Reserva endocrina ovárica en mujeres con falla ovárica prematura / Endocrine ovarian reserve in women with premature ovarian failure

RESUMEN

Se estudiaron 19 mujeres con falla ovárica prematura que acudieron a consulta por amenorrea secundaria hipergonadotrópica, para determinar en ellas la existencia de algún grado de reserva endocrina ovárica. Se confeccionó historia clínica minuciosa y exámenes complementarios para definir la causa. Se determinaron los niveles basales de hormona folículo estimulante (FSH), luteinizante (LH), estradiol (E2), prolactina (Prl) y tirotropina (TSH). Se determinó también reserva ovárica esteroidea mediante la prueba dinámica de inhibición hipofisaria de gonadotropinas (Gn) con etinilestradiol y, posteriormente, se estimuló con hormona gonadotrópica menopáusica (HMG), y se determinaron los niveles basales de FSH, LH, E2, testosterona (T) y androstenediona (A'd), durante la inhibición y posterior al estímulo con HMG. Se halló que los niveles basales medios de FSH fueron más altos que los LH; los de E2 fueron bajos y la Prl fue normal al analizarlas como grupo. El nivel medio de E2 basal fue bajo y no hubo aumento en los niveles medios del mismo posterior al estímulo con HMG. Los niveles medios basales de T fueron normales a diferencia de la A'd que fue baja, no se obtuvo aumento de los mismos posestímulo al analizarlas como grupo. Se comprobó que el 52,6 (por ciento) de estas pacientes mantienen reserva ovárica estrogénica, mientras que sólo el 20 (por ciento), aproximadamente mantiene reserva androgénica. No hubo diferencias importantes en los resultados de la prueba dinámica al dividir a las pacientes en 2 grupos, según la edad cronológica, tiempo de amenorrea y causa de la FOP, excepto que solamente se halló reserva de T en las de causa idiopática, lo cual no se observó en las de causa inmunológica(AU)

ABSTRACT

19 women with premature ovarian failure that were seen at the physician's office due to secondary hypergonadotropic amenorrhea were studied to determine the existence of some degree of ovarian endocrine reserve. A detailed medical history was taken and complementary examinations were made to define the cause. The basal levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), Prolactin (Prl), and Thyrotropin (TSH) were determined.The steroideal ovarian reserve was also determined by the dynamic test of hypophyseal inhibition of gonadotropins (Gn) with ethynyl estradiol and, later, it was estimulated with gonadotropic menopausic hormone (GMH).The basal levels of FSH, LH, E2, testosterone (T) and androstenedione (A'd) were calculated during inhibition and after the stimulation with GMH. It was found that the mean basal levels of FSH were higher than those of LH, the levels of E2 were low and Prl was normal on analyzing them as a group. The mean basal level of E2 was low and there was no increase of its mean levels after the stimulation with GMH. The mean basal levels of T were normal, unlike A'd that was low. No rise was observed poststimulation on being analyzed as a group. It was proved that 52.6 % of these patients have an ovarian estrogenic reserve, whereas only 20 % have an androgenic reserve. There were no important differences in the results of the dynamic test on dividing patients into 2 groups, according to the chronological age, time of amenorrhea and cause of POF, excepting that the reserve of T that was only found in those of idiopathic cause, which was not observed in those of immunological cause(AU)