Evaluación del efecto de la prasterona en el tratamiento del deseo sexual hipoactivo en mujeres posmenopáusicas / Evaluation of the effect of the Prasterone in the treatment of hypoactive sexual desire in postmenopausal women

Resumen OBJETIVO: Determinar los efectos de la dosis oral diaria de 50 mg de dehidroepiandrosterona en la función sexual de pacientes posmenopáusicas. MATERIALES Y MÉTODOS: Estudio experimental, clínico, prospectivo y longitudinal efectuado en pacientes posmenopáusicas atendidas en el Hospital Juárez de México entre los meses de abril a julio de 2017. La muestra se seleccionó de pacientes posmenopáusicas atendidas por primera vez que cumplieran los criterios de inclusión. Administración de 50 mg de prasterona (Biolaif™) por vía oral cada 24 horas durante 12 meses a las pacientes con protocolo de estudio completo; consulta de seguimiento cada 3 meses. Estadística descriptiva y análisis bidimensional de Friedman. Los estudios estadísticos se realizaron con el programa SPSS versión 22. RESULTADOS: En 29 pacientes se evaluó el índice de función sexual que se incrementó, posterior al tratamiento oral con 50 mg diarios de prasterona, de una media de 10.8 a 28.1, y a 12 meses en 18 pacientes de una media de 10.6 a 29.1. CONCLUSIONES: La disfunción sexual es un problema de salud infradiagnosticado en pacientes posmenopáusicas. La administración oral de prasterona (dehidroepiandrosterona) a dosis de 50 mg al día mejoró todos los dominios del índice de función sexual femenina de todas las pacientes estudiadas con resultados estadísticamente significativos, sin efectos secundarios de hiperandrogenismo.

Abstract OBJECTIVE: To determine the effects of the administration of 50 mg of DHEA orally daily on sexual function of menopausal patients. MATERIALS AND METHODS: We performed an experimental, clinical, prospective and longitudinal study in menopausal patients. We selected the sample from april to july 2017 with menopausal patients who attended for the first time at the clinic who met the inclusion criteria, having a final sample of 29 patients. Patients with a complete study protocol who met the entry criteria were administered 50 mg of prasterone (Biolaif™) orally daily for 12 months, with a follow-up consultation every 3 months. Descriptive statistics were used for the statistical analysis. Also, Friedman's two-dimensional analysis was used. All statistical studies were conducted in the SPSS program, v.22. RESULTS: Sexual Function Index evaluated with 29 patients at 6 months increased from an average of 10.8 to 28.1. At 12 months with 18 patients, after the treatment with 50 mg prasterone orally daily, it increased from an average of 10.6 to 29.1. CONCLUSIONS: Sexual dysfunction is an underdiagnosed health problem in patients over the postmenopausal stage. Administration of prasterone (DHEA) at a dose of 50 mg orally daily improved the domains of Female Sexual Function Index of all our patients with statistically significant results, without side effects of hyperandrogenism.

Relación entre síndrome vasomotor y obesidad en pacientes con posmenopausia espontánea temprana / Vasomotor syndrome and the relationship with obesity in patients with early spontaneous postmenopause

Resumen OBJETIVO: Evaluar la relación entre síntomas vasomotores y obesidad en pacientes con posmenopausia espontánea temprana de una clínica de climaterio. MATERIALES Y MÉTODOS: Estudio transversal, prospectivo y observacional efectuado en pacientes posmenopáusicas atendidas en la Clínica de Climaterio del Hospital Juárez de México, entre junio y agosto de 2018. Se calculó una muestra de 140 pacientes, con base en la fórmula estadística para población infinita: n = Z2(PQ)/d2 con una precisión de 10% calculado y prevalencia de 33%. Criterios de inclusión: pacientes con posmenopausia espontánea temprana (etapa +1a, +1b y +1c del STRAW+10) que acudieron a consulta por síntomas vasomotores. El análisis estadístico se realizó con el programa SPSS versión 24. RESULTADOS: Se encontró relación estadísticamente significativa (p < 0.05) entre síntomas vasomotores y obesidad en pacientes con posmenopausia espontánea temprana. Del total de pacientes, 45.7% manifestó síntomas leves, 30% moderados y 24.3% severos. En el grupo de estudio, 16 de 70 reportaron síntomas leves, 30 de 70 moderados y 24 de 70 severos versus el grupo control con 48, 12 y 10 de 70 pacientes, respectivamente. CONCLUSIONES: Las pacientes posmenopáusicas con IMC alto (obesidad) tienen mayor posibilidad de sufrir síntomas vasomotores moderados-severos. Puesto que la obesidad es un factor de riesgo relacionado con síntomas vasomotores, se sugiere el control adecuado o disminución del del peso.

Abstract OBJECTIVE: Evaluate the relationship between obesity and vasomotor symptoms in patients with spontaneous early postmenopause of a climacteric clinic. MATERIALS AND METHODS: A cross-sectional, prospective and observational study was carried out in postmenopausal patients treated at the Climacteric Clinic of Hospital Juárez de México, between June and August of 2018. We calculated a sample of 140 patients, based on the same infinite population: n = Z2 (PQ) / d2 with a precision of 10% and prevalence of 33%. Inclusion criteria: patients with early spontaneous postmenopause (stage + 1a, + 1b and + 1c of STRAW + 10) who attended a consultation due to vasomotor symptoms. The statistical analysis was carried out with the SPSS program, version 24. RESULTS: A statistically significant relationship (p <0.05) was found between vasomotor symptoms and obesity in patients with early spontaneous postmenopause. Of the total of patients, 45.7% presented symptoms, 30% moderate and 24.3% severe. In the study group, 16 of 70 reported symptoms, 30 of 70 moderate and 24 of 70 severe versus the control group with 48, 12 and 10 of 70 patients, respectively. CONCLUSIONS: Postmenopausal patients with high BMI (obesity) are more likely to suffer moderate-severe vasomotor symptoms. It is a risk factor related to vasomotor symptoms.

[Consensus conference of the Mexican Association for the Study of Climateric on veralipride prescription for patients with vasomotor symptoms]. / Consenso de la Asociación Mexicana para el Estudio del Climaterio para la indicación de veraliprida a pacientes con síntomas vasomotores.

Vasomotor symptoms are one of the main reasons for climateric women to consult a physician. Hormone therapy is the first treatment choice, but it is not indicated to all patients. Veralipride is an option for those who cannot or will not try hormone treatment. The Mexican Association for the Study of Climateric (AMEC) assembled an interdisciplinary group of medical experts so that they revised the medical literature on the subject and reached a consensus on veralipride indication, doses, counterindications and safety. The recommendations of the consensus conference on veralipride are: (1) Physicians must be familiar with its indication, side effects, pharmacokinetics and dosage. (2) Patients must be informed on other therapeutical options. (3) Patients' mental and neurological state must be evaluated, in particular to identify movement disorders, extrapyramidal symptoms (tremor or dystonia), anxiety and depression that can be mistaken for climateric symptoms. (4) Any adverse effect associated with the drug must be reported. (5) A random multicenter trial must be carried out in order to identify the frequency and severity of side effects, and (6) Written information on possible health risks when using the drug must be provided.

[Antiphospholipid syndrome and human reproduction]. / Síndrome antifosfolipídico y reproducción humana.

Recurrent pregnancy loss is secondary to multiple illnesses. An important cause sometimes undiagnosed is the antiphospholipid syndrome, an autoimmune disease with various clinical alterations (miscarriage, hypertensive disorders, preterm delivery, vascular thrombosis, intrauterine retard growth, death intrauterine, abruption placentae). There are major and minor clinical criteria and precise indications that guide the physician to its recognition. Antibodies related with the syndrome are anticardiolipin and lupic anticoagulant, but other phospholipids seems to be implicated on this pathology and its participation on trombotic events is even unknown. Opportune diagnosis is of vital importance for fetomaternal morbidity and mortality. The repercussions are important during gestational stage, but effects c an persist o r even appear during the puerperium, predisposing t o trombotic events. The antiphospholipid s yndrome th at accompanies gestation, requires of efficient valuation and a special treatment, with a narrow prenatal surveillance. The best therapy for reproductive future which has less undesirable effects, is with heparin and acetylsalicylic acid administration; prednisone (steroids) is used in cases of active illness. The current knowledge about this disease makes possible that a pregnancy at term can be achieved with the least as possible number of complications.

[Mechanism of action of insulin sensitizer agents in the treatment of polycystic ovarian syndrome]. / Mecanismos de acción de los agentes sensibilizantes de insulina en el tratamiento del sindrome de ovario poliquístico.

Polycystic ovarian disease (PCOD) is the most important endocrine abnormality that affects women in reproductive age. It is characterized by chronic anovulation and hyperandrogenemia probably secondary to insulin resistance. Hence insulin sensitizers agents had been used in PCOD. Metformin is a biguanide used in the treatment of PCOD via decrease of hepatic gluconeogenesis and insulinemia; improvement peripheral glucose utilization, oxidative glucose metabolism, nonoxidative glucose metabolism and intracellular glucose transport. Such effects, when this drug is administered alone during 3 to 6 months, increase sex hormone binding globulin (SHBG), reduce free androgens index and hirsutism, decrease insulin resistance, and regulate menses in 60 to 70% of cases. Thiazolidinodiones are drugs that decrease insulin resistance in the liver with hepatic glucose production. Their mechanism of action is through the peroxisome proliferator-activated receptors gamma (PPAR-gamma), that help to decrease plasmatic concentrations of free fatty acids, pre and postprandial glucose, insulin, triglycerides, increased HDL cholesterol and decreased LDL, menses return to normality, with improvement of ovulation and decreased hirsutism. It seems that by modulation and attenuation of insulin resistance, hypoglucemic agents such as metfomin and thiazolidinodiones can be used effectively to treat anovulation, infertility and hyperandrogenemia.

[Hypogonadism caused by Gorlin-Goltz syndrome]. / Hipogonadismo causado por el síndrome de Gorlin-Goltz.

The Gorlin-Goltz syndrome is a dominant autosomic disorder characterized by cancerigenic predisposition and multiple development defects, apparently without reproductive compromise. The complex is characterized by four primary symptoms, which include nevoid basal cell epitheliomas malignantly prone, keratocystic jaw, skeletal abnormalities and intracranial calcifications. Apparently, reproductive problems reported had been rarely associated with this syndrome. We present the case of a patient with clinic stigmatae of Gorlin-Goltz syndrome, who had a characteristic progress as seen in the literature; he was the fifth product of a 43 year-old female (father was 48 years old); who at birth disclosed right eye microftalmy, bilateral cryptorchidism surgically treated at age of six. At puberty, an odontogenic cyst of the jaw was noted and enucleated. He also showed facial nevi in neck, thorax and abdomen. When he was admitted being 14 years old in our clinic, he had recurrent bilateral cryptorchidism, sexual immatturity and infertility. It is important to take into consideration Gorlin-Goltz stigmatae in cases of hypogonadism in order to recognize a further genetic influence.

[Present usefulness of diagnostic tests in hyperandrogenism]. / Utilidad actual de las pruebas diagnósticas de hiperandrogenismo.

There are diagnostic tests that allow to differentiate feminine hyperandrogenism of tumorous, non-tumorous, ovarian, adrenal and peripheral origin. We made a review of the current available tests accordingly to a case of amenorrhea and hyperandrogenism. By means of the low-dose dexamethasone suppression and human chorionic gonadotropin hormone (hCG) stimulation test we confirmed a suprarenal participation. There was spontaneous menses when treated with dexamethasone.

[Prevalence of postmenopausal simple ovarian cyst diagnosed by ultrasound]. / Prevalencia de quistes simples de ovario diagnosticados por ultrasonido en mujeres posmenopáusicas.

INTRODUCTION: The high-resolution ultrasound has taken to discover small ovary cysts in postmenopausal asymptomatic women who in another situation would not been detected; these cysts frequently disappear spontaneously and rarely develop cancer; however, they are treated aggressively. OBJECTIVE: To know the prevalence, evolution and treatment of ovary simple cysts in the postmenopausal women in our department, since in our country there are not studies that had analyzed these data. MATERIAL AND METHODS: We made a retrospective and descriptive study in the Service of Biology of the Human Reproduction of the Hospital Juarez de Mexico, in a four-year period (2000-2003) that included 1,010 postmenopausal women. The statistical analysis was made using the SPSS software program with which we obtained descriptive measurements in localization, dispersion and by a graphic analysis. RESULTS: We found a simple cysts prevalence of 8.2% (n = 83); the average of age at the diagnosis time was 50.76 years with a standard deviation of 5.55; the cysts diameter was between 0.614 to 12,883 cm with a mean and standard deviation of 2.542 and 1.91 cm respectively; in 27.71% of the cases (n = 23), the cysts disappear spontaneously in the follow up of 3 to 36 month (mean of 14.1). Surgery was indicated in 16.46% (n = 13), by increase in the size of the cyst in 9 patients (11.64%) and by changes in morphology from simple to complex in 4 (4.82%). Tumor like markers were made only to 37 patients (44.57%), which were in normal ranks; no carcinoma was found in this group. CONCLUSIONS: The prevalence of ovary simple cysts was similar to the reported in literature. Risk of cancer of these cysts is extremely low when a suitable evaluation is made, a reason why the conservative treatment is suggested when these are simple cysts lesser than 5cm with Ca-125 levels within normal ranks. We recommend a follow up every 3-6 months by Doppler color ultrasound and tumor like markers for five years.

[Early menarche as a risk factor of breast cancer]. / Menarquia temprana como factor de riesgo de cáncer de mama.

BACKGROUND: Most of the information in medical literature report diverse factors of breast cancer, which are related to the reproductive life of the woman. It is mentioned that menarche before the 12 years elevates the relative risk of this disease, in comparison with its appearance after the 13 years. OBJECTIVE: To determine if early menarche is a risk factor associated to breast cancer. MATERIAL AND METHODS: This retrospective, observational and descriptive study included 162 women with breast cancer from a 3 years period (2002-2004), in the Juarez Hospital of Mexico. In addition other well known risk factors for breast cancer were evaluated. The statistical analysis was made with the software program SPSS; the descriptive analysis was made by means of summary of statistics, histograms, box and bar charts. RESULTS: Early menarche doesn't have correlation with breast cancer nor with the appearance of the disease in early ages; it was present in the 12.3% (n = 20) of the patients; the menarche initiated between 12 and 13 years in 64.4% (n = 104.3) of the cases. The average age at the time of the diagnosis of breast cancer in the early menarche group was of 55 years and for the group in general of 47.6 years. The factor that seems to be related to breast cancer is overweight and obesity with 54.26 and 17.11% respectively, with an average body mass index of 27.7 kg/m2. CONCLUSIONS: There was not a correlation between early menarche as risk factor for breast cancer neither between the reproductive risk factors considered habitual and increased risk of breast cancer. Overweight and obesity seem to be related to the appearance of the disease, reason why it is required to investigate this with different random control groups in the country. We propose to study other factors that may be implicated in the genesis of breast cancer such as inflammatory factors, similar insulin growth factors and hyperinsulinism.

[Insulin sensitizers in the treatment of polycystic ovary]. / Sensibilizantes de la insulina en el tratamiento del ovario poliquístico.

Polycystic ovary is characterized by anovulation, hyperandrogenemia and insulin resistance. Hyperinsulinemia is known to be associated with an increase in cardiovascular risk and the development of diabetes mellitus. The finding that insulin resistance has important implications in the pathogenesis of polycystic ovarian disease has elicit the concept of a therapeutic approach of insulin-sensitizing drugs. Last decade multiple clinical trials about these drugs and upon genesis of polycystic ovary were designed; hence there is now sufficient evidence in the literature to support its clinical use. The management of polycystic ovary includes short-term objectives, such as treatment of infertility and control of androgen excess, as well as long-term considerations, such as prevention of endometrial cancer and management of dysmetabolic syndrome with its associated risk for developing type 2 diabetes and cardiovascular disease. The present review justifies the rationale use of insulin-sensitizing drugs in order to treat both short-term and long-term issues regarding polycystic ovarian disease.

[Epidemiological analysis of infertility in a Mexican population]. / Análisis epidemiológico de la infertilidad en una población mexicana.

BACKGROUND: Infertility is defined as the failure to conceive after a year of sexual life without a method of birth control. Most studies indicate that 15% of all couples will experience primary or secondary infertility in some moment of their reproductive life. OBJECTIVE: To gain knowledge of general characteristics from patients with infertility in our environment (social, clinical, diagnostic and therapeutic) that attended the Reproductive Biology Department of Hospital Juárez de Mexico. PATIENTS AND METHODS: A descriptive, observational, situational, and retrospective indagatory study was performed on 116 infertile patients, seen in the outpatient clinic, from January through December 1999. All had entered our protocol of infertility and selected treatment. RESULTS: The altered ovarian endocrine factor was the most frequent (82.7%), followed by cervical factor (80%), masculine factor (38%) and tuboperitoneal factor (29%). In most cases the cause was multifactorial. The percentage of successful pregnancies (31.88%) was similar to that reported in the literature. CONCLUSIONS: The most common factors that influence infertility resembled those exhibited by specialized clinics of affluent countries with similar pregnancy rates.

[Spermatogenesis arrest]. / Detención de la espermatogénesis.

Spermatogenesis arrest is a complex process of interruption in the differentiation of germinal cells of specific cellular type, which elicits an altered spermatozoa formation. In contrast, hypospermatogenesis is defined as a decrease in number of germ cells and its proportion. Factors identified intervening upon spermatogenesis arrest are: genetic, hormonal, growth factors, interaction between Sertoli and germ cells and ectoplasmic specialization integrity of spermatozoa. In addition, environmental toxic effects have shown to exert subletal and letal cellular damage with gene disruption. Hence in this work we review sperm physiology along with etiologic elements associated to spermatogenesis arrest delineating the most appropriate conduct for diagnosis and treatment.

[Heterosexual precocious puberty due to arrhenoblastoma. Postsurgical spontaneous pregnancy]. / Pubertad precoz heterosexual por arrenoblastoma: embarazo espontáneo postescisión.

It is presented the case of a female with heterosexual precocious puberty associated to hyperandrogenism and virilization due to arrhenoblastoma, who became pregnant after surgery. Clinical study: a 14-year-old female initiated at age 6 years with premature pubarche and telarche. By age 11, the patient only had one menstrual period along with virilization. Physical exam disclosed: facial acne, cricoid enlargement, breast Tanner II, pubic hair Tanner III, clitoromegaly of 4.5 cm and hypotrophy of labia majora. Ferriman and Gallwey: 12. Basal quantitation of circulating testosterone: 1.25 ng/mL (normal: 0.2 to 0.8 ng/mL), androstenedione 13.9 ng/mL (normal: 0.5 to 2.4 ng/mL). A pelvic ultrasonographic study showed: uterus of 66 x 25 x 30 mm, right ovary of 50 x 50 mm, hyperechoic with echolucid and nodular areas (vol. 65.3 cc). Left ovary was of 30 x 30 mm with echolucid areas of 2.0 mm (vol. 5.1 cc). Cariotype: 46XX. Surgical right oophorectomy was performed containing an ovoid tumor of 4 x 3 x 3 cm. Histologic analysis revealed a Sertoli Leydig (Type II, Mayoer) cell tumor. The patient resumed menses and became pregnant at age 20 (22 week obitus). In the last assessment, performed 6 years after surgery, the patient resumed normal menses, Ferriman and Gallwey 5, Tanner V and regression of clitoromegaly to 3.0 cm. In this case, surgery provided remission of hyperandrogenism, normal menstrual cycles and fertility restoration.

[Craniopharyngioma and its impact upon human reproduction: analysis of 15 cases at the Hospital Juarez de Mexico]. / Craneofaringioma y sus repercusiones en la reproducción humana: análisis de 15 casos en el Hospital Juárez de México.

BACKGROUND: Craniopharyngiomas are intracranial tumors of non-glial origin derived from cellular remnants of the Rathke's pouch. Their frequency is 1-3% of intracranial tumors and 13% of suprasellar neoplasms. Histologically, it is a benign lesion, albeit clinically severe with a high index of relapse and sequelae upon the reproductive function. OBJECTIVE: To identify the clinical characteristics of patients with craniopharyngiomas before and after treatment. MATERIAL AND METHODS: We reviewed our experience of 15 cases with craniopharyngioma seen at the Hospital Juarez de Mexico from 1995 throughout 2002. RESULTS: Prevalence was higher in males (ratio 2:1) with ages between 6-45 years old (X 17.9 +/- 6.45 years). The most common symptoms were cephalalgia (100%) and visual disorders (93%); the average levels of hormonal determination were in females: FSH 1.0 mIU/mL, LH 0.5 mIU/mL, estradiol 11.0 pg/mL, PRL 80 mg/mL. In males: FSH 1.7 mIU/mL, LH 2.6 mIU/mL, testosterone 0.6 mg/dL and PRL 29 mg/mL. All patients had hypogonadotropic hypogonadism. Tumoral relapse was mostly seen in patients who underwent only surgery (n = 7, 46.6%). The ones with surgery and radiotherapy (n = 8, 53.3%) did not disclose symptoms that required another surgery. CONCLUSIONS: The main repercussion of craniopharyngioma, due to its proximity to hypothalamus and hypophysis, is on the endocrine and reproductive areas of human being.

[Absence of antiosteopenic effect of hormone replacement therapy in postmenopausal women]. / Ausencia de efecto antiosteopénico de la terapia de reemplazo hormonal en mujeres posmenopáusicas.

BACKGROUND: Several studies suggest that hormone replacement therapy (HRT) stops bone loss in postmenopausal women while increasing their bone mineral density up to 20%; however, there are studies where hormone replacement therapy does not increase bone density, only prevents it. OBJECTIVE: To analyze the effect of hormone replacement therapy upon bone mineral density of hip and lumbar spine in postmenopausal women. MATERIAL AND METHODS: Clinical files of several patients with sudden menopause diagnosis seen at the Hospital Juarez of Mexico were reviewed in the year 2000. They received hormone replacement therapy of conjugated estrogens and medroxyprogesterone acetate, with annual controls of estradiol in blood, equal or higher than 50 pg/mL and bone mineral density measurement (BMD) with DEXA (dual energy X-ray absortiometry) central (hip and lumbar spine), and at least one control within a period of four years. 89 patients were included and four groups were determined: all of them had basal densitometry in one (group 1), two (group 2), three (group 3), and four years (group 4) of monitoring. The percentage of bone mineral density was calculated in both anatomic areas and per group. In each study group the number or patients that showed gain, loss or whose mineral bone density stayed the same was assessed. The statistical analysis was made using the Student t test. RESULTS: The 89 patients mean age was of 50.5 (SD +/- 6.42) years. All of them showed spontaneous menopause. The average time of menopause evolution was of 6.9 (SD +/- 4.7) years. The body mass index (BMI) average was of 27.5 (SD +/- 3.97) kg/m2. After admittance, all patients received hormone replacement therapy with conjugated equine estrogens (0.625 mg and medroxyprogesterone acetate 2.5 mg/day). A gain of bone mineral density in the second and third year of treatment in the left hip and in the lumbar spine was observed; however, there were no important differences in any study group when results were treated statistically. CONCLUSION: Hormone replacement therapy was not effective to prevent bone loss, neither to increase bone density. Only one treatment was tested, and might be necessary to investigate the effect of other routes of administration or formulations.

[The impact of prolactinoma in human reproduction]. / Impacto del prolactinoma en la reproducción humana.

AIMS: Prolactinomas represent a 60% of pituitary tumors with various symptoms, hormonal and reproductive abnormalities. OBJECTIVE: Assessment of epidemiology of prolactinomas in our hospital. PATIENTS AND METHOD: We reviewed the clinical charts of 32 patients seen throughout 1991-2001. RESULTS: Twenty seven patients (84%) were females and 5 (16%) males. Average age was 30.3 +/- SD 11.3 years with a range of 6 to 58 years. Menstrual irregularities was the most frequent finding in patients with micro and macroadenoma; infertility was seen in 4 (33%) patients with pituitary microadenoma and 2 (10%) with macroadenoma. A patient with macroadenoma had delayed puberty and another with microadenoma isosexual precocious puberty. All cases showed hyperprolactinemia (microadenomas x 94.5 +/- SD 96.4 ng/mL; macroadenomas x 108.8 +/- SD 79.4 ng/mL). Hypothyroidism and hypogonadal hypogonadotropism were the most common associated diagnoses before an after treatment for both groups. Radiologic presence of microadenoma was observed in 12 (38%) patients and in 20 (26%) with macroadenoma. Bitemporal hemianopsia was the most common finding during visual field evaluation (28% microadenoma, 44% macroadenoma). Pharmacologic treatment with bromocriptine (2.5 - 7.5 mg) prevailed and showed a major impact upon symptoms improvement and significant decrease of serum prolactin levels (p < 0.05). Only five patients out of 20 who underwent surgery developed transient diabetes insipidus. Tumor relapse was observed in 10 (63%) of 16 patients with macroadenomas that required surgery. CONCLUSIONS: In our study prolactinomas prevailed among females in reproductive age with a higher incidence of macroadenomas. The most common alterations related to reproductive tract were menstrual irregularities, galactorrhea, infertility, hyperprolactinemia, hypogonadism and hypothyroidism. Abnormalities of puberty were also seen. Treatment with dopaminergic agonists (bromocriptine) was highly effective to decrease prolactin circulating levels.

[Epidemiologic assessment of erectile function in a selected mexican population]. / Análisis epidemiológico de la función eréctil en una población mexicana escogida.

UNLABELLED: We determined the incidence, epidemiology and type of erectile dysfunction, as well as risk factors related to erectile function in a Mexican population. MATERIAL AND METHODS: 452 surveys were applied in direct form, integrated by 38 questions with open answers, dichotomics and multiple to men that accompanied patients that requested medical attention in our clinic and to workers of the Hospital Juárez de México, 18 years or older, with active sexual life, that knew how to read and write. An analytic, prospective and transverse study was performed; obtaining the incidence, frequency of presentation (organic or psychological) of erectile dysfunction and the odds ratio of risk factors observed in the study. RESULTS: The incidence of erectile dysfunction in the population studied was 26.1% (n = 118); 67.8% probably of psychological origin and 32.2% organic. People younger than 40 years had a presentation of 16.45% and for those > or = 40 years was 50%. Factors of risk: > or = 40 years (OR-5.08), Obesity (OR-1.48), started sexual life > or = 18 years (OR-1.17), intercourse < or = 3/week (OR-1.86), monthly income < or = 250 american dollars (OR-4.81), married (OR-1.39) and in free union (OR-1.44), peasants (OR-3.43), bricklayers (OR-2.96), merchants (OR-2.34), using antihypertensive medication (OR-6.18), with diabetes mellitus (OR-4.09). DISCUSSION: The incidence of erectile dysfunction and its psychological origin was higher than that referred in the literature revised; the higher risk factors associated to erectile dysfunction were: age, diabetes mellitus, obesity, and the use of antihypertensive drugs.

[Frequency of altered male factor in an infertility clinic]. / Frecuencia del factor masculino alterado en parejas que consultan por infertilidad.

UNLABELLED: Infertility is the incapacity of a couple to conceive after a year of regular sexual life without using a method for family planning. The infertility state is dependent on the female factor as well as masculine factor; an altered masculine factor is designated when any cause or causes of infertility reside in the male. The masculine factor as a cause of infertility is present in 40 to 50% of cases hence the importance of an integral evaluation of male alterations and its fertility. The World Health Organization (WHO) has proposed to classify the masculine infertility based on semen features. OBJECTIVE: To determine the frequency of the masculine factor altered in association to diagnosed abnormalities, according to the number of affected seminal indexes based on seminograms performed in infertile patients seen at the department of Human Reproductive Medicine, Hospital Juárez de México. MATERIAL AND METHODS: An observational, descriptive, transverse, retrospective study was performed. SUBJECTS: the seminograms practiced were reviewed from 571 clinical files of couples that the consultation for infertility from January 1993 to February 2001. Collection and analysis of semen samples was based on standards settled by WHO. RESULTS: Of 571 seminogram informs, 371 (65%) showed alterations in the seminal indexes, the stocking of age of this group was of 31.89 years +/- SD 6.3 years. Our findings were: azoospermia in 89 (23.98%), astenonecrozoospermia in 44 (11.85%), hypospermia in 43 (11.59%), astenozoospermia in 33 (8.89%), oligoastenozoospermia in 31 (8.35%) hyponecrozoospermia in 30 (8.08%), oligozoospermia in 25 (6.73%), others in 21 (5.7%), necrozoospermia in 19 (5.12%), hypoastenozoospermia in 18 (4.85%), cryptozoospermia in 11 (2.97%), and hypooligoastenozoospermia in 7 (1.88%). In 62.6% of seminograms practiced there was an isolated alteration, in 34.4% two alterations and in the remaining 3% more than two alterations. CONCLUSION: We found masculine factor altered in 65% of couples who were requiring consultation for infertility. The three main alterations of seminal indexes were azoospermia, astenonecrozoospermia and hypospermia.

[Polycystic ovarian disease: clinical and biochemical expression]. / Ovarios poliquísticos: expresión clínica y bioquímica.

UNLABELLED: The policystic ovary (PO) results from a systemic hormonal dysfunction, characterized by hyperandrogenemia, insulin resistance and anovulation. OBJECTIVE: Assessment was made of clinical and biochemical features of patients with PO. MATERIAL AND METHODS: A retrospective analysis of 211 clinical of charts of patients with ultrasonographic diagnosis of PO seen at the Hospital Juárez de México from 1996 to 2000 was performed. Evaluation was made of body mass index (BMI), waist hip index (WHI), Ferriman index, acanthosis nigricans, lipid and hormonal profile. RESULTS: Of patients studied (n = 211) 64% had infertility and abnormal menses associated to PO, while the rest was normal. Both groups (PO and normal), were similar in age and distribution as well as family back grown for diabetes mellitus, hypertensive disease and obesity. The clinical manifestations observed on patients with PO were infertility 79.16%, anovulation 68.42%, hirsutism 66.9% obesity (66.9%). Biochemical findings in PO patients vs normal patients were: hyperandrogenism (86.73% vs 71.4%), insulin resistance (60.46% vs 37.5%), dislipidemic (56.41% vs 31.5%), LH/FSH ratio > 2 (19.51% vs 10.51%). Regarding sensitivity and specificity for clinical and biochemical findings ranged from 0.64 at 0.90, minimum value had infertility and maximum anovulation; specificity (interval 0.31 to the 0.71) minor corresponded to hyperprolactinemia and higher to infertility. The estimated risk factor (OR) for the population studied exhibited anovulation (OR, 7; 95% IC, 1.79-32.92); infertility (OR, 4.51; 95% IC, 2.03-10.13); insulin resistance (OR, 3; 95% IC, 0.82-8.16); hyperandrogenism (OR, 2.61; 95% IC, 1.02-6.69); and obesity (OR, 2.16; 95% IC, 1.17-4). We concluded that population with PO has a higher risk of infertility, anovulation, obesity, hyperandrogenism, dyslipidemia, insulin resistance and abnormal menses.

Frecuencia y etiología de azoospermia en el estudio de parejas infértiles / Frequency and etiology of azoospermia during assessment of infertile couples

Una de cada 10 parejas busca apoyo por problemas de infertilidad, el hombre se estima sea el responsable de 30-50 por cientode casos y se atribuye a la azoospermia de 10 a 20 por ciento. Por lo anterior se decidió estudiar la frecuencia y etiología de la azoospermia en varones de matrimonios infértiles. Material y método. Se revisaron 331 casos de parejas infértiles vistas en el Servicio de Biología de la Reproducción Humana del Hospital Juárez de México, de enero de 1993 a febrero del 2000. Sesenta y seis pacientes tuvieron azoospermia (19.93 por ciento). Dependiendo de la etiología posible se solicitaron los estudios siguientes: seminogramas, ultrasonido testicular y transrectal, cariotipo, hormona foliculoestimulante, hormona luteinizante, testosterona, deferentovesiculografía y biopsia testicular. Resultados. Se excluyeron 12 pacientes (18.18 por ciento), nueve por abandono y tres por estar todavía en estudio. La etiología de los 54 casos restantes fue: secretora 46(85.19 por ciento); de estos los más frecuentes fueron la idiopática (41.3 por ciento), aplasia de células germinales (10.9 por ciento), varicocele (10.9 por ciento) y síndrome de Klinefelter (10.9 por ciento). Presentaron azoospermia secretora secundaria dos casos con síndrome de Kallman. Hubo un caso de azoospermia excretora y siete casos con azoospermia obstructiva. Conclusiones. La azoospermia se observó en 19.93 por ciento de 331 casos evaluados; la edad media de pacientes fue 30 años. Se registró 85.19 por ciento de azoospermia secretora primaria, con incremento de FSH en 85.8 por ciento y LH en 56.4 por ciento (p<0.05). La azoospermia obstructiva se observó en 12.96 por ciento y sólo un caso (1.85 por ciento) presentó azoospermia excretora.