Epigenética del síndrome de ovario poliquístico / Epigenetics of polycystic ovary syndrome

Polycystic ovarian syndrome (PCOS) is an endocrine and metabolic dysfunction, highly prevalent in women in their reproductive years. Hyperandrogenism, oligo-ovulation, polycystic ovarian morphology are the main features of this syndrome. PCOS is a genetic disorder with a multifactorial etiology and has a strong link with environmental components. It is frequently associated with obesity and insulin resistance. Recently, epigenetic mechanisms have been involved in the pathogenesis of PCOS. Several studies showed that methylation in DNA and miRNAs is altered in women with PCOS in blood, serum, adipose tissue, granulose cells and theca. This evidence indicates that women with PCOS have a different epigenetic regulation, which might be triggered by an adverse intrauterine environment or by postnatal environmental elements such as diet and or obesity.

Consenso elaborado por la Sociedad Chilena de Endocrinología y Diabetes sobre resistencia a la insulina(RI) y síndrome metabólico (SM): aspectos clínicos y terapéuticos / Chilean society of endocrinology and diabetes consensus on clinical and therapeutic aspects of insulin resistance and metabolic syndrome

Background: The concept insulin resistance as the basis for a series of metabolic alterations and diseases was introduced by Gerald Reaven in 1988, when he described a cluster of alterations that named syndrome X. Aim: To review and discuss the present information about insulin resistance (IR) and metabolic syndrome (MS). Material and methods: The IR concept is defined,the affected metabolic ways, its consequences and relationship with different diseases are presented. The importance of central obesity with its metabolic, inflammatory and prothrombotic consequences playing a key role in cardiovascular risk, is discussed. The cluster of factors focused on cardiovascular disease and eventually diabetes is named MS. Several definitions of MS are analyzed and compared. A proposition is made about the definition to be used in the Chilean population. Differences between IR syndrome and MS are discussed. Diagnostic methods of IR and MS are presented, recommendations are made about their usefulness and reliability. Non pharmacological and pharmacological treatments of IR and MS are analyzed. Other related diseases, such as polycystic ovary syndrome, non alcoholic steatohepatitis and sleep apnea are discussed. Conclusions. Until further studies are made to define a local waist circumference cut-off associated with high risk, the ATPIII MS definition is preferred. A clinical approach is recommended for diagnosis. A search for all components of the MS is important. There is no evidence about the benefits of MS treatment on the prevention of cardiovascular diseases or diabetes. Evidence supports the use of lifestyle changes and some drugs, such as metformin on the prevention of diabetes in prediabetic states.

Inducción de ovulación mediante la administración crónica de naltrexona en paciente con amenorrea hipotalámica secundaria / Ovulation induced by chronic administration of naltrexona in a patient with secondary hypothalamic amenorrhea

Se presenta el caso de un ciclo ovulatorio en una paciente portadora de amenorrea hipotalámica secundaria, cuya inducción de ovulación se efectuó mediante la administración oral de un antagonista opiáceo específico: Naltrexona, en una dosis de 50 mg/día por 26 días. El desarrollo folicular fue monitorizado mediante ultrasonografía transabdominal y mediciones plasmáticas seriadas de hormona luteinizante (LH), folículo estimulante (FSH), estradiol (E2) y progesterona (P4). Tanto el perfil hormonal como el seguimiento ecográfico fueron compatibles con ciclo ovulatorio con folículo único. Después de la discontinuación del tratamiento, la paciente se hizo nuevamente amenorreica declinando los valores de gonadotrofinas y estradiol a los niveles observados antes del inicio del tratamiento. Estos datos demuestran que la naltrexona puede ser un agente útil en la inducción de ovulación de pacientes con amenorrea hipotalámica