[New medical treatments for polycystic ovary syndrome]. / Les nouveaux traitements médicaux du syndrome des ovaries polykystiques.

Polycystic ovary syndrome (PCO) is a polygenic disease worsened by obesity and environmental factors. PCO is characterized by chronic menstrual irregularity and hypofertility and metabolic disorders. Routine care includes appropriate diet, exercise and annual check-up to search for high blood pressure. Laboratory tests should include a lipid profile and fasting serum glucose. Insulin sensitizing drugs improve the metabolic pattern, induce ovulation and increase pregnancy rate. Here, we review the different therapeutic options for these patients.

[Polycystic ovary syndrome: treatment with insulin-sensitizing agents]. / Traitement du syndrome des ovaires polykystiques par les anti-diabétiques oraux.

Polycystic ovary syndrome (PCOS) is a common disorder. Its prevalence is 5 to 10% in women of reproductive age. PCOS is associated with hyperinsulinism and insulin resistance. The pathophysiological situations has lead many authors to study the action of insulin-sensitizing agents on menses, ovulation rate, and pregnancy in patients with PCOS. Metformin (a member of the biguanide family), is used for treatment of type II diabetes mellitus in obese patients. Although metformin restores cyclic pituitary- gonadal function and improves fertility, it can decrease levels of androgen and LH and increase levels of SHBG in women with PCOS. Trooglitazone (a member of the thiazolidinedione family) has been withdrawn from use because of its liver toxicity. Troglitazone improves ovulation and hisrsutism in women with PCOS without change in body mass index. Other similar drugs with less liver toxicity may be useful for the treatment of PCOS. D-chiro-inositol is a mediator of insulin action and improves ovulatory cycles. Most of the studies reported have not been randomized but the results appear to be quite promising. These drugs may provide a substantial advance in the treatment of women with polycystic ovary syndrome.

[Hypertension and diabetes]. / Hypertension artérielle et diabète.

Hypertension is often associated with diabetes mellitus. Its physiopathology is different when it's a question of type 1 or type 2 diabetes mellitus. In the case of type 1 diabetes mellitus, hypertension is often the result of a underlying nephropathy. In the case of type 2 diabetes mellitus, hypertension is more often essential and it lies within a plurimetabolic syndrome and insulin resistance context. In all cases, hypertension worsens the patients' prognostics, increasing the risk of macrovascular and microvascular complications. The optimal blood pressure control allows to limit their evolution. It is necessary to fight against all cardiovascular risks like sedentary lifestyle, obesity, tabacco or hyperlipemia. ANAES recommends a blood pressure control lower or equal to 140/80 mmHg. In type 1 diabetes mellitus, the angiotensin converting enzyme inhibitors (ACE) are the first recommended treatment because of their action in case of nephropathy. In type 2 diabetes mellitus, besides ACE, diuretics. beta-blockers can be used in first line. Often, therapeutic associations are necessary.