Evolución menstrual y reproductiva favorable en mujeres adultas, que presentaron en la adolescencia trastornos menstruales por disfunción hipotalámica con respuesta alterada al clomifeno / Favorable reproductive and menstrual evolution in women with hypothalamic dysfunction and lack of response to clomiphene

Background: Hypothalamic dysfunction is a cause of menstrual disturbances in women, in whom other diseases have been discarded. This condition is characterized by a failure of the GNRH pulse generation system and is associated to psychological and environmental factors. A lack of ovulatory response to the administration of clomiphene can be a sign of bad prognosis in hypothalamic dysfunction. Aim: To report the natural history of patients with hypothalamic dysfunction and a bad or deficient response to the administration of clomiphene. Patients and methods: Fifty patients with hypothalamic dysfunction, that consulted for menstrual disturbances at the age of 15 to 20 years old, were studied. All received clomiphene and 31 had an ovulatory response, 12 had menses without ovulation and 7 did not menstruate. Of these 19 women eleven were interviewed again about their menstrual and reproductive history, after a lapse of 9 to 17 years of loss from follow up. Results: Eight of the eleven women had stressful events during adolescence (going away from family house in 3, starting university studies in 3, migration out of the natal country in one and non competitive physical activity in one). All restarted their menses and eight with active sexual life had spontaneous pregnancies, giving birth from two to five children. Ovulatory cycles were documented in women without active sexual life. Conclusions: In teenagers with hypothalamic dysfunction and menstrual disturbances, a deficient or bad response to clomiphene does not necessarily indicate a bad prognosis in terms of menses or fertility

Tratamiento del hirsutismo con espironolactona y con espironolactona más dexametasona / Treatment of hirsutism with spironolactone and with spironolactone plus dexamethasone

Background: Spironolactone has an anti androgenic effect, inhibiting the binding of androgens to their receptor. This antagonistic effect is the basis for the use of spironolactone in the treatment of hirsutism. Aim: To study the effectiveness and safety of spironolactone in the treatment of hirsute women and of the association of spironolactone plus dexamethasone in the treatment of hirsutism with glucocorticoid sensitive hyperandrogenism. Patients and method: Sixteen women (group 1) with peripheral hirsutism (defined as those with normal androgens levels, normal menstrual cycles and ovulation) and 24 women (group 2) with glucocorticoid sensitive hyperandrogenic hirsutism were studied. Group 1 was treated with spironolactone 50 mg bid and group 2 with same spironolactone dose plus dexamethasone 0.5 mg at 23 h during one month and 0.25 mg thereafter. Patients were followed during one year. Results: After one year of treatment, a 54 percent reduction in Moncada hirsutism escore was observed in group 1 and 52 percent reduction in group 2. Observed secondary effects of spironolactone were increases in diuresis, fatigability, acne aggravation and seborrhea in two patients. Two additional patients had spotting. No secondary effect attributable to glucocorticoid use were observed. Conclusions: Spironolactone is effective and safe in the treatment of hirsutism. Androgenic supression did no increases its effectiveness, underscoring the peripheral anti androgenic activity os spironolactone

Factores causales de infertilidad masculina: contribución del factor endocrino / Causes of male infertility: the contribution of endocrine factors

Background: Male infertility is responsible for 35 percent of infertile couples. Aim: To investigate the causes of male infertility and the relative importance of endocrine factors. Patients and methods: Patients referred to an andrology clinic due to an abnormal spermiogram were studied. A testitular examination, spermiogram and determination of FSH, LH, testosterone and prolactin were done to all. Testicular biopsy was done to patients with severe oligospermia or azoospermia. Causes of infertility were defined and classified as pretesticular, testicular, posttesticular or unclassified. Results: Two hundred fifty seven males were studied. In 3.5 percent of them, the cause of infertility was defined as pretesticular (that included hypothalamic and pituitary endocrine causes), in 66.9 percent it was classified as testicular, in 15.6 percent as posttesticular and in 14 percent, as unclassified. Thirty percent of infertility cases were idiopathic, 17.9 percent were associated to varicocele, 12.8 percent were associated to cryptorchidism, 8.9 percent to Klinefelter syndrome and 6.6 percent to exposure to toxic substances. In 50 percent of patients with cryptorchidism, this abnormality was found during the specialized andrological examination and referrals for surgical correction were made late. Two thirds of patients with Klinefelter syndrome were hypoandrogenic. Conclusions: Causes for male infertility should be investigated and diagnosed accurately. Primary hypoandrogenic testicular failures must be treated with hormone replacement therapy

¿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

Insulinomas / Insulinomas

El Insulinoma o tumor de células ß del páncreas, es una neoplasia poco frecuente, y que en ocasiones se encuentra inserto dentro de las Neoplasias Endocrinas Múltiples (NEM) tipo 1. Se presentan cinco casos diagnosticados y tratados en los últimos 10 años. Las formas de presentación más importantes fueron neurológicas, con crisis convulsivas y/o alteraciones de conciencia. En uno de estos pacientes se corroboró el diagnóstico de NEM tipo 1 asociado a Insulinoma. El estudio endocrinológico incluyó Test de Ayuno y medición de insulinemia. El estudio topográfico fue completo en todos los pacientes, no encontrándose en ninguno de ellos la certeza de localización del Insulinoma. Todos los pacientes se intervinieron, efectuándose enucleación del tumor en dos casos y pancreatectomía distal con conservación de bazo en los tres restantes. En la evolución postoperatoria destaca aparición de fístula pancreática en dos casos. La evolución a largo plazo demostró mejoría en todos los pacientes. Desde el punto de vista quirúrgico, dado el escaso rendimiento diagnstico de la imagenología actual, parece fundamental la adecuada exploración pancreática y la experiencia del operador para obtener resultados favorables

Hiperandrogenismo suprarrenal funcional: perspectivas cambiantes en su evolución histórica / Functional adrenal hyperandrogenism: changings perspectives in it historical evolution

The approach to adrenal hyperandrogenism, due to genetical or non-genetical enzymatic alterations, has changed dramatically during the last 50 years. To allow a better understanding of the subject, we focused it from a historical perspective, defining four stages analyzed in detail. Now there is consent on the existence of a functional adrenal hyperandrogenism, which has an important role in acne, hirsutism and menstrual disturbances

Hirsutismo: experiencia en diagnóstico y tratamiento en el período 1970-1995 / Hirsutism: experience in diagnosis and treatment in the period 1970-1995

En la anamnesis de la hirsuta, destaca el inicio peripuberal del hirsutismo y en el examen físico la importancia del vello pubiano que aporta el 40 por ciento del score total. Del 74 por ciento de hirsutas hiperandrogénicas, el 34 por ciento poseen elevación exclusiva de la testosterona, el 24 por ciento de la dehidroepiandrosterona sulfato y el 42 por ciento un alza de ambas. El alto porcentaje de dehidroepiandrosterona sulfato aumentada, sola o junto a testosterona, sugiere un compromiso suprarrenal en la etiología del hirsutismo, respaldado por un 50 por ciento de prueba de estimulación suprarrenal con hiperrespuesta de este andrógeno, en hirsutas y en pacientes con síndrome de ovario poliquístico. El alza de la 17 hidroxiprogesterona basal, obliga a realizar prueba de estimulación cob ACTH para descartar su origen ov+arico y confirmar el déficit de la 21 hidroxilasa. Un 5 por ciento de las hirsutas tenían acantosis nigricans con resistencia insulínica y alteraciones lipídicas. Se analiza el tratamiento con antiandrógenos, ciproterona y espironolactona y la frenación con glucocorticoides

Endocrinología y disfunciones sexuales / Endocrinology and sex disfunctions

Se analiza la formación y el desarrollo sexual tanto desde el punto de vista orgánico-endocrinológico, como el de la formación de la identidad sexual en las etapas prenatal y postnatal, puberal, del adulto y adulto mayor, relacionando estos hechos con la práctica clínica. Se dan orientaciones algorítmicas para el manejo y estudio de las disfunciones sexuales desde el punto de vista del endocrinólogo