Résumé
Objective. To investigate the ovarian activity before and after gonadal suppression with GnRH-analog in patients with PCO, hyperandrogenism, hyperinsulinism and ancathosis nigricans. Design: Controlled clinical study. Setting: Tertiary academic medical center. Patients: Six patients with clinical findings of PCO, hirsutism and acanthosis nigricans. Interventions. Morning blood samples in the follicular phase to determine the seteroid levels, glucose and insulin curve, comparing to a control group. Administration for 2 consecutive months of a GnRH-analog, comparing, in the study group, the free testosterone levels before and after ovarian suppression. Main Outcome Measure. Determination of insulin levels in PCO, hirsutism and acanthotic patients and the free-testosterone levels before and after gonadal suppression. Results. Insulin levels were significantly higher in the study group when compared to normal women during the glycemic test. We also found a significant decrease in the free-testosterone levels after 2 months of gonadal suppression with GnRH-analog when compared to the initial time. Conclusions. Patients with PCO, hirsutism and acanthosis nicrigans present high levels of in sulin, suggesting an ovarian hyperesponsiveness, which is not sustained when gonadotrophic blockage was achieved.
Sujets)
Femelle , Humains , Adolescent , Adulte , Hormone de libération des gonadotrophines/analyse , Maladies endocriniennes/métabolisme , Acanthosis nigricans/métabolisme , Syndrome des ovaires polykystiques/métabolisme , Ovaire/physiopathologie , Hormone de libération des gonadotrophines/analogues et dérivés , Hyperandrogénie/métabolisme , Hyperglycémie provoquée , Hyperinsulinisme/métabolisme , Insuline/analyseRésumé
Se presenta el caso de un hombre de 43 años, obesidad mediana, con hiperqueratosis de aréola y pezón, acantosis nigricans en cuello y axilas y granulado digital. Los exámenes de laboratorio demostraron insulino-resistencia, debido a un defecto a nivel de los receptores o post-receptores. El cuadro es clasificado dentro del tipo III de Levy-Franckel, aunque se hace reserva de incluirlo en un futuro tipo IV hormono-inducido. La hiperplasia dermoepidérmica que caracteriza a estas tres entidades puede ser explicada por acción de la insulina sobre los rescptores celulares de los factores de crecimiento, debido a la similitud ,olecular entre éstos y la hormona