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Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán

2003, Número 3

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Rev Biomed 2003; 14 (3)


Síndrome de ovarios poliquísticos: abordaje diagnóstico y terapéutico

Vargas-Carrillo MA, Sánchez-Buenfil G, Herrera-Polanco J, Vargas-Ancona L

Idioma: Español
Referencias bibliográficas: 89
Paginas: 191-203
Archivo PDF: 298.04 Kb.


RESUMEN

El síndrome de ovarios poliquísticos es una entidad frecuente en la mujer joven. La importancia de su diagnóstico radica en la exclusión de patologías potencialmente graves, como las neoplasias ováricas y adrenales o la hiperplasia adrenal congénita y en el reto que representa para los clínicos, en cuanto a prevención se refiere, por su nexo fisiopatológico con los estados de resistencia a la insulina e hiperinsulinemia compensatoria. Hoy sabemos que estas mujeres tienen riesgos significativamente elevados de diabetes tipo 2, hipertensión arterial y cardiopatía isquémica, lo que repercute en un aumento en su mortalidad. La presente revisión ofrece una actualización del tema, haciendo énfasis en los aspectos clínicos y las implicaciones de su fisiopatología en las decisiones médicas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Dewailly D. Definition of polycystic ovary syndrome. Hum Fertl 2000; 3: 73-6.

  2. Balen A, Rajkowha M. Polycystic ovary syndrome-a systemic disorder? Best Pract Res Clin Obstet Gynaecol 2003; 17: 263-74.

  3. American Association of Clinical Endocrinologists Medical guidelines for clinical practice for the diagnosis and treatment of hyperandrogenic disorders. Hyperandrogenic Disorders Task Force. Endocrine Practice 2001; 7: 120-34.

  4. Wild RA. Obesity, lipids, cardiovascular rik and androgen excess. Am J Med. 1995; 98: 27S-32S.

  5. Consenso Mexicano de Resistencia a la Insulina y Síndrome Metabólico. Rev Mex Cardiol 1999; 10: 3-19.

  6. Slowey MJ. Polycystic Ovary syndrome: new perspective on and old problem. South Med J 2001; 94: 190-6.

  7. Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord 2002; 26: 883-96.

  8. Ehrmann DA, Barnes RB, Rosenfield RL. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999 22: 141-6.

  9. Legro RS, Dunaif A. The role of insulin resistance in polycystic ovary syndrome. Endocrinologist 1996; 6: 307-21.

  10. Wild RA. Metabolic and cardiovascular issues in women with androgen excess. Endocrinologist. 1996; 6: 86-92.

  11. Wild S, Perpoint T, Jacobs H, McKeigue P. Long term consequences of polycystic ovary syndrome: results of a 31 year follow-up study. Hum Fertil 2000; 3: 101-5.

  12. Dahlgreen E, Janson PO, Lapidus L, Oden A. Polycystic ovary syndrome and risk for myocardian infarction. Acta Obstet Gynecol Scand 1992; 71: 599-603.

  13. Birdsall MA, Farquhar C, White H. Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catheterization. Ann Intern Med 1997; 126: 32-5.

  14. Harvad Health Letter. In Brief: Irregular periods linked to Heart Attacks. Harvard Health Online Books and Newsletters. November 2002. p. 874-8.

  15. Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med. 2001; 111: 665-6.

  16. Dejaguer S, Pichard C, Giral P, Bruckert E, Federspield MC, Beucler I, et al. Smaller LDL particle size in women with polycystic ovary syndrome compared to controls. Clin Endocrinol 2001; 54: 455-62.

  17. Sabuncu T, Vural H, Harma M, Harma M. Oxidative stress in polycystic ovary syndrome and its contribution to the risk of cardiovascular disease. Clin Biochem 2001; 34: 407-13.

  18. Paradisi G, Steinberg HO, Hempfling A. Polycistic ovary syndrome is associated with endothelial dysfunction. Circulation 2001; 103: 1410-5.

  19. Taskinen MR. Triglyceride is the major atherogenic lipid in NIDDM. Diabetes/Metabolism Reviews, 1997; 13: 93-8.

  20. Betteridge D. Cholesterol is the major atherogenic lipid in NIDDM. Diabetes/Metabolism Reviews, 1997; 13: 99-104.

  21. Ambrosch A, Muhlen I, Kope D. LDL size distribution in relation to insulin sensitivity and lipoprotein pattern in young and healthy subjects. Diabetes Care 1998; 21: 2077-84.

  22. Vrbikova J, Bendlova B, Hill M, Vankova M, Vondra K, Starka L. Insulin sensitivity and beta cell function in women with polycystic ovary syndrome. Diabetes Care 2002; 25: 1217-22.

  23. Kelly CJ, Lyall H, Petrie JR, Gould GW, Connell JM, Rumley A, et al. A specific elevation in tissue plasminogen activator antigen in women with polycistic ovary syndrome. J Clin Endocrinol Metab 2002; 87: 2387-90.

  24. Loverro G, Lorusso F, Mei L, Depalo R, Cormio G, Selvaggi L. The plasma homocysteine levels are increased in polycystic ovary syndrome. Gynecol Obstet Invest 2002; 53: 157-62.

  25. Kashyap S, Claman P. Polycistic ovary disease and the risk of pregnancy induced hypertension. J Reprod Med 2000; 45: 991-4.

  26. Cibula D, Skrha J, Hill M, Fanta M, Haakova L, VrbIkova J, Zivny J. Prediction of insulin sensitivity in nonobese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2002; 87: 5821-5.

  27. Quibrera R, Vargas L, Avila H. Epidemiología de la obesidad en México. En Vargas L, Bastarrachea R, Laviada H, Gonzalez J, editores Obesidad Consenso. México: Mc Graw Hill; 2002. p. 25-48.

  28. Vargas-Ancona L. Epidemiología de la Diabetes Mellitus, Intolerancia a la glucosa y factores de riesgo aterogénico en Yucatán, México. Rev Biomed 1994: 5: 151-9.

  29. Laviada H, Vargas L, Arroyo P, Pardío J, Fernández V. Prevalencia de Diabetes Mellitus Tipo 2 en la población urbana de Yucatán. Revista de Endocrinología y Nutrición 1999; 7: 82

  30. Valles S, Vargas L, Laviada H, Pardío J. Prevalencia de Dislipidemias en la población urbana de Yucatán. Revista de Endocrinología y Nutrición 1999; 7: 82.

  31. Poretsky L, Piper B. Insulin resistance, hypersecretionof LH, and a dual-defect hypothesis for the pathogenesis of polycystic ovary syndrome. Obstet Gynecol 1994; 84:613–21

  32. Poretsky L. Insulin resistance and hyperandrogenism: Update 1994. Endoc Rev 1994; 2: 26-35

  33. Poretsky L, Kalin MF. The gonadotropic function of insulin. Endoc Rev 1987; 8: 145-9

  34. Barbieri RL, Makris A, Randall RW, Daniels G, Kistner RW, Kenneth JR. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986; 62: 904-9.

  35. Poretsky L, Grigorescu F, Seibel M, Moses AC, Flier JS. Distribution and characterization of insulin and insulin-like growth 1 receptors in normal human ovary. J Clin Endocrinol Metab. 1985; 61:355-62

  36. Rosenbaum D, Haber RS, Dunaif A. Insulin resistance in polycystic ovary syndrome: decreased expresión of Glut-4 glucose transporters in adipocytes. Am J Physiol 1993; 264: 197-202.

  37. Taylor AE. Polycystic ovary syndrome. Endoc Metab Clin N A 1998; 27: 877-902.

  38. Poretsky L. The insulin-related ovarian regulatory system in health and disease. Endoc Rev 1999; 20: 535-82.

  39. Moran C, Asís R. The role of the adrenal cortex in polycistic ovary síndrome. Obstet Gynecol Clin N A 2001; 28: 63-75.

  40. McCarney CR, Eagleson CA, Marshall JC. Regulation of gonadotropin secretion: implications for polycystic ovary syndrome. Sem Reprod Med 2002; 20: 317-26.

  41. Shaw JC. Acne: effect of hormones on pathogenesis and management. Am J Clin Dermatol 2002; 3: 571-8.

  42. Katz AS, Goff DC, Feidman SR. Acanthosis nigricans in obese patients: presentations and implications for prevention of atherosclerotic vascular disease. Dermatol Online J 2000; 6: 25-8

  43. Rendon MI, Cruz PD Jr, Sonheimer RD, Bergstresser PR. Acanthosis Nigricans: A cutaneous marker of tissue resistance to insulin. J Am Acad Dermatol 1989; 21: 461-9.

  44. Stuart CA, Driscoll MS, Lundsquit KF, gilkison CR, Shaheb S, Smith MM. Acanthosis nigricans. J Basic Clin Physiol Pharmacol 1998; 9: 407-18.

  45. Varthakavi PK, Patel KL, Wadhwa SL, Shopkar U, Sengupta RA, Merchant PC, Mahtalia SD, Nihalani KD. A study of insulin resistance in subjects with acanthosis nigricans. J Assoc Physicians India 2001; 49: 705-12.

  46. Hud JA Jr, Cohen JB. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol 1992; 128: 941-4.

  47. Gilkison C, Stuart CA. Assessment of patients with acanthosis nigricans skin lesions for hiperinsulinemia, insulin resistance and diabetes risk. Nurse Pract 1992; 17: 26-8.

  48. Dunaif A, Graf M, Mandeli J. Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J Clin Endocrinol Metab 1987; 65: 499-507.

  49. Burke JP, Hale D. A quantitative scale of acanthosis nigricans. Diabetes Care, 1999; 22: 1655-9.

  50. Penttila TL, Koskinen P. Obesity regulates bioavailable testosterone levels in women with oy without polycystic ovary syndrome. Fertil Steril 1999; 71: 457-61.

  51. Asís R. 21-Hidroxylase-deficient nonclassic adrenal hyperplasia. Endocrinologist 1995; 5:297-303.

  52. Kloss R, Gross M. Incidentally discovered adrenal masses. Endoc Rev 1995; 18: 460-81.

  53. Barzon L, Scaroni C. Risk factors and long-term follow up of adrenal incidentalomas. J Clin Endocrinol Metab 1999; 84: 520-6.

  54. Moran LJ, Noakes M, Clifton PM. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88: 812-9.

  55. Bagis T, Gockcel A. The effects of short term medroxyprogesterone acetate and micronized progesterone on glucose metabolism and lipid profiles in patients with polycystic ovary syndrome: A prospective randomized study. J Clin Endocrinol Metabolism 2002; 87: 4536-40.

  56. Mastorakos G, Koliopoulos C, Creatsas G. Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives. Fertil Steril 2002; 77: 919-27.

  57. Bloomgarden ZT, Futterweit W. Use of insulin-sensitizing agents in patients with polycystic ovary syndrome. Endoc Pract 2001; 7: 279-86.

  58. Ciotta L, De Leo V. Endocrine and metabolic effects of insulin sensitizers in the treatment of patients with polycystic ovary syndrome and hyperinsulinemia. Gynecol Obstet Invest 2001; 51: 44-50.

  59. Nestler JE, Stovall D. Strategies for the use on insulin sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril 2002; 77: 209-15.

  60. Blonde L, Guthrie RD, Sandberg MI. Metformin: an effective and safe agent for initial monotherapy in patients with non-insulin-dependent diabetes mellitus. Endocrinologist 1996; 6: 431-8.

  61. Ibáñez L, Valls C, Ferrer A. Sensitizacion to insulin induces ovulation in nonobese adolescents with anovulatory hyperandrogenism. J Clin Endocrinol Metab 2001; 86: 3595-8.

  62. Batunkan C, Baysal B. Metformin improves ovulation and pregnancy rates in patients with polycystic ovary syndrome. Arch Gynecol Obstet 2001; 265: 124-7.

  63. Stadtmauer LA, Tona SK, Riehl RM, Tarbert LM. Impact of metformin therapy on ovarian stimulation and outcome in coasted patients with polycystic ovary syndrome undergoing in vitro fertilization. Reprod Biomed Online 2002; 5: 112-5.

  64. Moghetti P, Castello R, Negri C. Metformin effects on clinical features, endocrine and metabolic profiles and insulin sensitivity in polycystic ovary syndrome: A randomized, double-blind, placebo-controlled 6 month trial, followed by open, long term clinical evaluation. J Clin Endocrinol Metab 2000; 85: 139-46.

  65. Loverro G, Lorusso F, De Pergola G, Nicolardi V, Mei L, Selvaggi L. Clinical and endocrinological effects of 6 months of metformin treatment in young hyperinsulinemic patients affected by polycystic ovary syndrome. Gynecol Endocrinol 2002; 16: 217-24.

  66. Kelly CJ, Gordon D. The effect of metformin on hirsutism in polycystic ovary syndrome. Eur J Endocrinol 2002; 147: 217-21.

  67. Elter K. Clinical, endocrine and metabolic effects of metformin added to ethinyl estradiol-cyproterone acetate in non-obese women with polycystic ovary syndrome: A randomized controlled study. Hum Reprod 2002; 17: 1729-37.

  68. Ibañez L, Valls C. Additive effects of insulin sensitizing and anti androgen treatment in young, nonobese women with hyperinsulinism, hyperandrogenism, dylipidemia and anovulation. J Clin Endocrinol Metab 2002; 87: 2870-4.

  69. Nestler JE, Jacubowicz DJ, Evans WS, Pasquali R. Effects of Metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Eng J Med 1998; 338: 1876-80.

  70. Vrbikova J, Hill M,Starka I. The effects of long term metformin treatment on adrenal and ovarian steroidogenesis in women with polycystic ovary syndrome. Eur J Endocrinol 2001; 144: 619-28.

  71. Arslanian SA. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to ACTH with reduction of insulinemia/insulin resistance. J Clin Endocrinol & Metab. 2002; 87: 1555-9.

  72. Park KS, Ciaraldi TP, Lindgren K. Troglitazone effects on gene expression in human skeletal muscle of type 2 diabetes involve up regulation of peroxime proliferator activated receptor gamma. J Clin Endocrinol Metab 1998; 83: 2830-5.

  73. Dunaif A, Scott D, Finegood D. The insulin-sensitizing agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endoc Metab 1996; 81: 3299-306.

  74. Azziz R, Ehrmann D. Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: A multicenter, double blind, placebo controlled trial. J Clin Endocrinol Metab 2001; 86: 1626-31.

  75. Paradisi G, Steinberg HO. Troglitazone therapy improves endothelial function to near normal levels in women with polycystic ovary syndrome. J Clin Endocrinol & Metab. 2003; 88: 576-80.

  76. Conway GS. Polycystic ovary syndrome: Clinical aspects. Clin Endocrinol Metabol 1996; 10:263-79.

  77. Moghetti P, Castello R, Negri C. Metformin effects on clinical features, endocrine and metabolic profiles and insulin sensitivity in polycystic ovary syndrome: A randomized, double-blind, placebo-controlled 6 month trial, followed by open, long term clinical evaluation. J Clin Endocrinol Metab 2000; 85: 139-46.

  78. Bateman BG, Nunley WCJ, Kolp LA. Exogenous estrogen therapy for treatment of clomiphene citrate-induced cervical mucus abnormalities: is ti effective? Fertil Steril 1990; 54:557-80.

  79. Polson DW, Kiddy DS, Mason HD, Franks S. Induction of ovulation with clomiphene citrate in women with polycystic ovary syndrome: the difference between responders and nonresponders. Fertil Steril 1999; 51: 30-4.

  80. Sing KB, Dunnihoo DR, Mahajan DK, Bairnsfather LE. Clomiphene-Dexamathasone treatment of clomiphene resistant women with polycystic ovary syndrome. J Reprod Med 1992; 37:215-8.

  81. Issacs JD, Lincolns SR, Cowan BD. Extended clomiphene citrate and prednisona for treatment of chronic anovulation resistant to clomiphene citrate alone. Fertil Steril 1997; 67: 641-3.

  82. Agarwal SK, Buyalos RP. Corpus luteum function and pregnancy rates with clomiphene citrate teraphy: comparison of human chorinic gonadotropin-induced versus spontaneous ovultation. Hum Reprod 1995; 10: 111-30.

  83. Homburg R, Esthel A, Armar NA, Tucker M. One hundred pregnancies after treatment with pulsatile luteinizing hormone releasing hormone to induce ovulation. Br Med J 1999; 289: 809-12.

  84. Tan SL, Farhi J, Homburg R, Jacobs HS, Induction of ovulation in clomiphene resistant polycystic ovary syndrome with pulsatile GnRH. Obstet Gynecol 1996; 88: 221-6

  85. Prevelic GM, Puzigaca Z, Balint-Peric LJA. Effects of an oral contraceptive containing cyproterone acetate on the symptoms, hormone profile and ovarian volumen of hirsute women with polycystic ovarian syndrome. Ann NY Acad Sci 1997; 687: 255-62.

  86. Wiebe RH, Morris CV. Effect of anoral contraceptive on adrenal and ovarian androgenic steroids. Obstet Gynecol 1994; 63:12-4.

  87. Jeffcoate W. Treatment of women with hirsutism. Clin Endocrinol 1993; 38:727-35.

  88. Lobo RA, Shoupe D, Serafini P, Brinton D, Horton R. Effects of spironolactone on serum androgens and anagen hair in hirsute women. Fertil Steril 1999; 43:200-5.

  89. Shaw JC. Spironolactone in dermatologic therapy. J Am Acad Dermatol 2001; 24:236-43.




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