Marcadores bioquímicos propuestos para el estudio de la sarcopenia / Proposed biochemical markers for the study of sarcopenia

La sarcopenia asociada a la edad es una condición clínica caracterizada por una disminución en la fuerza, calidad y cantidad de masa muscular así como también en la función muscular. Un biomarcador se define como una característica que es medible objetivamente y evaluable como indicador de un proceso biológico normal, patológico o respuesta terapéutica a una intervención farmacológica. Los marcadores bioquímicos propuestos para el estudio de la sarcopenia pueden ser categorizados en dos grupos. El primero de ellos evalúa el estatus musculoesquelético; este panel de marcadores está formado por miostatina/folistatina, procolágeno aminoterminal tipo III e índice de sarcopenia. El segundo grupo de marcadores bioquímicos evalúa factores causales, para lo cual se sugiere medir el factor de crecimiento insulino-símil tipo 1 (IGF-1), dehidroepiandrosterona (DHEAS), cortisol, facto-res inflamatorios [proteína C reactiva (PCR), interleuquina 6 (IL-6) y factor de necrosis tu-moral (TNF-a)]. Las recomendaciones realiza-das están basadas en la evidencia científica disponible en la actualidad y la disponibilidad de la metodología apropiada para cada uno de los biomarcadores. (AU)

Sarcopenia is a progressive and generalized skeletal muscle disorder defined by decrease in the strength, quality and quantity of muscle mass as well as in muscle function. A biomarker is defined as a feature objectively measured and evaluated as an indicator of a normal biologic process, a pathogenic process or a pharmacologic response to therapeutic intervention. The biochemical markers proposed for the study of sarcopenia may be classified in two groups. The first group evaluates the musculoskeletal status, made up by myostatin/follistatin, N-terminal Type III Procollagen and the sarcopenia index. The second evaluates causal factors, where the measurement of the following is suggested: hormones insulin-like growth factor-1 (IGF-I), dehydroepiandrosterone sulphate (DHEAS), cortisol, inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-a (TNF-a)]. The recommendations made are based on scientific evidence currently available and the appropriate methodology availability for each biomarker. (AU)

The effect of walnut on the weight, blood glucose and sex hormones of diabetic male rats / Efecto del nogal sobre el peso, glucosa en la sangre y hormonas sexuales de ratas macho diabéticas

Diabetes leads to reproductive dysfunctions by producing free radicals. It seems that using walnut can be effective in the damage induced by diabetes. The aim of the present study was to evaluate the effects of walnut consumption on sex hormones in diabetic Wistar male rats induced by STZ (streptozotocin). Diabetes animals were induced by STZ (60 mg/kg). Rats were randomly divided into 5 groups (n=6), including normal diet and healthy (Sham), Diabetic by normal diet (control) and diabetic by 6, 9 and 12% walnut in their diet (experimental groups), and were examined for 6 weeks. Body weight, blood glucose (3 times), and sex hormones (testosterone, FSH and LH) were measured. Overall, in terms of the mean index, there was a significant difference in the percentage of weight changes between the groups (p<0.001). Blood glucose (3 times) significantly increased in experimental and control groups in comparison with sham group (p<0.001). FSH concentration significantly decreased in control group (p<0.05) and testosterone hormone decreased in experimental and control groups compared to sham group (p<0.05). Oral administration of walnut seems to prevent severe weight loss in the experimental models of diabetic rats and exerts appropriate and useful changes in blood glucose level as well as positive effects on the secretion of sex hormones.

La diabetes conduce a disfunciones reproductivas mediante la producción de radicales libres. Parece que el uso del nogal puede ser eficaz para contrarestar el daño inducido por la diabetes. El objetivo fue evaluar los efectos del consumo de nueces sobre las hormonas sexuales en ratas Wistar macho diabéticas, inducidas por estreptozotocina (STZ). La diabetes en los animales fue inducida por STZ (60 mg/kg). Los animales fueron divididos aleatoriamente en 5 grupos (n= 6 ): saludable con dieta normal (Sham), diabéticos con dieta normal (control) y diabéticos con consumo de nogal en 6, 9 y 12% en su dieta (grupos experimentales), quienes se examinaron durante 6 semanas, donde se midieron el peso corporal, glucosa en la sangre (3 veces) y hormonas sexuales (testosterona , FSH y LH). En general, en términos del índice promedio, hubo una diferencia significativa en el porcentaje de cambios de peso entre los grupos (p<0,001). La glucosa en sangre aumentó significativamente en los grupos experimentales y de control en comparación con el grupo Sham (p<0,001). La concentración de FSH se redujo significativamente en el grupo control (p<0,05); la testosterona disminuyó en los grupos experimentales y control en comparación con el grupo sham (p<0,05). La administración oral de nogal parece prevenir la pérdida severa de peso en los modelos experimentales de ratas diabéticas y ejerce cambios apropiados y útiles en el nivel de glucosa en la sangre, así como efectos positivos sobre la secreción de hormonas sexuales.

Hormonas esteroideas foliculares y su relación con los resultados globales del ciclo de estimulación ovárica / Follicular steroid hormones and their relationship to the overall results of ovarian stimulation cycle

Objetivo: Relacionar los niveles de hormonas esteroideas foliculares con el ciclo de estimulación ovárica y sus resultados globales. Métodos: Se incluyeron pacientes < 38 años, con esterilidad de causa masculina, tubárica o desconocida, que recibieron un protocolo largo con agonistas de GnRH y rFSH. Se recogieron las muestras de la primera y segunda aspiración folicular de cada ovario y se realizó un quimioinmunoanálisis de estradiol, progesterona, testosterona y DHEAS. Resultados: Se obtuvieron cifras menores de DHEAS folicular en las pacientes con más días de frenado con agonistas de GnRH (p=0,0003). Cuantos más días de rFSH administrados, mayores fueron los niveles de testosterona y DHEAS folicular (p=0,03; p=0,03). En los resultados globales del ciclo, se obtuvo una correlación negativa entre las cifras de testosterona folicular y el número de complejos puncionados (r= -0,360; p=0,002) y entre la testosterona folicular y el número de embriones de calidad D (r= -0,233; p=0,047). El número de ovocitos maduros fue menor en pacientes con mayores niveles de testosterona folicular (p=0,008). La progesterona folicular fue superior en ovocitos de buena calidad frente a los de calidad no destacable (p=0,006) y muy mala calidad (p=0,04). Conclusiones: Las cifras altas de testosterona folicular se correlacionaron con menor número de complejos puncionados, ovocitos maduros y embriones de calidad D. La buena calidad ovocitaria se asoció a niveles de progesterona folicular superiores.

Objective: To relate the levels of follicular steroid hormones with the ovarian stimulation cycle and its overall results. Method: It was included patients < 38 years old with sterility of male, tubaric or unknown origin who underwent a long protocol with GnRH agonists and rFSH. Samples were obtained from the first and second follicular aspiration of each ovary. A chemiluminescent immunoassay of estradiol, progesterone, testosterone and DHEAS was performed. Results: Figures of follicular DHEAS decreased as the days of treatment with GnRH agonists increased (p=0.0003) and levels of follicular testosterone and DHEAS increased along with the days of treatment with rFSH (p=0.03, p=0.03). In regard to the outcomes of the overall cycle it was found a negative correlation between follicular testosterone levels and the number of punctured complexes (r= -0.360; p=0.002) and between follicular testosterone and the number of D quality embryos (r= -0.233; p=0.047). The number of mature oocytes was lower in patients with higher levels of follicular testosterone (p=0.008). Follicular progesterone was higher in good quality oocytes as compared to those of no remarkable quality (p=0.006) and very poor quality (p=0.04). Conclusions: High levels of follicular testosterone were correlated with a fewer number of punctured complexes, mature oocytes and D quality embryos. Good oocyte quality was associated with higher follicular progesterone levels.

Physiological and histopathological studies on bisphenol-a compound as xenoestrogen in male albino rats

Xenoestrogens are compounds like estrogens in effect but not in structure which are mimicking the action of endogenous estrogen and activate estrogen receptor. Xenoestrogens are chemically distinct industrial products potentially able to disrupt the endocrine system by mimicking the action of endogenous steroid hormones. Among such compounds, the ubiquitous environmental contaminants bisphenol-A [BPA] may promote adverse effects in humans triggering estrogenic signals in target tissues. Bisphenol- A is widely used in food and drinks packaging. The present study is carrying out to evaluate the effect of bisphenol-A on sexual hormonal pattern in male albino rats. 64 adult male Sprague-Dawley rats [100-120 g] were divided to four groups [16 rats/group].Group [1]: control group without any treatment. Group[2]: positive control group was injected subcutaneously [s.c] with sesame oil daily. Group [3]: received BPA daily with low dose [10 mg/kg/day s.c]. Group [4]: received BPA daily with high dose [30 mg/kg/day s.c]. The experiment durated 30 days, half rats of each group were sacrificed after 15 days of treatment and the other half of groups after 30 days. The blood was collected, serum was separated and used for estimation of [hormonal levels, prolactin, gonadotrophin and testosterone] and some biochemical parameters [liver enzymes, kidney function, protein and lipid profile]. Testis, liver and kidney were taken for the histopathological examination. Biochemical results showed significant elevation in prolactin and FSH levels and significant reduction in LH and testosterone levels in all groups compared to the control group. Increased serum enzymes [ASAT, ALATand ALP] levels with increased concentration of urea and creatinine were detected in all the treated groups compared to the control group. Decline in protein profile and elevation in the concentration of lipid profile, while HDL was decreased in all the treated groups. Histopathological results showed dystrophic changes in the form of congestion in the blood vessels of the testis, liver and kidney of rats with thickening of walls of the blood vessels especially in the testis. In liver, focal inflammatory areas, with dilated and congested central and portal veins were found. Vacuolar degenerative changes in hepatocytes were seen. In the kidney, mild nephritis, sclerotic changes in glomerular tuft, hyaline casts in the lumen of epithelial cells which lining convoluted tubule were noticed. From the previous results we concluded that bisphenol-A has dangerous effects on the testis, liver and kidney tissues. Also it disrupted sexual hormonal pattern and affect biochemical and lipid parameters. So, we recommended minimizing the utililizing of these compound to protect people from its hazardous effects

Gonadal steroids levels and vitellogenesis in the formation of oocytes in Prochilodus lineatus (Valenciennes) (Teleostei: Characiformes)

The objective of this study was to obtain information about the possible mechanisms related to poor reproductive performance in tropical rheophilic fish. To that effect, cages (Cs) and earthen ponds (EPs) were used as experimental systems to provide unsuitable and suitable conditions, respectively, for curimbatá (Prochilodus lineatus) breeders. Fish were maintained under experimental conditions for 18 months, and during this period females were randomly sampled every two months for biometric analysis (n=30), blood (n=5/sampling) and ovary (n=5/sampling). After this period EPs females (EPFs) and Cs females (CFs) were submitted to the induced breeding experiments. The results showed that rearing curimbatá for such long time in a cage at this stocking density, reduces its growth, plasma E2 levels and vitellogenesis. During vitellogenesis, the mean plasma estradiollevels of CFs were three times lower than those of EPFs (P<0.01). CFs presented poorer results than EPFs for all the examined parameters of reproductive performance. Taken together these data showed that the reduced estradiol levels during vitellogenesis (and the consequently less intense transition from the previtellogenic to vitellogenic phase) and reduced amounts of yolk are mechanisms associated with the formation of low quality oocytes and shortened and delayed breeding season in this species. Moreover, our data showed that the onset of vitellogenesis (six months before the spawning season) must be considered as a key period related to the formation of oocytes of good quality, and adequate management should be provided throughout the year.

Este estudo teve como objetivo gerar informações básicas sobre os possíveis mecanismos relacionados com os resultados desfavoráveis obtidos com o desempenho reprodutivo em peixes reofílicos tropicais. Para isso tanques-rede (Cs) e viveiros escavados (EPs) foram utilizados como sistemas experimentais para propociar respectivamente condições inadequadas e adequadas para reprodutores de Prochilodus lineatus. Os peixes foram mantidos por 18 meses em viveiros escavados (EPs) e tanques-rede (Cs), e durante este período, foram aleatoriamente coletados a cada dois meses para análise biométrica (n=30), coleta de sangue (n=5/tratamento) e amostragem do ovário (n=5/tratamento). Após este período as fêmeas mantidas em EPs (EPFs) e as fêmeas mantidas em Cs (CFs) foram submetidas aos experimentos de reprodução induzida. Os resultados mostraram que manter curimbatás por este período em Cs, na densidade de estocagem utilizada, reduz seu crescimento, níveis plasmáticos de E2 e vitelogênese. Durante a vitelogênese, os níveis plasmáticos de estradiol das CFs foram três vezes menores do que os das EPFs (P <0,01). As CFs apresentaram resultados inferiores aos das EPFs para todos os parâmetros analisados de desempenho reprodutivo. Em conjunto, estes dados mostram que os níveis reduzidos de estradiol durante a vitelogênese (bem como o consequente atraso na transição da fase previtelogênica para a vitelogênica) e as quantidades reduzidas de vitelo são mecanismos associados com a formação de ovócitos de baixa qualidade; redução e atraso na época de desova nesta espécie. Além disso, nossos dados mostraram que o início da vitelogênese (seis meses antes da época de desova) é um período-chave para formação de ovócitos de boa qualidade, e o manejo adequado deve ser aplicado durante todo o ano.

Aspectos reprodutivos e perfil hormonal dos esteróides sexuais do pirarucu, Arapaima gigas (SCHINZ,1822), em condições de cativeiro / Reproductive aspects and sexual steroids hormonal profiles of pirarucu, Arapaima gigas (SCHINZ,1822), in captivity conditions

Esta pesquisa teve como objetivo caracterizar a reprodução e o perfil hormonal dos esteróides sexuais do pirarucu, Arapaima gigas, além de validar um aspecto do dimorfismo sexual secundário. O experimento foi realizado na Fazenda Santo Antônio II, em Presidente Figueredo-AM, no período de fevereiro de 2004 a fevereiro de 2005. Foram selecionados 24 exemplares e divididos em três grupos de oito peixes (grupo "A", "B" e "C" com pirarucus de mais de quatro anos de idade, com três anos e dois anos, respectivamente). Os pirarucus foram estocados em três tanques de 400m², um para cada grupo. Aspectos comportamentais, como o interesse por alimento, brigas, formação de casais e presença de ninhos, foram observados ao longo de todo o experimento. Amostras de sangue foram coletadas mensalmente, de todos os peixes, observou-se a presença de uma mancha alaranjada no macho como uma característica sexual secundária. Foram mensurados os níveis de testosterona (T), 17beta-estradiol (E2) e 17alfa-hidroxi-progesterona (17aOHP) através de radioimunoensaio (RIA) de fase sólida. Todos os machos dos grupos "A" e "B" puderam ser identificados pela mancha alaranjada na região inferior da cabeça, corroborada pela concentração de testosterona, comprovando o conhecimento empírico dos ribeirinhos. Os níveis de T e E2 nos peixes do grupo "A" e "B" tiveram maiores picos no início do período de chuva, enquanto que o 17aOHP teve oscilações constantes e pequenos picos no final do período chuvoso, os peixes do grupo "C" acompanharam essa tendência em concentrações menores.

The purpose of this study was to characterize the growth, reproduction and hormonal profile of pirarucu, Arapaima gigas, and validate one sexual dimorphism characteristic. The experiment was carried in the fish farm Santo Antonio II, Presidente Figueredo city in the state of Amazonas Brazil, from February 2004 to February 2005. In the experiment, 24 fishes were selected and divided in three groups, with eight fish in each one. The pirarucus from "A" group were older than four years. In "B" group the fishes were three years old and in "C" group these were two years old. The pirarucus were stocked in 400 m² excavated ponds, one pond for each group. Reproductive behavior like feeding interest, fights, pair formation and presence of nest were observed. Blood samples were taken monthly from all fishes during the experiment period, the sexual dimorphism characteristic was observed. Testosterone (T), 17b-estradiol (E2) and 17ahidroxi-progesterona (17aOHP) levels were measured by radioimunoassay (RIA) in solid phase. All males of group "A" and "B" could be identified by an orange mark under the head, and the levels of T validated this data, proving the empirical knowledge of river men. T and E2 levels of group "A" and "B" picked in the beginning of raining period and the 17áOHP levels were higher in the end of raining period. The levels of these hormones in "C" group fishes followed the tendency of "A" and "B" group hormonal levels, but in lower concentration.

Características clínicas, endocrinas y metabólicas de una población argentina de niñas con pubarca prematura / Clinical, hormonal and metabolic findings in argentinean girls with premature pubarche

La pubarca prematura se ha asociado con alteraciones hormonales y metabólicas. Se estudiaron 40 niñas con pubarca prematura de 7,23 ± 0,29 años (media ± ESM). Se evaluó grado de desarrollo, talla, edad ósea, IMC y peso al nacimiento (PN). Se dosaron andrógenos, gonadotrofinas, lípidos, glucemia e insulina, HOMA e índice glucemia/insulina (G/I) y se compararon con un grupo control normal de 25 niñas. Las pacientes se dividieron según el nivel de sulfato de dehidroepiandrosterona (SDHEA) en dos grupos, Pre A (Pre adrenarca), < 400 ng/ml, n= 17 y Post A (Post adrenarca) < 400 ng/ml , n= 23. El grupo Post A tuvo mayor edad cronológica, edad ósea y grado de vello pubiano que el Pre A, sin diferencias en IMC ni en peso de nacimiento (PN). Insulina y HOMA fueron mayores y G/I menor en Post A que en Pre A y grupo control. Dos niñas en Post A tuvieron franca resistencia a la insulina. 64 % de las niñas en Pre A y 59 % en Post A tuvieron valores elevados o limítrofes de colesterol total (CT). Conclusiones: el grupo Post A presentó menor sensibilidad insulínica y ambos grupos de pacientes tuvieron valores de CT elevados, alteraciones que podrían favorecer el riesgo de futuras complicaciones. Se recomienda el seguimiento a largo plazo de todas las niñas con pubarca prematura.

Precocious pubarche in girls is caused by premature adrenarche in most cases. Less frequently it occurs in absence of biochemical markers of adrenarche being ascribed to increased target tissue sensitivity. Premature pubarche with pronounced adrenarche has been associated with insulin resistance and dyslipemia, especially in girls with history of low birth weight. Most studies have been conducted in hispanic and affrican-american patients. We studied a total of 40 argentinean girls with isolated premature pubarche, aged 7.23 ± 0.29 years (mean ± SEM) at the moment of diagnosis. Grade of sexual development, height, weight, BMI and birth weight (BW) were recorded. Dehidroepiandrosterone sulphate (DHEAS), androstenedione (A), testosterone (T), 17OH progesterone (17 OHP), SHBG, LH, FSH, PRL and estradiol were measured. Total cholesterol (TC), LDL cholesterol (LDL- C), triglycerides (TGC), glucose, insulin, HOMA and fasting glucose/ insulin index (G/I) were evaluated and compared with those in a control group of 25 normal girls. Patients were divided into two groups: Pre A (Pre adrenarche), with DHEAS < 400 ng/ml, and Post A (Post adrenarche), with DHEAS > 400 ng/ml. Post A girls had higher chronological age, bone age advancement and grade of pubic hair development than Pre A girls. No difference was found regarding BMI or BW. Besides higher DHEAS levels, Post A girls showed elevated A and 17OHP levels than Pre A girls (86 ± 8 vs 35 ± 4 ng/dl, p<0. 0001 and 1.1 ± 0.09 vs 0.75 ± 0.07 ng/ml, p< 0.01, respectively). Insulin levels (µUI/ml) were 4.51 ± 0.75 in Pre A, 6.53 ± 1.11 in Post A and 4.05 ± 0.45 in control group. Fasting G/I was 24.07 ± 3.75 in Pre A , 18.4 ± 2.34 in Post A and 25.41 ± 2.31 in controls. HOMA was 0.90 ± 0.12 in Pre A, 1.35 ± 0.22 in Post A and 0.89 ± 0.11 in control group. Post A girls had higher insulin and HOMA and lower G/I than control group girls (p<0.05) while those parameters in Pre A girls were not different than in normal control subjects. Only two patients in Post A group had HOMA and G/I consistent with insulin resistance. TC was higher in Pre A than in control group (182.2 ± 4.9 vs156.7 ± 8.5 mg/dl, p<0.05). According to The National Cholesterol Education Program definition, 64 % of Pre A girls and 59 % of Post A girls had elevated or borderline TC levels. TGC values were not different among Pre A, Post A and control group (81.1 ±7.1, 77.6 ± 6.1 and 71.9 ± 4.7 mg/dl, respectively. Summary and Conclusions: In this cohort of argentinean girls with premature pubarche, we did not find a significant history of intrauterine growth retardation. Patients with biochemical pattern of adrenarche showed clinical signs of androgen exposure (accelerated bone age, more advanced degree of pubic hair development) and a serum profile suggestive of reduced insulin sensitivity compared with those without biochemical adrenarche. Both groups of patients had undesirable total cholesterol levels. These findings support the recommendation of long-term follow-up for all girls with premature pubarche.

Female infertility: role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation.

Female infertility can be categorised into those who fail to ovulate (anovulatory infertility) because of some defect at hypothalamic-pituitary-ovarian axis and those who are ovulatory (ovulatory infertility), but are infertile because of some lesion present in genital tract. The role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation in the detection of ovulation and various ovulatory dysfunction was studied in 42 infertile female patients. On the basis of cytological findings, of the 42 patients, 14 were found to be ovulatory, 26 anovulatory (which include 5 cases of atrophic changes) and 2 inconsistent due to inflammatory changes. Endometrial biopsy showed evidence of ovulation in 15, anovulation in 27 cases. Hormonal evaluation indicated some sort of endocrinological disorders in 15 patients, which may underlie anovulatory infertility in these patients, while results were within normal range in the rest 27 patients. Results of vaginal cytology and endometrial biopsy showed correlation in respect to ovulation in 93.33% of the cases.

Estradiol and testosterone concentrations in follicular fluid as criteria to discriminate between mature and immature oocytes

The objective of the present study was to examine the association between follicular fluid (FF) steroid concentration and oocyte maturity and fertilization rates. Seventeen infertile patients were submitted to ovulation induction with urinary human follicle-stimulating hormone, human menopausal gonadotropin and human chorionic gonadotropin (hCG). A total of 107 follicles were aspirated after hCG administration, the oocytes were analyzed for maturity and 81 of them were incubated and inseminated in vitro. Progesterone, estradiol (E2), estrone, androstenedione, and testosterone were measured in the FF. E2 and testosterone levels were significantly higher in FF containing immature oocytes (median = 618.2 and 16 ng/ml, respectively) than in FF containing mature oocytes (median = 368 and 5.7 ng/ml, respectively; P < 0.05). Progesterone, androstenedione and estrone levels were not significantly different between mature and immature oocytes. The application of the receiver-operating characteristic curve statistical approach to determine the best cut-off point for the discrimination between mature and immature oocytes indicated levels of 505.8 ng/ml for E2 (81.0 percent sensitivity and 81.8 percent specificity) and of 10.4 ng/ml for testosterone (90.9 percent sensitivity and 82.4 percent specificity). Follicular diameter was associated negatively with E2 and testosterone levels in FF. There was a significant increase in progesterone/testosterone, progesterone/E2 and E2/testosterone ratios in FF containing mature oocytes, suggesting a reduction in conversion of C21 to C19, but not in aromatase activity. The overall fertility rate was 61 percent but there was no correlation between the steroid levels or their ratios and the fertilization rates. E2 and testosterone levels in FF may be used as a predictive parameter of oocyte maturity, but not for the in vitro fertilization rate.

Disfunción ovárica en esclerosis sistémica progresiva/CREST / Ovarian disfunction in progressive systemic sclerosis/CREST

Objetivo. Estudiar la función ovárica en esclerosis sistémica progresiva (ESP)/CREST. Metodología. Se estudiaron 13 mujeres con ESP/CREST y 18 controles sanas, subdivididas en menstruantes y menopáusicas y analizadas desde los puntos de vista reumatológico, endocrinológico y ginecológico. Resultados. La ESP inició a edad más temprana que el CREST (p=0.02). Ocho enfermas menstruantes (Grupo 1) tuvieron opsomenorrea y amenorrea y 2 infertilidad. En las pacientes ESP/CREST menopáusicas (Grupo 2), 3 tuvieron menopausia temprana. En el Grupo 1, la hormona folículo estimulante (HFE) y la prolactina (PRL) en suero resultaron elevadas (p=NS) y el estradiol (E2) sérico disminuido en la fase preovulatoria respecto de las controles (p<0.05). En el Grupo 2 la HFE y la luteinizante estuvieron elevadas en suero (p<0.04 y p<0.03, respectivamente) y el E2 fue bajo (p=NS) respecto de las controles. El Grupo 1 tuvo inmunoglobulinas séricas (p=0.0001 y 0.004) y velocidad de sedimentación globular (VSG, p=0.016) mayores que las controles. En el grupo de ESP/CREST hubo correlación entre E2 e IgA (p<0.001) y los niveles de PRL e IgM (p<0.001), que fueron diferentes a los de las controles. Conclusión. En pacientes con ESP/CREST existe disfunción ovárica, con problable participación de E2 y PRL como intermediarias de la inflamación y/o de la respuesta inmunológica

Hermafroditismo verdadero / True hermaphroditism

El hermafroditismo verdadero es la más rara variante de la intersexualidad humana, sin embargo, debe ser considerada en el diagnóstico diferencial de genitales ambiguos. Presentamos una revisión del cuadro clínico, el perfil hormonal, los hallazgos citogenéticos así como los posibles orígenes del hermafroditismo verdadero, discutiendo particularmente, el papel que jugaría el antígeno H-Y