries of rats with PCOS, responsible for the high levels of androgens and estradiol. .

Objetivo: avaliar a expressão imunoistoquímica de marcadores de proliferação, apoptose e enzimas esteroidogênicas nos ovários de ratas com síndrome dos ovários policísticos (SOP). Métodos: vinte ratas foram divididas em dois grupos: controle (GCtrl), na fase de estro, e com síndrome dos ovários policísticos (GSOP). Os animais do GCtrl permaneceram com período de luz das 7 às 19 horas, e os do GSOP com iluminação contínua, durante 60 dias. Posteriormente, os animais foram anestesiados, os ovários removidos e fixados em formol a 10% para inclusão em parafina. Cortes histológicos foram corados pelo H.E. e outros submetidos a métodos imunoistoquímicos para detecção de Ki-67, caspase 3 clivada, CYP11A1, CYP17A1 e CYP19A1. Os resultados foram submetidos ao teste t de Student (p < 0,05). Resultados: a morfologia mostrou evidências da origem das células intersticiais a partir das células da teca interna dos cistos ovarianos em degeneração no GSOP. A imunoexpressão do Ki-67 mostrou-se aumentada nas células da granulosa no GCtrl e na teca interna do GSOP, enquanto a caspase 3 clivada se mostrou aumentada nas células da granulosa dos cistos ovarianos do GSOP e na teca interna do GCtrl. A imunorreatividade da CYP11A1 nas células da teca interna, bem como da granulosa e intersticiais, mostrou-se semelhante entre os dois grupos. As CYP17A1 e CYP19A1 apresentaram-se aumentadas nas células da granulosa e intersticiais no grupo SOP. Conclusão: os resultados indicam que as células intersticiais são oriundas da teca interna e que ocorrem alterações enzimáticas nas células da teca interna e intersticiais do ovário de ratas com SOP, responsáveis pelos altos níveis de androgênios e de estradiol. .

Características clínicas y metabólicas de síndrome de ovario poliquístico en la ciudad de Temuco / Clinical and metabolic characteristics of polycystic ovary syndrome in the city of Temuco

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder, its etiologyis multifactorial. It is associated with multiple metabolic abnormalities. Objective: To evaluate statistical association between the clinical characteristics of patients diagnosed with PCOS. Patients and Methods: Descriptive study, 121 patients between 13 and 44 years with PCOS were included, and their clinical characteristics, blood glucose, insulin, lipid profile and calculated HOMA were evaluated. Data was analyzed with Chi2, considering p < 0.05 as statistically significant. Results: Mean age 25,5 years, 12,5 years menarche. 22 percent with a history of abortion. Mean BMI 31,4. Acanthosis nigricans was presented in 58,6 percent. Average Glucose 96,5 mg/dl. Insulin resistance (IR) was found in 79.3 percent. Average HOMA 4,5. 64 percent of patients with IR presented Acanthosis nigricans (p = 0.002).It showed direct relationship between BMI and RI (p 0.000). 38,8 percent had dysglycemia. RI was found in 78,7 percent of patients with dysglycemia (p 0.8). Lipid profile was measured in 78 patients, of whom 40 percent had total cholesterol above 200 mg/dl, 49 percent hypertriglyceridemia and high LDL in 13 percent of cases. Conclusions: The data reported are similar to those reported in the international literature. Ourpopulation has obesity and dyslipidemia figures higher than those reported in national studies. The menarche occurs at a younger age while the prevalence of dyslipidemia and RI is greater than the general population, forming a higher risk group...

¿Qué hay de nuevo en el síndrome de ovario poliquístico? / What’s new in polycystic ovary syndrome

Polycystic ovary syndrome is recognized as a risk factor for the development of type 2 diabetes and metabolic syndrome. The prevalence of the condition is 6 to 10 percent in different populations. Its etiology is not well known and there are genetic and epigenetic phenomena involved. Due to its association with insulin resistance, it has been incorporated as another component of Reaven plurimetabolic syndrome. Therefore polycystic ovary syndrome evolved from an ovarian disease to a multisystem disorder and it must be considered a public health problem.

Does carotid intima-media thickness have relationship with polycystic ovary syndrome?

Polycystic ovary syndrome [PCOS] is a common reproductive endocrine disorder associated with cardiovascular disease [CVD] risk factors and metabolic disturbances and a genetically heterogeneous disease. Intima-media thickness [IMT] is an indicator of atherosclerosis. This study aimed to determine the relation between IMT and PCOS in women. This cross-sectional study was performed on 44 PCOS patients and 44 healthy women. Data collection included lipid profiles, blood pressure, waist circumference, body mass index [BMI], and common and internal IMT of carotid artery which were measured in studied subjects. IMT was measured by a radiologist using a linear 12 MHz ultrasound probe [LOGIC S6, GE] in carotid setting. IMT of common carotid artery [56.8 +/- 7.6 in cases versus 49.8 +/- 7.3 in controls], internal carotid artery [56.9 +/- 6.03 in cases versus 49.6 +/- 6.9 in controls], and both common and internal carotid artery [56.6 +/- 6.7 in cases versus 49.7 +/- 6.9 in controls] were significantly higher in PCOS patients than healthy women [P < 0.001]. In summary, results demonstrated that carotid artery thickness as a risk for premature atherosclerosis in patients with PCOS is higher than healthy subjects. And hence care and monitoring of PCOS women with these risk factors sounds to be important and necessary.

Morfologia das células intersticiais de ovários policísticos de ratas: um estudo experimental / Morphology of the interstitial cells of rat polycystic ovaries: an experimental study

OBJETIVOS: Avaliar a histomorfometria das células intersticiais dos ovários, bem como analisar a concentração sanguínea de esteroides sexuais de ratas portadoras de ovários policísticos induzidos pela luz contínua. MÉTODOS: Vinte ratas foram divididas em dois grupos: ratas na fase de estro (GCtrl ) e ratas portadoras de ovários policísticos induzidos pela iluminação contínua (GOP). Os animais do GCtrl permaneceram com período de luz das 7:00 s 19:00 horas, e os animais do GOP, com iluminação contínua (400 Lux), durante um período de 60 dias. Ao final desse período todos os animais foram anestesiados, foi coletado o sangue, para determinação dos níveis séricos de estradiol (E2), progesterona (P4) e testosterona (T), seguido da retirada dos ovários que foram fixados em formol a 10% e processados para inclusão em parafina. Cortes histológicos com 5 µm corados pela hematoxilina e eosina foram utilizados para análise histomorfométrica. As análises morfológicas, contagem de cistos, determinação da concentração e do volume nuclear das células intersticiais foram realizadas com o auxílio de microscópio de luz adaptado a uma câmera de alta resolução (AxioCam), cujas imagens foram transmitidas e analisadas em computador com software AxioVision Rel 4.8 (Carl Zeiss). Os dados obtidos foram submetidos ao teste t de Student (p<0,05). RESULTADOS: A morfologia mostrou a presença de cistos nos ovários pertencentes ao Grupo OP e de corpos lúteos no GCtrl, mostrando ainda evidências da origem das células intersticiais a partir das células da teca interna desses cistos. Com relação aos níveis hormonais o GOP apresentou níveis séricos de estradiol (pg/mL) aumentados em relação ao GCtrl (GOP=124,9±4,2>GCtrl=73,2±6,5; p<0,05), o mesmo ocorrendo com os níveis de testosterona (pg/mL) (GOP=116,9±4,6>GCtrl=80,6±3,9; p<0,05). Entretanto os níveis de progesterona (ng/mL) foram mais elevados no GCtrl em relação ao GOP (GCtrl=16,3±2,0>GOP=4,2±1,5; p<0,05). A morfometria mostrou haver aumento significante do volume nuclear no grupo GOP (GOP=102,1±5,2>GCtrl=63,6±16,5; p<0,05), assim como da área ocupada (%) pelas células intersticiais (GOP=24,4±6,9>GCtrl=6,9±3,2; p<0,05) em relação aos animais do GCtrl. CONCLUSÃO: As células intersticiais do ovário policístico da rata provavelmente provêm dos cistos ovarianos devido degeneração das células da granulosa e diferenciação das células da teca interna. As elevações dos níveis séricos de testosterona e de estradiol provavelmente provêm do aumento significativo da atividade celular e da área ocupada pelas células intersticiais.

PURPOSES: To evaluate the histomorphometry of ovarian interstitial cells, as well as the blood sex steroid concentrations of female rats with polycystic ovaries induced by continuous light. METHODS: Twenty female rats were divided into two groups: Control Group - in the estrous phase (CtrlG), and a group of rats with polycystic ovaries induced by continuous illumination (POG). CtrlG animals were maintained on a light period from 07:00 a.m. to 07:00 p.m., and POG animals with continuous illumination (400 Lux) for 60 days. After this period all animals were anesthetized and blood was collected for the determination of serum estradiol (E2), progesterone (P4), and testosterone (T), followed by removal of the ovaries that were fixed in 10% formalin and processed for paraffin embedding. Five-µm histological sections were stained with hematoxylin and eosin and used for histomorphometric analysis. Morphological analyses, cyst count, determination of concentration and of the nuclear volume of interstitial cells were performed with the aid of a light microscope adapted to a high resolution camera (AxioCam), whose images were transmitted to and analyzed by the computer using AxioVision Rel 4.8 software (Carl Zeiss). Data were analyzed statistically by the Student's t-test (p<0.05). RESULTS: Morphological analysis showed the presence of ovarian cysts in POG animals and corpora lutea in CtrlG animals, as well as evidence of the origin of interstitial cells from the internal theca of these cysts. POG animals presented increased serum estradiol levels (pg/mL) compared to CtrlG animals (POG=124.9±4.2>CtrlG=73.2±6.5, p<0.05), the same occurring with testosterone levels (pg/mL) (POG=116.9±4.6>CtrlG=80.6±3.9, p<0.05). However, progesterone levels (ng/mL) were higher in CtrlG than in POG animals (CtrlG=16.3±2.0>POG=4.2±1.5, p<0.05). Morphometry showed a significant increase in nuclear volume in POG animals (POG=102.1±5.2>CtrlG=63.6±16.5, p<0.05), as well as in the area occupied (%) by interstitial cells (POG=24.4±6.9>CtrlG=6.9±3.2, p<0.05) compared to CtrlG animals. CONCLUSION: The interstitial cells of the rat polycystic ovary probably originate from ovarian cysts due to the degeneration of granulosa cells and differentiation of the internal theca cells. The elevations of serum testosterone and estradiol were probably due to the significant increase in cell activity and in the area occupied by interstitial cells.

Determinación del valor umbral de tamizaje de la glicemia en ayunas para identificación de tolerancia anormal a la glucosa en mujeres con síndrome de ovarios poliquísticos / Determining the screening threshold fasting glucose for identification of abnormal glucose tolerance in women with polycystic ovary syndrome

Se determinó el valor predictivo de la cifra de corte umbral -cut off- de 101 mg/dl de la glucosa en ayunas para identificar tolerancia anormal a la glucosa en pacientes con síndrome de ovario poliquístico. A un total de 100 mujeres con diagnóstico de síndrome de ovario poliquístico, se les realizó una medición de glicemia en ayunas y de la glicemia dos horas postpandrial durante una curva de tolerancia a 75 g de glucosa; una curva ROC ("receiver operating characteristic") se elaboró para definir el valor de corte umbral de tamizaje de la glucosa en ayunas más adecuada para identificar tolerancia anormal a la glucosa...

Concentração dos hormônios esteroides no fluido folicular de folículos ovarianos maduros e imaturos de pacientes com síndrome dos ovários policísticos submetidas à fertilização in vitro / Concentration of steroid hormones in the follicular fluid of mature and immature ovarian follicles of patients with polycystic ovary syndrome submitted to in vitro fertilization

OBJETIVO: avaliar a concentração dos hormônios esteroides no fluido folicular (FF) de folículos pequenos (10-14 mm) e grandes (> 18 mm) de mulheres com síndrome dos ovários policísticos (SOP) submetidas à hiperestimulação ovariana controlada (HOC) e ciclos de fertilização in vitro (FIV). MÉTODOS: estudo caso-controle foi conduzido em 13 mulheres inférteis com SOP (17 ciclos) e 31 mulheres inférteis por fator masculino - Grupo Controle (31 ciclos). Os FF foram aspirados individualmente e dividos em 4 grupos: G1 (FF pequeno do Grupo Controle), G2 (FF pequeno do grupo SOP), G3 (FF grande do Grupo Controle) e G4 (FF grande do grupo SOP). A metodologia utilizada para as dosagens de estradiol, progesterona e β-hCG foi a quimioluminescência, e de testosterona e androstenediona o radioimunoensaio. Para a análise das dosagens hormonais no FF entre os grupos SOP e Controle utilizou-se o teste t não-pareado, e para a comparação entre os quatro grupos, o ANOVA. Para a taxa de gravidez, foi utilizado o teste exato de Fisher. RESULTADOS: os folículos pequenos dos dois grupos tiveram valores menores de progesterona (8.435±3.305 ng/mL) comparados aos grandes (10.280±3.475 ng/mL), com valor de p<0,01. Os níveis de progesterona de todos os folículos do grupo SOP (8.095±4.151 ng/mL) foram inferiores ao Controle (9.824±3.128 ng/mL), com valor de p=0,03. Os níveis de testosterona diferiram entre G1 (326,6±124,4 ng/dL) e G3 (205,8±98,91 ng/dL), com valor de p<0,001, e entre G3 (205,8±98,91 ng/dL) e G4 (351,10±122,1 ng/dL), com valor de p<0,001. Os folículos pequenos (508,9±266 ng/dL) apresentaram valores superiores de testosterona comparados aos grandes (245,10±123 ng/dL), com valor de p<0,0001. As taxas de gravidez não diferiram entre os grupos SOP (5/13, 38,5 por cento) e Controle (9/31, 40,9 por cento), com valor de p=072. CONCLUSÕES: mulheres com SOP apresentam altas concentrações de testosterona no FF, independentemente do estágio de desenvolvimento folicular, e níveis de progesterona diminuídos, sugerindo que fatores parácrinos podem inibir sua secreção pelas células foliculares. As taxas de gravidez mostraram que o tratamento de HOC e FIV é uma boa opção para mulheres com infertilidade secundária à SOP.

PURPOSE: to evaluate the concentration of steroid hormones in follicular fluid (FF) of small (10-14 mm) and large (> 18 mm) follicles of women with polycystic ovary syndrome (PCOS) submitted to controlled ovarian hyperstimulation (COH) and in vitro fertilization (IVF) cycles. METHODS: a case-control study was conducted on 13 infertile women with PCOS (17 cycles) and 31 infertile women due to male factor - Control Group (31 cycles). FF was aspirated individually and divided into four groups: G1 (FF of small follicles of the Control Group), G2 (FF of small follicles of the PCOS group), G3 (FF of large follicles of the Control Group) and G4 (FF of large follicles of the PCOS group). Estrogen, progesterone and β-hCG were determined by chemiluminescence, and testosterone and androstenedione by radioimmunoassay. The unpaired t-test was used to compare the hormone determinations in the FF of the PCOS and Control Groups, and the four groups were compared by ANOVA. Fisher's exact test was used to compare the pregnancy rates. RESULTS: the small follicles of the two groups had lower progesterone levels (8,435±3,305 ng/mL) than large follicles (10,280±3,475 ng/mL), p-value <0.01. The progesterone levels of all follicles of group PCOS (8,095±4,151 ng/mL) were lower than Control (9,824±3,128 ng/mL), p-value =0.03. Testosterone differed between G1 (326.6±124.4 ng/dL) and G3 (205.8±98.91 ng/dL), p-value <0.001, and between G3 (205.8±98.91 ng/dL) and G4 (351.10±122.1ng/dL), p-value <0.001. Small follicles had higher testosterone levels (508.9±266 ng/dL) than large follicles (245.10±123 ng/dL), p-value <0.0001. The pregnancy rates did not differ between the PCOS (5/13, 38.5 percent) and the Control groups (9/31, 40.9 percent), p-value =072. CONCLUSIONS: women with PCOS had high testosterone concentrations in the FF, regardless of the stage of follicle development, and reduced progesterone levels, suggesting that paracrine factors may inhibit the secretion of the latter by follicular cells. The pregnancy rates showed that treatment with COH and IVF is a good option for women with infertility secondary to PCOS.

Prevalencia y repercusiones del Síndrome de Ovario Poliquístico, asociado a la obesidad en mujeres entre 18 a 43 años que asistieron al Centro de Alto Riesgo Obstétrico, Enero 2006 a Septiembre de 2009 / Prevalence and implications of Polycystic Ovary Syndrome, associated with obesity in women aged 18-43 years at the Center for High Risk Obstetrics, January 2006 to September 2009

Stein y Leventhal describen por primera vez la asociación existente entre amenorrea, hirsutismo y obesidad, estudios previos que no incluyen a Bolivia indican una prevalencia de Síndrome de Ovario Poliquístico (S.O.P.) de entre 5 a 10%, la cual en presencia de obesidad aumenta a más del 50%. El S.O.P. es un problema de interés, por las serias implicaciones en la salud y el costo al que se someten para un diagnóstico precoz y tratamiento oportuno, aún más si se acompaña de alguna repercusión. Se consideraba a la obesidad como un signo más del S.O.P. y como un factor de riesgo para la morbilidad; actualmente un estudio corrobora la relación genética entre obesidad y S.O.P. Este estudio fue retrospectivo, con enfoque cuantitativo, tipo descriptivo realizado en mujeres con S.O.P. de la Clínica CENAROB de enero 2006 a septiembre 2009, para describir la prevalencia y repercusiones del S.O.P. asociadas a la obesidad, obteniéndose una prevalencia alta de S.O.P. de 17 % y mayor en pacientes con obesidad y sobrepeso, en las que también se evidenciaron repercusiones de gravedad como la esterilidad, diabetes e hipertensión como factor de riesgo para enfermedad cardiovascular.La obesidad además de ser un signo clínico del S.O.P., es también un factor causal y agravante en el proceso clínico y patológico de la enfermedad.

Obesidade e alteração da estrutura arterial em mulheres jovens com síndrome dos ovários micropolicísticos / Obesity and altered arterial structure in young women with micropolycystic ovary syndrome

OBJETIVO: comparar os fatores ecográficos de risco cardiovascular em pacientes obesas e não obesas, com síndrome dos ovários micropolicísticos (SOMP). MÉTODOS: foram incluídas 30 pacientes obesas com SOMP (Índice de massa corporal, IMC>30 kg/m²) e 60 não obesas (IMC<30 kg/m²), com idade entre 18 e 35 anos neste estudo transversal. Foram avaliados: a dilatação mediada por fluxo (DMF) da artéria braquial, espessura íntima-média da artéria carótida (IMT), o índice de rigidez da artéria carótida (β), as medidas antropométricas, pressão sanguínea sistólica (PAS) e diastólica (PAD). As mulheres estavam sem nenhum tratamento prévio e nenhuma delas apresentava qualquer comorbidade (além da SOMP e/ou da obesidade).Na análise estatística, foram utilizados os testes t não-pareado ou de Mann-Whitney. RESULTADOS: as pacientes obesas com SOMP apresentaram maior peso em relação às não obesas (92,1±11,7 kg versus 61,4±10,7 kg, p<0,0001), bem como a medida da cintura que também, foi mais elevada nas pacientes obesas (105,0±10,4 cm versus 78,5±9,8 cm, p<0,0001). A PAS das pacientes obesas foi superior quando comparadas às não obesas (126,1±10,9 mmHg versus 115,8±9,0 mmHg, p<0,0001) e a IMT também foi maior nas obesas (0,51±0,07 mm versus 0,44±0,09 mm, p<0,0001). Não houve diferença entre os grupos quanto à dilatação mediada por fluxo (DMF) da artéria braquial ou ao índice de rigidez da artéria carótida (β). CONCLUSÕES: a obesidade em portadoras jovens de SOMP está associada a níveis pressóricos mais elevados e à alteração da estrutura arterial, representada pela maior espessura íntima-média da artéria carótida.

PURPOSE: to compare echographical cardiovascular risk factors between obese and non-obese patients with micropolycystic ovarian syndrome (MPOS). METHODS: in this transversal study, 30 obese (Body Mass Index, BMI>30 kg/m²) and 60 non-obese (BMI<30 kg/m²) MPOS patients, aging between 18 and 35 years old, were included. The following variables were measured: flow-mediated dilatation (FMD) of the brachial artery, thickness of the intima-media of the carotid artery (IMT), anthropometric data, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP). The women had no previous medical treatment and no comorbidity besides MPOS and obesity. For statistical analysis, the non-paired tand Mann-Whitney's tests were used. RESULTS: obese weighted more than non-obese patients (92.1±11.7 kg versus 61.4±10.7 kg, p<0.0001) and had a larger waist circumference (105.0±10.4 cm versus 78.5±9.8 cm, p<0.0001). The SBP of obese patients was higher than that of the non-obese ones (126.1±10.9 mmHg versus 115.8±9.0 mmHg, p<0.0001) and the IMT was also bigger (0.51±0.07 mm versus 0.44±0.09 mm, p<0.0001). There was no significant difference between the groups as to FMD and carotid rigidity index (β). CONCLUSIONS: obesity in young women with MPOS is associated with higher blood pressure and alteration of arterial structure, represented by a thicker intima-media of the carotid artery.

Polycystic ovarian syndrome and hyperinsulinaemia

To determine the occurrence of hyperinsulinaemia in women with polycystic ovarian syndrome [PCOS]. A descriptive study. Isra University Hospital, Hyderabad from January 2002 to December 2003. Total 64 subjects were recruited from gynaecological outpatients department, between the ages of 15 and 40 years with clinical diagnosis of polycystic ovarian syndrome, presenting with weight gain, oligomenorrhoea, secondary amenorrhoea, hirsuitism or infertility and either ultrasound evidence of PCOS or raised Leutinizing Hormone [LH]/ Follicular Stimulating Hormone [FSH] ratio. Patient's venous blood was checked for fasting serum insulin. Out of total 64 women selected, 37[57.81%] were between 21 - 30 years of age. Weight gain was the commonest presenting complain [84.37%] followed by oligomenorrhoea [79.68%]. Infertility was found in 46 women [71.87%] and hyperandrogenism was observed in 43 women [62.49%]. Thirty-nine women [60.93%] had ultrasound evidence of PCOS and 43 [67.18%] had LH / FSH ratio greater than 2:1. Hyperinsulinaemia was seen in 27 [42.19%] women. In this study, 27 women [42.19%] had hyperinsulinaemia which indicates significant insulin resistance. Thus, all the patients presenting with clinical or biochemical evidence of PCOS must undergo checking of fasting serum insulin levels

Características clínicas e hormonais das pacientes com a síndrome dos ovários policísticos, em relaçäo à distribuiçäo de gordura corporal / Clinical and hormonal features in women with PCO according to body fat distribution pattern

Avaliar as características clínicas e laboratoriais das pacientes com Síndrome dos Ovários Policísticos (SOP) em funçäo da distribuiçäo de gordura corporal. Em 69 pacientes portadoras da SOP, divididas em dois grupos, um com distribuiçäo de gordura tipo ginecóide (Cintura/Quadril<8) (n=22) e outro com tipo androgênica (C/Q>0,8) (n=47), foram comparadas as freqüências da acne, hirsutismo, acantose nigricans, IMC, LH, FSH, PRL, T3, T4, TSH, T, glicemia e insulina de jejum, GTT, e curva de insulina. O IMC foi significativamente maior, e a acantose nigricans foi sete vezes mais freqüente nas pacientes com distribuiçäo de gordura androgênica (p=0,0001). Os níveis de insulina e de glicemia de jejum, de testosterona, os valores médios da glicemia e insulina, durante o teste de tolerância à glicose, foram maiores nas pacientes com distribuiçäo de gordura androgênica. Observamos um valor da área sob a curva significativamente maior no grupo das pacientes com distribuiçäo androgênica. A resposta insulinêmica e glicêmica, frente ao teste de estímulo com dextrasol foi significativamente maior nas pacientes portadoras da SOP com distribuiçäo de gordura tipo androgênica.

Síndrome de ovarios poliquísticos de origen extraovárico: revisión / Polycystic ovarian syndrome: review

Una esteroidogénesis ovárica anormal es uno de los hechos establecidos en el síndrome de ovarios poliquísticos (SOP). Aunque ello implica un defecto ovárico intrínseco, también puede estar influenciado por factores extraováricos. Aunque de etiología desconocida, el SOP es una de las alteraciones endocrinológicas más comunes de la práctica ginecológica. Esta entidad se manifiesta, desde hallazgos ultrasonográficos de morfología ovárica poliquística, hasta la aparición de infertilidad, hiperandrogenismo y trastornos menstruales. Existe una serie de mecanismos implicados en la elevación de los andrógenos de origen extraovárico presentes en las pacientes con SOP. Entre estos factores, están involucrados los de origen central y periférico, aunado a disfunción adrenocortical y genéticos. De esta manera, las alteraciones producidas pueden involucrar aspectos genéticos, moleculares, bioquímicos, fisiológicos y endocrinológicos, incluso, en ocasiones, varios de ellos pueden interactuar al mismo tiempo. Los niveles elevados de andrógenos séricos pueden suprimir la producción de gonadotripinas a nivel hipofisiario, ya sea directamente o como producto de su conversión periférica, además de ocasionar las manifestaciones clínicas de acné, alopecia y la detención de la maduración folicular, por lo cual estas pacientes presentan trastornos menstruales, anovulación e infertilidad. Las características del SOP de origen extraovárico incluye la elevación de la 17-hidroxiprogesterona en respuesta al test de ACTH y la supresión de andrógenos adrenales por la dexametasona. Es posible mejorar la función ovárica de algunas pacientes con SOP, cuando se asocian los glucocorticoides al tratamientocon citrato de clomifeno para inducir la ovulación, debido a la supresión de la secreación de ACTH

Poliquistosis ovárica: revisión bibliográfica / Ovarian Poliquistosis: bibliographical overhaul

Expone que el síndrome de ovario poliquístico es de origen desconocido que se exterioriza con múltiple sintomatología cuya afectación es más frecuente en mujeres obesas; la base de esta patología es una alternación hormonal donde se evidencia un aumento notable de hormona hipofisiaria LH con el consiguiente aumento de andrógenos por lo que se debe hacer un diagnóstico diferencial con patología corticosuprarrenal ya que su tratamiento será diferente; de todas maneras trastornos del ciclo menstrual, infertilidad, hirsutismo y el acné son problemas predominantes.