Riscos de infecção por SARS-CoV-2 e COVID-19 em mulheres com síndrome dos ovários policísticos / Risks of SARS-CoV-2 and COVID-19 infection in women with polycystic ovary syndrome

Esta revisão narrativa teve como objetivo avaliar possíveis riscos da associação entre a infecção por SARS-CoV-2 (causa da COVID-19) e as características metabólicas e endócrinas frequentemente encontradas em mulheres com a síndrome dos ovários policísticos (SOP). A COVID-19 é mais grave em indivíduos com obesidade, diabetes mellitus, dislipidemia e hipertensão arterial. Como essas condições são comorbidades comumente associadas à SOP, foi hipotetizado que mulheres com SOP teriam maior risco de adquirir COVID-19 e desenvolver formas clínicas mais graves da doença. Considerando vários estudos epidemiológicos, a presente revisão mostra que mulheres com SOP têm risco 28% a 50% maior de serem infectadas pelo vírus SARS-CoV-2 em todas as idades e que, nessas mulheres, a COVID-19 está associada a maiores taxas de hospitalização, morbidade e mortalidade, especialmente naquelas com alterações no metabolismo de carboidratos e lipídios, hiperandrogenemia e aumento do tecido adiposo visceral. Os mecanismos que explicam o maior risco de infecção por COVID-19 em mulheres com SOP são considerados.(AU)

Variabilidad clínica del síndrome de ovario poliquístico / Clinical variability in polycystic ovary syndrome

Introducción: El síndrome de ovario poliquístico es la forma más común de anovulación crónica relacionada con exceso de andrógenos. La prevalencia oscila según el criterio diagnóstico utilizado entre 4-21 pòr ciento. Objetivo: Describir las características clínicas de las pacientes con síndrome de ovario poliquístico. Métodos: Se seleccionaron los consensos hasta ahora realizados y artículos originales de los último 10 años, disponibles en los siguientes buscadores: Pubmed, Medscape, Scielo, Bireme. Se consideraron otras publicaciones que por su importancia clínica no han sido replicados. Conclusiones: La variedad de fenotipos presentes en el SOP hace que las manifestaciones clínicas y factores de riesgo para otras morbilidades sean heterogéneas. La influencia que ejerce además su etiopatogenia, no completamente dilucidada, hace que el diagnóstico y por consiguiente el manejo actual de estas pacientes tenga un enfoque multidisciplinario, individualizado y enfocado a las prioridades e inconformidades que puedan afectar su calidad de vida(AU)

Introduction: Polycystic ovary syndrome (PCOS) is the most common form of chronic anovulation related to androgen excess. The prevalence ranges according to the diagnostic criteria used between 4-21 percent. Objective: To describe the clinical characteristics of patients with polycystic ovary syndrome. Methods: The consensuses and original articles of the last 10 years were selected, which were available in the following search engines: Pubmed, Medscape, Scielo, and Bireme. Other publications that due to their clinical importance have not been replicated were considered. Conclusions: The variety of phenotypes present in the polycystic ovary syndrome makes the clinical manifestations and risk factors for other morbidities heterogeneous. The influence exerted also by its etiopathogenesis, not completely elucidated, causes the diagnosis and therefore the current management of these patients to have a multidisciplinary approach which is individualized and focused on the priorities and nonconformities that may affect the patients' quality of life(AU)

Prevalencia de síndrome de ovario poliquístico en pacientes que acudieron a una consulta de ginecología-obstetricia y endocrinología en La Romana, República Dominicana, durante el período enero 2019-enero 2020 / Prevalence of polycystic ovary syndrome in patients who attended a gynecology-obstetrics and endocrinology private practice in La Romana, Dominican Republic during the period January 2019-January 2020

Introducción: el síndrome de ovario poliquístico (SOP) es un trastorno endocrino metabólico altamente dominante, el cual es considerado como una de las afecciones más comunes en las mujeres, tanto adolescentes como adultas durante su etapa fértil. Presenta una prevalencia de aproximadamente un 21 % a nivel global. Objetivo: determinar la prevalencia del síndrome de ovario poliquístico en pacientes que acudieron a una consulta de ginecología-obstetricia y endocrinología en la Romana, República Dominicana. Metodología: estudio observacional, retrospectivo, analítico y de corte transversal en el que se analizaron 252 récords médicos de distintas pacientes con y sin SOP para determinar la prevalencia de esta. Como herramienta de estudio se utilizó un formulario creado por el asesor y colaboradores, que se aplicó a los récords médicos empleando los criterios de Rotterdam como determinantes para el diagnóstico del SOP. Resultados: los resultados mostraron que un 67 % de las mujeres no presentaron SOP, correspondiendo a 170 pacientes, mientras que las 82 pacientes restantes presentaron SOP, representando un 33 %. Asimismo, el grupo etario con mayor frecuencia de SOP correspondió al rango de 26 a 35 años con un 52.4 %. Por otra parte, se presentaron más pacientes con SOP no obesas con un 71 %. Con relación a la presencia de ciclos menstruales regulares e irregulares, las pacientes irregulares con SOP indicaron un 47.6 % y las pacientes regulares sin SOP indicaron un 16.7 %, resultando que se acepta la hipótesis nula. Conclusiones: la prevalencia de síndrome de ovario poliquístico fue de un 33 %. El rango de edad más frecuente fue de 26 a 35 años. Predominó la presencia de pacientes con SOP no obesas. La comparación de las pacientes con ciclos menstruales irregulares fue mayor para aquellas que padecen SOP

Introduction: Polycystic ovary syndrome (PCOS) is a highly dominant endocrine metabolic disorder, which is considered one of the most common conditions in women, both adolescents and adults during their fertile stage. It has a prevalence of approximately 21% globally. Objectives: To determine the prevalence of polycystic ovary syndrome in patients who attended a gynecology-obstetrics and endocrinology consultation in la Romana, Dominican Republic. Methodology: An observational, retrospective, analytical and cross-sectional study in which 252 medical records of different patients with and without PCOS were analyzed to determine its prevalence. As a study tool, a form created by the advisor and collaborators was used, which was applied to medical records, the Rotterdam criteria were employed as determinants for the diagnosis of PCOS. Results: The results showed that 67% of the women did not present PCOS corresponding to 170 patients, while the remaining 82 patients presented PCOS representing 33%. Likewise, the age group with the highest frequency of PCOS corresponded to the range of 26 to 35 years with 52.4%. On the other hand, there were more non-obese PCOS patients with 71%. Regarding the presence of regular and irregular menstrual cycles, irregular patients with PCOS indicated 47.6% and regular patients without PCOS indicated 16.7%, resulting in the acceptance of the null hypothesis. Conclusions: The prevalence of polycystic ovary syndrome was 33%. The most frequent age range was 26 to 35 years. The presence of non-obese PCOS patients predominated. The comparison of patients with irregular menstrual cycles was higher for those with PCOS

Relación entre hipotiroidismo y síndrome de ovario poliquístico / The relationship between hypothyroidism and polycystic ovary syndrome

INTRODUCCIÓN: Se ha documentado la asociación del síndrome de ovario poliquístico con alteraciones metabólicas y enfermedades cardiovasculares. Su relación con trastornos autoinmunitarios no está claramente establecida, pero se ha encontrado una importante prevalencia de desórdenes tiroideos en pacientes con síndrome de ovario poliquístico. OBJETIVO: Describir las diferentes teorías existentes que puedan explicar la relación entre hipotiroidismo y síndrome de ovario poliquístico, junto con su posible impacto en la morbilidad asociada. Método: Se realizó una búsqueda en PubMed y LILACS con las palabras clave "Polycystic ovary síndrome", "Hypotyroidism", "thyroid disease" y sus respectivos términos en español, durante julio de 2020. Resultados: Se seleccionaron 51 artículos relacionados con el tema, publicados en los últimos 10 años. La fisiopatogenia entre ambos trastornos no está claramente establecida. Se ha encontrado un importante impacto metabólico en este grupo de pacientes y se considera que su riesgo cardiovascular podría estar aumentado. CONCLUSIONES: Al considerarse la prevalencia significativa y las complicaciones que tanto a corto como a largo plazo podrían tener las mujeres con ambas alteraciones, se hace necesario discutir la necesidad de la exclusión del hipotiroidismo de los criterios diagnósticos aplicados para el síndrome, la tamización temprana y el estudio de las implicaciones terapéuticas que trae su abordaje.

INTRODUCTION: The association of polycystic ovary syndrome with other metabolic disorders and cardiovascular diseases has been documented; nevertheless, its relationship with autoimmune disorders is not clearly established, however, an important prevalence of thyroid disorders has been found in this group of patients. OBJECTIVE: To describe the different existing theories that can explain the relationship between hypothyroidism and polycystic ovary syndrome along with its possible impact on associated morbidities. Method: A search was conducted in PubMed and LILACS with the keywords of "Polycystic ovary syndrome", "Hypothyroidism", "Thyroid disease" and with its respective Spanish terms, in July 2020. Results: 51 articles related to the subject were selected, published in the last 10 years. The pathogenesis between both disorders is not clearly established. An important impact has been found at the metabolic level in this group of patients and it is considered that their cardiovascular risk could be increased. CONCLUSIONS: Considering the significant prevalence and complications that both short and long term, women with both alterations could have, it is necessary to discuss the need for the exclusion of hypothyroidism from the diagnostic criteria applied for the syndrome, early screening of the syndrome, and the study of the therapeutic implications that its approach brings.

Autoinmunidad tiroidea en mujeres con Síndrome de Ovario Poliquístico / Thyroid autoimmunity in women with polycystic ovary syndrome

Introducción: Las bases fisiopatológicas del Síndrome de ovario poliquístico pueden predisponer a mayor riesgo de autoinmunidad a las mujeres que tienen esta condición y existen evidencias, aunque escasas, de mayor prevalencia de autoinmunidad tiroidea en ellas. Objetivos: Determinar la frecuencia de marcadores serológicos de autoinmunidad tiroidea en mujeres con Síndrome de ovario poliquístico e identificar si existe asociación entre la presencia de ellos y las concentraciones de progesterona y testosterona. Métodos: Se realizó un estudio en 50 mujeres con Síndrome de ovario poliquístico y 50 sin el síndrome. Se realizaron determinaciones de autoanticuerpos tiroideos (anti tiroglobulina (Anti-Tg) y anti peroxidasa (anti-TPO) a las mujeres de ambos grupos de estudio. Se realizaron determinaciones de hormonas (testosterona y progesterona) solo al grupo de estudio de mujeres con SOP. Se crearon categorías por anticuerpos: Positivo si los títulos fueron superior al rango de referencia y negativo dentro del rango. Se consideró respuesta autoinmune positiva, cuando al menos uno de los anticuerpos se encontró elevado. Para la asociación entre la presencia de autoinmunidad y las variables independientes se hicieron análisis bivariados mediante comparación de medias y test no paramétricos. Se consideró un nivel de significancia de α = 0,05. Resultados: En las mujeres con Síndrome de ovario poliquístico, 62 por ciento mostraron anticuerpos positivos y 14 por ciento en las sin el síndrome. En las mujeres sin síndrome, de las 7 mujeres con marcadores de autoinmunidad positivos, en 6 (85,7 por ciento) el anti-Tg fue el que dio positivo. No hubo diferencias significativas en cuanto a la asociación con los niveles de testosterona y progesterona. Conclusiones: Las mujeres con Síndrome de ovario poliquístico tienen mayor frecuencia de desarrollar respuesta autoinmune tiroidea, independiente de los niveles de progesterona y testosterona(AU)

Introduction: The physio-pathological bases of polycystic ovary syndrome may predispose women with this condition to a higher risk of autoimmunity and there is evidence, albeit scarce, of higher prevalence of thyroid autoimmunity in them. Objectives: Determine the frequency of serological markers of thyroid autoimmunity in women with polycystic ovary syndrome and identify whether there is an association between the presence of them and progesterone and testosterone concentrations. Methods: A study was conducted in 50 women with polycystic ovary syndrome and 50 without the syndrome. Determinations of thyroid autoantiantibodies (anti-thyroglobulin (Anti-Tg) and anti-peroxidase (anti-TPO) were made to women in both study groups. Hormone determinations (testosterone and progesterone) were made only to the study group of women with PCOS. Categories were created by antibodies: Positive if the titles were greater than the reference range, and negative if within the range. It was considered a positive autoimmune response when at least one of the antibodies was found increased. For the association between the presence of autoimmunity and independent variables, bivariate analyses were performed by means comparison and non-parametric tests. It was considered a significance level of α =0.05. Results: In women with polycystic ovary syndrome, 62 percent showed positive antibodies and 14 percent in those without the syndrome. In women without the syndrome, of the 7 women with positive autoimmune markers, in 6 (85.7 percent) the anti-Tg was the one that tested positive. There were no significant differences in the association with testosterone and progesterone levels. Conclusions: Women with polycystic ovary syndrome are more often able to develop thyroid autoimmune response, independently from the progesterone and testosterone levels(AU)

Síndrome dos ovários policísticos: conceito, epidemiologia e fisiopatologia aplicada à prática clínica / Polycystic ovary syndrome: concept, epidemiology and pathophysiology applied to clinical practice

Desde 1935, quando Stein e Leventhal descreveram o quadro dos "ovários policísticos", muitos estudos foram desenvolvidos no sentido de aprimorar os conhecimentos sobre esse tema. Contínuas discussões relativas a fisiopatologia, associações clínicas, repercussões sobre a saúde reprodutiva e conduta terapêutica foram realizadas ao longo desse intervalo de tempo. Do ponto de vista clínico, a síndrome dos ovários policísticos (SOP) tem se destacado como uma das desordens endócrinas mais comuns na idade reprodutiva, e sua prevalência varia de 6% a 10% em mulheres na menacme. A sua etiologia ainda permanece uma incógnita, tendo em vista que vários fatores devem estar envolvidos na sua gênese. A sua relação com os desvios do metabolismo lipídico e glicídico tem sido alvo de muitos estudos, pois hoje a SOP é vista como uma doença metabólica, com todas as suas implicações. O foco deixou de ser exclusivamente o sistema reprodutor, mas sim o organismo como um todo, o que tem gerado o interesse e a preocupação de outros profissionais da saúde sobre essas pacientes. Nesta matéria de capa, são abordados todos os aspectos dessa intrigante doença, como a etiologia, a fisiopatologia, a terapia e, especialmente, os desequilíbrios metabólicos que elevam os riscos de doenças cardiovasculares e diabetes nessas pacientes, sobretudo nas obesas. Com tantos recursos científicos disponíveis nos dias de hoje, não é mais possível ao ginecologista, isoladamente, abordar com competência todos os passos dessa terapia complexa das pacientes com SOP. Há necessidade do apoio de outros profissionais da área da saúde, como psicólogo, nutricionista, educador físico, entre outros. Não há dúvidas de que os fenômenos biológicos, psicológicos, sociais e ambientais são todos interdependentes e de que a abordagem das pacientes com SOP deve ser holística e multiprofissional.(AU)

Frecuencia de componentes del síndrome metabólico en familiares de mujeres con síndrome de ovario poliquístico / Frequency of metabolic syndrome´s components in relatives of women with polycystic ovary syndrome

Introducción: se conoce que la mujer con síndrome de ovario poliquístico tiene mayor riesgo de desarrollar complicaciones cardiometabólicas, pero también existen evidencias de que sus familiares son más propensos a estas. Objetivo: identificar la frecuencia de componentes del síndrome metabólico en familiares de mujeres con síndrome de ovario poliquístico. Métodos: se realizó un estudio descriptivo transversal en el Instituto Nacional de Endocrinología durante el periodo de 2012 al 2014, que incluyó 25 mujeres con síndrome de ovario poliquístico y 36 de sus familiares (casos), y 50 mujeres sin síndrome de ovario poliquístico y 65 de sus familiares (controles). En los familiares se indagó sobre antecedentes de hipertensión arterial, diabetes mellitus, dislipidemia, se tomó la tensión arterial, el peso y talla. Se realizó prueba de tolerancia a la glucosa oral midiendo glucemia e insulinemia (exceptuando a los que padecían diabetes mellitus), colesterol y triglicéridos. Se determinaron frecuencias y se empleó chi2 para las comparaciones. Resultados: el 76,0 por ciento de las mujeres con síndrome de ovario poliquístico refirió un familiar con diabetes mellitus, el 80,0 por ciento con hipertensión arterial y el 20,0 por ciento con algún trastorno lipídico. En las mujeres sanas el 28,0 por ciento tuvo algún familiar con diabetes mellitus, el 36,0 por ciento con hipertensión arterial y con dislipidemia el 12,0 por ciento. Según la prueba de tolerancia a la glucosa oral, se diagnosticó glucemia alterada en ayunas en 16,7 por ciento de los familiares de las mujeres con síndrome de ovario poliquístico y 12,3 por ciento de los familiares de las sanas, con tolerancia a la glucosa alterada hubo 19,4 por ciento de los familiares de los casos y 3,1 por ciento de los de las controles; con diabetes mellitus hubo 5,6 por ciento de los parientes de las mujeres con síndrome de ovario poliquístico y 1,5 por ciento de los de las sanas. En el 47,2 por ciento de los familiares de mujeres con síndrome de ovario poliquístico y el 21,5 por ciento de los de las sanas se detectó hipertrigliceridemia. Conclusiones: la frecuencia de los componentes del síndrome metabólico en familiares de mujeres con síndrome de ovario poliquístico, es mayor al compararlo con el de los familiares de mujeres que no lo presentan(AU)

Introduction: it is known that women with polycystic ovary syndrome have a higher risk of developing cardiometabolic complications, but there is also evidence that their relatives are more prone to those too. Objective: to identify the frequency of components of the metabolic syndrome in relatives of women with polycystic ovary syndrome. Methods: a cross-sectional, descriptive study was conducted in the National Institute of Endocrinology from 2012 to 2014, which included 25 women with polycystic ovary syndrome and 36 of their relatives (cases); and 50 women without polycystic ovary syndrome and 65 of their relatives (controls). The relatives were inquired about a history of hypertension, diabetes mellitus, dyslipidemia; and blood pressure, weight and height were measured. An oral glucose tolerance test was carried out for measuring glycaemia and insulinaemia (excepting those suffering from diabetes mellitus), and cholesterol and triglycerides. Frequencies were determined and chi2 was used for comparisons. Results: 76.0 percent of women with polycystic ovary syndrome reported a relative with diabetes mellitus, 80.0 percent a relative with arterial hypertension, and 20.0 percent a relative with a lipid disorder. In healthy women, 28.0 percent of them had a family member with diabetes mellitus, 36.0 percent a relative with arterial hypertension, and 12.0 percent a relative with dyslipidemia. According to the oral glucose tolerance´s test, impaired glucose in fasting was diagnosed in 16.7 percent of the relatives of women with polycystic ovary syndrome, and in 12.3 percent of the relatives of healthy women. There were 19.4 percent of the relatives of the cases with impaired glucose tolerance, and 3.1 percent of the controls. There were 5.6 percent of the relatives of the women with polycystic ovary syndrome with diabetes mellitus and 1.5 percent of those of the healthy ones. In 47.2 percent of the relatives of women with polycystic ovary syndrome and 21.5 percent of those of healthy women, hypertriglyceridemia was detected. Conclusions: the frequency of metabolic syndrome components in family members of women with polycystic ovary syndrome is higher when compared to the relatives of women who do not have it(AU)

Investigation of Demodex folliculorum frequency in patients with polycystic ovary syndrome

Abstract: Background: Background: Demodex mites are acari that reside in the pilosebaceous unit of the skin and have been associated with skin disorders. Objective: The objective of this study was to investigate the prevalence of Demodex folliculorum (D. folliculorum) mites in polycystic ovary syndrome patients as well as to examine the relationship between Demodex infestation and the presence of acne and oily or dry skin types in polycystic ovary syndrome patients. Methods: 41 polycystic ovary syndrome patients and 47 non-polycystic ovary syndrome control subjects were enrolled in the study. polycystic ovary syndrome was diagnosed according to the revised 2003 ESHRE/ASRM polycystic ovary syndrome Consensus Workshop Group diagnostic criteria. Microscopic examination of D. folliculorum mites was carried out by standardized skin surface biopsy. The result was considered positive when there were more than 5 mites per cm2. Results: D. folliculorum was positive in 53.7% of the polycystic ovary syndrome patients and 31.9% of the non-polycystic ovary syndrome group (p=0.052). Demodex positivity was significantly associated with acne (p=0.003) and oily skin (p=0.005) in the polycystic ovary syndrome patients but not in the controls. Study limitation: Our study is limited by the relatively small number of subjects and the observational nature of the study design. Conclusion: Demodex mites might have a role in acne pathogenesis in patients with polycystic ovary syndrome. Anti-Demodex treatment may increase the response to treatment of acne. Further studies are indicated.

Metabolic syndrome in infertile women with polycystic ovarian syndrome

ABSTRACT Objective The aim of the present study was to determine the prevalence of metabolic syndrome (MS) in infertile Iranian women with polycystic ovary syndrome (PCOS) using the ATPIII criteria. Subjects and methods In this cross-sectional study, 624 women with PCOS were enrolled at a tertiary referral center in Tehran, Iran, between April, 2012 and March, 2013. Diagnosis of MS was according to ATPIII criteria. Also, we divided PCOS patients into following two main groups: (i) with MS (n = 123) and (ii) without MS (n = 501), and then compared variables between two groups. Results The mean age, body mass index (BMI) and waist circumference were 28.6 ± 4.3 years, 26.7 ± 3.7 kg/m2 and 85.2 ± 8.7 cm, respectively. The prevalence of MS was 19.7%. Our findings showed that age, BMI, waist circumference and all metabolic parameters were higher in PCOS women with MS than related values in those without MS. The most and least prevalent forms of MS were low level of high density lipoprotein-cholesterol (HDL-C) and hypertension, respectively. Conclusion It seems the prevalence of metabolic syndrome in our country isn’t as high as western countries. The prevalence rate of MS increased with age and BMI. One of the major cardiovascular risk factors, low level of HDL-C, is the most prevalent metabolic abnormality in our participants.

Epidemiología del síndrome de ovario poliquístico en Chillán-Chile / Epidemiology of polycystic ovary syndrome in Chillan-Chile

Introducción: El síndrome de ovario poliquístico (SOP) es una disfunción endocrino metabólica de alta prevalencia, definida por alteraciones menstruales, hirsutismo, y ováricos morfológicamente poliquístico. Objetivos: Describir las características clínicas de las pacientes con SOP atendidas en el consultorio adosado de especialidades (CAE) del Hospital clínico Herminda Martin (HCHM) de Chillán. Materiales y método: Estudio transversal de 116 pacientes con diagnóstico de SOP (CIE-10 E28.2), en edad fértil, con diagnóstico realizado en CAE del HCHM durante 2010 y 2014. Se obtuvieron datos demográficos y clínicos, luego fueron tabulados en Excel para su análisis. Resultados: El grupo etario más frecuente fueron las pacientes entre 15 y 19 años. En la mayoría de los casos, la consulta se debió a alteraciones menstruales e hirsutismo. Un 33,6% de las pacientes correspondieron a SOP clásico. Un 72,4% presentó insulinoresistencia (IR) y un 40% sobrepeso. Discusión: Su fuerte relación con síndrome metabólico, nos lleva a plantear la posibilidad de aplicar medidas de prevención primaria, en los grupos poblacionales que han sido caracterizados enfrentando esta patología como una enfermedad endocrino-metabólica y tratarla de forma integral por un grupo multidisciplinario. Se sugiere realizar una pesquisa sistemática en pacientes de riesgo, incluyendo el SOP en programas de pesquisa específicos para enfermedades no transmisibles (examen médico preventivo del adolecente y del adulto).

Introduction: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic dysfunction highly prevalence, defined by menstrual alterations, hirsutism, and polycystic ovarian morphologically. Objetive: To describe the clinical characteristics of patients with PCOS treated at the "Consultorio adosado de especialidades" (CAE) of the Hospital Clínico Herminda Martin (HCHM) of Chillán. Materials and methods: A cross-sectional study of 116 patients with a diagnosis of PCOS (ICD-10 E28.2), of childbearing age, with a diagnosis made at the HCHM CAE during 2010 and 2014. Demographic and clinical data were obtained and then tabulated in Excel for your analysis. Results: The most frequent age groups were patients aged 15 to 19 years. In most cases, the consultation was due to menstrual alterations and hirsutism. A total of 33.6% of the patients were classical PCOS. 72.4% had insulin resistance (IR) and 40% were overweight. Discussion: Its strong relationship with metabolic syndrome leads us to consider the possibility of applying primary prevention measures in the population groups that have been characterized as endocrine-metabolic disease and treated in an integral way by a multidisciplinary group. It is suggested to conduct a systematic study in patients at risk, including PCOS in specific programs for noncommunicable diseases (preventive medical examination of adolescents and adults).

Relación entre la insulinorresistencia y el síndrome de ovario poliquístico y sus comorbilidades metabólicas / Relationship between Insulin Resistance and Polycystic Ovary Syndrome and Its Metabolic Comorbidities

Introducción: el síndrome de ovario poliquístico es un desorden de etiología multifactorial, caracterizado por un cuadro clínico heterogéneo y a veces subclínico que dificulta su manejo y diagnóstico. Se vincula a varias comorbilidades sobre todo de tipo metabólicas, donde la insulinorresistencia puede jugar un papel relevante. Objetivo: describir la relación que existe entre la insulinorresistencia y la génesis del síndrome de ovario poliquístico y de algunas de sus comorbilidades metabólicas. Conclusiones: la insulinorresistencia guarda una estrecha relación con la génesis del síndrome de ovario poliquístico, así como en el desarrollo de algunas de sus comorbilidades metabólicas (diabetes mellitus tipo 2, dislipidemia, hígado graso no alcohólico y síndrome metabólico), las que deben ser identificadas y tratadas precoz y adecuadamente(AU)

Introduction: Polycystic ovary syndrome is a disorder of multifactorial etiology, characterized by a heterogeneous clinical and subclinical, which sometimes makes handling and diagnosis difficult, and it is linked to several metabolic comorbidities especially those insulin resistant that may play a significant role. Objective: Describe the relationship between insulin resistance and the genesis of polycystic ovarian syndrome and some of its metabolic comorbidities. Conclusions: Insulin resistance is closely related to the genesis of polycystic ovary syndrome, as well as the development of some of its metabolic comorbidities (diabetes mellitus Type 2, dyslipidemia, nonalcoholic fatty liver disease and metabolic syndrome), which must be identified and timely and properly treated(AU)

Prevalence of nnn-alcoholic fatty liver diseasein women with polycystic ovary syndrome and its correlation with metabolic syndrome / Prevalência de doença hepática gordurosa não alcoólica em pacientes com síndrome dos ovários policísticos e sua correlação com síndrome metabólica

Background The polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women at childbearing age. Metabolic syndrome is present from 28% to 46% of patients with PCOS. Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic expression of metabolic syndrome. There are few published studies that correlate PCOS and NAFLD. Objective To determine the prevalence of NAFLD and metabolic syndrome in patients with PCOS, and to verify if there is a correlation between NAFLD and metabolic syndrome in this population. Methods Study developed at Gynecology Department of Clinical Hospital of Federal University of Parana (UFPR). The sessions were conducted from April 2008 to January 2009. One hundred and thirty-one patients joined the analysis; 101 were diagnosed with PCOS and 30 formed the control group. We subdivided the PCOS patients into two subgroups: PCOS+NAFLD and PCOS. All the patients were submitted to hepatic sonography. For hepatoestheatosis screening, hepatic ecotexture was compared do spleen’s. For diagnosis of metabolic syndrome, we adopted the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria, as well as the criteria proposed by International Diabetes Federation. Statistical analysis were performed with t of student and U of Mann-Whitney test for means and chi square for proportions. Results At PCOS group, NAFLD was present in 23.8% of the population. At control group, it represented 3.3%, with statistical significance (P=0.01). Metabolic syndrome, by NCEP/ATP III criteria, was diagnosed in 32.7% of the women with PCOS and in 26.6% of the women at control group (no statistical difference, P=0.5). At PCOS+DHGNA subgroup, age, weight, BMI, abdominal circumference and glucose tolerance test results were higher when compared to PCOS group (P<0.01). Metabolic syndrome by NCEP/ATPIII criteria was present in 75% and by International Diabetes Federation criteria ...

Contexto A síndrome dos ovários policísticos (SOP) é um dos distúrbios endócrinos mais comuns nas mulheres na idade fértil. A síndrome metabólica está presente em 28% a 46% das pacientes com SOP. A doença hepática gordurosa não alcoólica (DHGNA) é considerada a expressão hepática da síndrome metabólica. Existem poucos estudos publicados da associação SOP e DHGNA. Objetivos Determinar a prevalência de DHGNA e síndrome metabólica em portadoras de SOP, verificar se existe correlação entre a ocorrência de DHGNA e síndrome metabólica nessa população. Métodos Estudo realizado no Ambulatório de Ginecologia do Hospital de Clínicas da Universidade Federal do Paraná. O período de estudo foi de abril 2008 a janeiro de 2009. Participaram da análise 131 pacientes, sendo 101 com SOP e 30 controles. Subdividimos as pacientes com SOP em dois subgrupos: SOP+DHGNA e SOP. Todas foram submetidas a exame ultrassonográfico do fígado. Para rastreamento da esteatose hepática, a ecotextura do parênquima hepático foi comparada com a do baço. Para do diagnóstico da síndrome metabólica foram adotados os critérios propostos pelo National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) e do International Diabetes Federation. A análise estatística foi feita com teste t de student e U de Mann-Whitney para medias e qui-quadrado para proporções. Resultados No grupo com SOP, a DHGNA esteve presente em 23,8% da população. No grupo controle, isso ocorreu em 3,3%, com diferença estatística (P=0,01). A síndrome metabólica pelos critérios NCEP/ATP III, esteve presente em 32,7% no grupo SOP e 26,6% no grupo controle (sem diferença estatística P=0,5). No subgrupo SOP+DHGNA, a idade, o peso, IMC, circunferência abdominal e teste de tolerância à glicose foram maiores quando comparados ao grupo SOP (P<0,01). A síndrome metabólica pelo critério NCEP/ATPIII esteve presente em 75% e pelo International Diabetes Federation em 95,8% no grupo SOP+DHGNA com P<0,01. ...

Agregación familiar de causa genética en familiares de primer grado de mujeres con síndrome de ovarios poliquísticos / Familial clustering of genetic origin in first-degree relatives of women with polycystic ovary syndrome

Introducción: La existencia de manifestaciones del síndrome de ovarios poliquísticos en familiares de primer grado de pacientes con ese síndrome, ha permitido sospechar la participación de un componente genético en su patogénesis.Objetivos: identificar características clínicas del síndrome de ovarios poliquísticos en familiares de primer grado de mujeres con ese síndrome, e identificar si existe agregación familiar para el síndrome de ovarios poliquísticos.Métodos: se realizó un estudio descriptivo transversal, en 28 mujeres con síndrome de ovarios poliquísticos y 28 mujeres sin él, todas entre 18 y 49 años. Se les realizó un interrogatorio, examen físico, así como un árbol genealógico detallado buscando familiares de primer grado con estigmas del síndrome. Se calcularon las estadísticas descriptivas de todas las variables. Se realizó un estudio de agregación familiar general, y luego particular de casos y controles. Se calculó el OR con un 95 pr ciento de intervalo de confianza, como estadígrafo que mide la magnitud de asociación, y se estimó el riesgo de padecer la enfermedad si existía el antecedente familiar. En todos los casos se consideró un nivel de significación de p< 0,05.Resultados: 19 de los familiares de primer grado de las mujeres con síndrome de ovarios poliquísticos tuvieron hirsutismo, y solo 3 de los controles (p= 0,00); en el caso de las alteraciones menstruales, 16 de los familiares de primer grado de parentesco de los casos, manifestó este trastorno, y en los controles fueron solamente 7 (p= 0,04). La calvicie de aparición en edades tempranas está presente en 16 de los hombres con parentesco de primera línea filial de las mujeres afectadas, y solo 3 se observaron en los controles (p= 0,03). De los 48 familiares de primer grado estudiados de las mujeres con síndrome de ovarios poliquísticos, el 37,50 por ciento tenían criterios del síndrome. En el estudio de agregación familiar se estimó una posibilidad de 14,27 veces mayor de padecer la enfermedad, si se es familiar de un paciente afectado. Conclusiones: los estigmas de síndrome de ovarios poliquísticos y el mismo como tal son frecuentes en los familiares de primer grado de mujeres con él, y se demostró que existe agregación familiar(AU)

Introduction: Manifestations of polycystic ovary syndrome in first-degree relatives of patients suffering this disorder have allowed suspecting the involvement of a genetic component in its pathogenesis.Objectives: to identify the clinical characteristics of the polycystic ovary syndrome in the first-degree relatives of women with this syndrome and to detect the familial clustering for the polycystic ovary syndrome. Methods: cross-sectional and descriptive study of 28 females with polycystic ovary syndrome and 28 syndrome-free females aged 18 to 49 years-old. They were questioned and physically examined, and a detailed family tree was created to look for first-degree relatives with the syndrome stigma. Summary statistics for all variables were estimated. A general familial clustering study in addition to a case and control study were performed. The 95 percent CI odds ratio was estimated as an statistic that measures the range of association. The risk of suffering the disease in case of familial background was also assessed. The level of significance was p< 0.05 in every case. Results: nineteen of the first-degree relatives of women with the polycystic ovary syndrome had hirsutism and just three of the controls (p= 0.00). Regarding the menstrual alterations, this disorder manifested itself in 16 of the first degree relatives and in 7 of the controls(p= 0.04). Baldness appears at early ages in 16 of first-degree male relatives and only 3 were found in the controls (p= 0.03). Of 48 studied first-degree relatives of women with polycystic ovary syndrome, 37.50 percent met the syndrome criteria. The familial clustering study estimated that the relative of a patient is 14.27 more likely to suffer the disease. Conclusions: polycystic ovary syndrome stigmas and the syndrome as such are frequent in the first-degree relatives of women suffering this disorder and it was proved that familiar clustering does exist(AU)

Síndrome de ovario poliquístico: diagnóstico en la adolescencia / Polycystic ovary syndrome: diagnosis during adolescence

La sospecha de Síndrome de Ovario Poliquístico es un motivo de consulta frecuente durante la adolescencia, esto probablemente está dado por la sobreposición de las características fisiológicas de este período con los criterios diagnósticos tradicionalmente usados para definir este síndrome, tales como ciclos menstruales irregulares, hiperandrogenismo y morfología ecográfica de ovario poliquístico. Es por esto que parece importante discutir si los criterios diagnósticos de Síndrome de Ovario Poliquístico aplicados en mujeres adultas pueden extrapolarse a los primeros años postmenarquia. En este artículo se discute el diagnóstico de Síndrome de Ovario Poliquístico en la adolescencia, sus controversias y su manejo.

The suspicion of polycystic ovary syndrome is a common complaint during adolescence, and is probably given by the overlap of physiological characteristics of this period of life with the diagnostic criteria traditionally used to define this syndrome, such as irregular menstrual cycles, hyperandrogenism and polycystic ovarian morphology. This is why it seems important to discuss whether these diagnostic criteria for polycystic ovary syndrome in adults can be extrapolated to the early years postmenarche. This article will discuss the diagnosis of polycystic ovary syndrome in adolescence, their controversies and their management.

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...

Síndrome do ovário policístico e fatores relacionados em adolescentes de 15 a 18 anos / Polycystic ovary syndrome and intervening factors in adolescents from 15 to 18 years old

OBJETIVO: Avaliar os fatores relacionados à presença da síndrome do ovário policístico (SOP) em adolescentes. MÉTODOS: Estudo transversal, com adolescentes do sexo feminino de 15 a 18 anos, divididas em grupo 1 (com diagnóstico médico de SOP) e grupo 2 (sem diagnóstico da síndrome). Utilizou-se o índice estatura para idade e índice de massa corporal para classificação do estado nutricional, e aplicou-se questionário semiestruturado. Foram aplicados testes de Mann-Whitney, Exato de Fisher, correlação de Spearman e regressão logística. RESULTADOS: Foram avaliados 485 adolescentes, com idade média de 16,3 ± 0,9 anos. A prevalência de SOP foi de 6,2%. Não se encontrou diferença entre os grupos quanto aos parâmetros antropométricos e tempo de uso de anticoncepcionais, porém houve diferença quanto à idade da menarca (p < 0,004), e a mais tardia foi fator de proteção para síndrome. CONCLUSÃO: verificou-se associação entre a ocorrência da menarca mais cedo e o desenvolvimento da SOP em adolescentes.

OBJECTIVE: To assess the factors related to the presence of polycystic ovary syndrome (PCOS) in adolescents. METHODS: This was a cross-sectional study, with female adolescents from 15 to 18 years old, divided into: group 1 (with a medical diagnosis of PCOS) and group 2 (not diagnosed with PCOS). The height-for-age index and the body mass index were used for classifying the nutritional status, and a semi-structured questionnaire was applied. The Mann-Whitney test, Fisher's exact test, Spearman correlation coefficients, and logistic regressionwere used. RESULTS: This study evaluated 485 adolescents with an average age of 16.3 ± 0.9 years old. The prevalence of PCOS was 6.2%. No difference was found between the groups regarding anthropometric parameters and period of contraceptive use; however, there were differences regarding the age at menarche (p < 0.004). Older age at menarche was a protection factor against the syndrome. CONCLUSION: An association was found between younger age at menarche and the development of the PCOS in adolescents.

Assessment of symptoms of urinary incontinence in women with polycystic ovary syndrome

OBJECTIVES: The pelvic floor muscles are sensitive to androgens, and due to hyperandrogenism, women with polycystic ovary syndrome can have increased mass in these muscles compared to controls. The aim of this study is to compare reports of urine leakage and quality of life between women with and without polycystic ovary syndrome. METHODS: One hundred thirteen 18-to 40-year-old nulliparous women with polycystic ovary syndrome or without the disease (controls) were recruited at the University Hospital of School Medicine of São Paulo University at Ribeirão Preto City, Brazil. The subjects were not taking any hormonal medication, had not undergone previous pelvic surgery and did not exercise their pelvic floor muscles. The women were divided into the following four groups: I-polycystic ovary syndrome with normal body mass index (n = 18), II-polycystic ovary syndrome with body mass index >25 (n = 32), III-controls with normal body mass index (n = 29), and IV-controls with Body Mass Index >25 (n = 34). Quality of life was evaluated using the SF-36 questionnaire, and the subjects with urinary complaints also completed the International Consultation on Incontinence Questionnaire Short Form to evaluate the severity of their urinary incontinence. RESULTS: The replies to the International Consultation on Incontinence Questionnaire Short Form revealed a significant difference in urinary function between groups, with 24 percent of the subjects in group IV reporting urinary incontinence. The mean scores for the SF-36 questionnaire revealed that group II had the lowest quality of life. CONCLUSIONS: The control obese group (IV) reported a higher prevalence of urinary incontinence. There was no difference in the reported frequency of urine loss between the polycystic ovary syndrome and control groups with normal body mass index or between the polycystic ovary syndrome and control groups with body mass index >25.

Evaluación de las alteraciones lipídicas en el síndrome de ovarios poliquísticos y su relación con la resistencia a la insulina / Assessment of the lipid alterations in polycystic ovaries syndrome and its relation to insulin-resistance

El síndrome de ovarios poliquísticos excede el eje reproductivo por su frecuente asociación con alteraciones metabólicas y cardiovasculares. Objetivo: basado en lo anterior se realizó un estudio descriptivo transversal para determinar la frecuencia y las características de las alteraciones lipídicas en un grupo de mujeres con síndrome de ovarios poliquísticos y su relación con las alteraciones en la sensibilidad a la insulina. Se estudiaron 23 mujeres según los criterios de la Androgen Excess Society, se realizaron determinaciones hormonales y lipídicas así como glucemia e insulinemia en ayunas para evaluar sensibilidad a la insulina. Resultados: 95,6 por ciento de las pacientes presentaron dislipidemia. La disminución de las lipoproteínas de alta densidad (cHDL) y apolipoproteínas (Apo) A-I fueron las alteraciones lipídicas más frecuentes (91,3 y 87,0 por ciento, respectivamente) mientras que el aumento de los triglicéridos (Tg) y del colesterol total (Ct) fueron infrecuentes (13 y 4,3 por ciento, respectivamente). Los índices lipídicos calculados: Tg/cHDL, Ct/cHDL, cHDL/cLDL y Apo B/A-I tuvieron valores medios superiores en las mujeres con insulinorresistencia, el índice Apo B/A-I fue el que mostró mayor diferencia en mujeres con insulinorresistencia y sin esta. La frecuencia de las alteraciones lipídicas en las mujeres estudiadas fue alta pero no todas se relacionan con la insulinorresistencia, lo cual sugiere que en la expresión del síndrome de ovarios poliquísticos podrían intervenir múltiples factores metabólicos y hormonales(AU)

The polycystic ovaries syndrome to exceed the reproductive axis due to its frequent association with metabolic and cardiovascular alterations. Objetive: based on above mentioned a cross-sectional and descriptive study was conducted to determine the frequency and the characteristic of lipid alterations en a group of women diagnosed with polycystic ovaries and its relation to alterations in insulin-sensitivity. Methods: twenty three women were studied according to Androgen Excess Society criteria, hormonal and lipid determinations were made as well as fasting glycemia and insulinemia to assess the insulin-sensitivity. RESULTS: the 95,6 percent of patients presenting with dyslipemia. The more frequent lipid alterations were a decrease of the high density lipoproteins (cHDL) and apolipoproteins (Apo) (91,3 and 87,0 percent, respectively) whereas the increase of triglycerides(Tg) and the total cholesterol (tC) were infrequent (13 and 4,3 percent, respectively). The estimated lipid rates: Tg/cHDL, Ct/cHDL, cHDL/cLDL and Apo B/A-I had higher mean values in women with insulin-resistance; the Apo B/A-I rate had the greater difference in women with insulin-resistance and without it. The lipid alterations frequency in study women suggest that in expression of polycystic ovaries syndrome could be involved many metabolic and hormonal factors(AU)

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.