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Colegio de Medicina Interna de México.

2012, Número 1

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Med Int Mex 2012; 28 (1)


Síndrome de ovario poliquístico: el enfoque del internista

Rodríguez FM

Idioma: Español
Referencias bibliográficas: 92
Paginas: 47-56
Archivo PDF: 299.12 Kb.


RESUMEN

El síndrome de ovario poliquístico es un estado hiperandrogénico reconocido como trastorno ginecológico en mujeres en edad fértil, por su fenotipo de exceso de hormonas androgénicas y por ser la principal causa de trastornos de la menstruación y la fertilidad que provocan el cuadro clínico clásico y que motivan la búsqueda de atención médica en la mayoría de las pacientes. Cada vez se apoya más el papel de los factores asociados y quizá predisponentes de la enfermedad, como la obesidad y la resistencia a la insulina, que han incrementado cada vez más su incidencia y repercusiones en la salud pública. En los últimos años se ha podido entender mejor cómo el exceso de hormonas androgénicas y las alteraciones ovulatorias del síndrome pueden interactuar con fenómenos metabólicos como la obesidad y la resistencia a la insulina, promoviendo una cascada de alteraciones en la secreción y función de hormonas y citocinas que contribuyen al cuadro clínico. Por ello, además de ser una enfermedad que requiere tratamiento por parte de ginecólogos y endocrinólogos para mejorar la fertilidad y disminuir las consecuencias del exceso de andrógenos, el síndrome de ovario poliquístico es un padecimiento que debe sospecharse, reconocerse y abordarse con medidas que, en muchos casos, incluyen la modificación de hábitos de alimentación y ejercicio en un grupo amplio de mujeres en la atención primaria y secundaria, en virtud de su elevada prevalencia en mujeres en edad reproductiva y por la relación que guarda con las enfermedades crónicas no trasmisibles.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Guzick DS. Polycystic Ovary Syndrome. Obstet & Gynecol 2004;103:181-193.

  2. Martínez-Bermejo E, Luque-Ramírez M, Escobar-Morreale HF. Obesity and the polycystic ovary syndrome. Minerva Endocrinol 2007;32(3):129-40.

  3. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanisms and implications for pathogenesis. Endocr Rev 1997;18:774-800.

  4. Schröder AK, Tauchert S, Ortmann O, Diedrich K, Weiss JM. Insulin resistance in patients with polycystic ovary syndrome. Ann Med 2004;36:426-439.

  5. Talbott E, Clerici A, Berga SL, Kuller L, Guzick D, Detre K, et al. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. Journal of Clinical Epidemiology 1998;51;415-422.

  6. Meirow D, Raz I, Yossepowitch O, Brzezinski A, Rosler A, Scherker JG, et al. Dyslipidaemia in polycystic ovarian syndrome: different groups, different aetiologies? Hum Reprod 1996;11(9):1848-1853.

  7. Berneis K, Rizzo M, Hersberger M, Rini GB, Fede GD, Pepe I, et al. Atherogenic forms of dyslipidaemia in women with polycystic ovary syndrome. Int J Clin Pract 2009;63(1):56-62.

  8. Stein IF, Leventhal ML. Amenorrhoea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935;29:181-191.

  9. Dunaif A, Givens JR, Haseltine FP, Merriam GR, eds. Polycystic ovary syndrome. Boston: Blackwell Scientific Publications, 1992: 377–384.

  10. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reprod 2004;19:41-47.

  11. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HE, Futterweit W, et al. Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline. J Clin Endocrinol Metab. 2006;91:4237-4245.

  12. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HE, Futterweit W, et al; (Task Force on the Phenotype of the Polycystic Ovary Syndrome of the Androgen Excess and PCOS Society). The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009;91(2):456-488.

  13. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and Characteristics of the Metabolic Syndrome in Women with Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2005;90:1929-1935.

  14. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrin Metab 1998;83:3078-3082.

  15. Gambineri A, Pelusa C, Vicennati V, Pagotto U, Pasquali, R. Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord 2002;26;883-896.

  16. Rivera JA, Barquera S, Campirano F, Campos I, Safdie M, Tovar V. Epidemiological and nutritional transition in Mexico: rapid increase of non-comunicable chronic diseases and obesity. Public Health Nutrition 2002;5(1A):113-122.

  17. Olaiz G, Rivera J, Shamah T, Rojas R, Villalpando S, Hernández M, et al. Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública, 2006.

  18. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:1929-1935.

  19. Ehrman EA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes mellitus in women with polycystic ovary syndrome. Diabetes Care 1999;22:141-146.

  20. Stern MP, Gonzalez C, Mitchell BD, Villalpando E, Haffner SM, Hazuda HP: Genetic and environmental determinants of type II diabetes in Mexico City and San Antonio. Diabetes 1992; 41:484-492.

  21. Tsilchorozidou T, Overton C, Conway GS. The pathophysiology of polycystic ovary syndrome. Clin Endocrinol 2004;60:1-17.

  22. Xita N, Georgiou I, Tsatsoulis A. The genetic basis of polycystic ovary syndrome. Eur J Endocrinol 2002;147:717-725.

  23. Franks S, Gharani N, Waterworth D, Batty S, White D, Williamson R, et al. The genetic basis of polycystic ovary syndrome. Hum Reprod 1997;12(12):2641-2648.

  24. Jakimiuk AJ, Weitsman SR, Navab A, Magoffin DA. Luteinizing Hormone receptor, Steroidogenesis Acute Regulatory Protein, and Steroidogenic Enzyme Messenger ribonucleic acids are overexpressed in thecal and granulosa cells from polycystic ovaries. J Clin Endocrinol Metab 2001;86:1318-1323.

  25. Hall JE, Taylor AE, Hayes FJ, Crowley WF. Insights into hypothalamic-pituitary dysfunction in polycystic ovary syndrome. J Clin Endocrinol Metab. 1998;21:602-611.

  26. Ehrman DA, Barnes RB, Rosenfield RL. Polycystic ovary syndrome as a form of functional ovarian hypendrogenism due to dysregulation of androgen secretion. Endocr Rev 1995;16(3):322-353.

  27. Mason H, Colao A, Blume-Peytavi U, Rice S, Qureshi A, Pellatt L, et al. Polycystic ovary syndrome (PCOS) trilogy: a translational and clinical review. Clin Endocrinol 2008;69:831-844.

  28. McKenna TJ. Current concepts: pathogenesis and treatment of polycystic ovary syndrome. N Engl J Med 1988;318:558-562.

  29. Snyder PJ. Editorial: the role of androgens in women. J Clin Endocrinol Metab 2001; 86:1006-1007.

  30. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: A prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999 84:165-169.

  31. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-1174.

  32. Vrbíková J, Bendlová B, Hill M, Vanková M, Vondra K, Stárka L. Insulin sensitivity and B-cell function in women with polycystic ovary syndrome. Diabetes Care 2002;25:1217-1222.

  33. Morales AJ, Laughlin GA, Bützow T, Maheshwari H, Baumann G, Yen SSC. Insulin, Somatotropic, and Luteinizing Hormone axes in lean and obese women with polycystic ovary syndrome: Common and distinctive features. J Clin Endocrinol Metab 1996;81:28542864.

  34. Dunaif A, Wu X, Lee A, Diamanti-Kandarakis E. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol Metab 2001;281:E392-E399.

  35. Tsai EC, Matsumoto AM, Fujimoto WY, Boyko EJ. Association of bioavailable, free, and total Testosterone with insulin resistance. Diabetes Care 2004;27(4):861-868.

  36. Laaksonen DE, Niskanen L, Punnonen K, Nyssönen, Tuomainen T, Salonen R, et al. Sex hormones, inflammation and the metabolic syndrome: a population based study. Eur J Endocrinol 2003;149:601-608.

  37. Dunaif A. Hyperandrogenic anovulation (PCOS): a unique disorder of insulin action associated with an increased risk of non-insulin-dependent diabetes mellitus. Am J Med 1995;98:33S-39S.

  38. Ming Li, Youngren JF, Dunaif A, Goldfine ID, Maddux BA, Zhang BB, et al. Decreased insulin receptor (IR) autophosphorylation in fibroblasts from patients with PCOS: Effects of serine kinase inhibitors and IR Activators. J Clin Endocrinol Metab 2002;87:4088-4093.

  39. O’Meara NM, Blackman JD, Ehrmann DA, Barnes RB, Jaspan JB, Rosenfield RL, et al. Defects in beta-cell function in functional ovarian hyperandrogenism. J Clin Endocrinol Metab 1993;76(5):1241-1247.

  40. Talbott E, Guzick D, Clerici A, Berga S, Detre K, Weimer K, et al. Coronary heart disease risk factors in women with polycystic ovary syndrome. Atheroscler Thromb Vasc Biol 1995;15:821-826.

  41. Cussons AJ, Watts GF, Burke V, Shaw JE, Zimmet PZ, Stuckey BGA. Cardiometabolic risk in polycystic ovary syndrome: a comparison of different approaches to defining the metabolic syndrome. Hum Reprod 2008;23(10):2352-2358.

  42. Bloomgarden ZT. American Association of Clinical Endocrinologists (AACE) Consensus Conference on the Insulin Resistance Syndrome. Diabetes Care 2003;26(3):933-939.

  43. Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C. Definition of Metabolic Syndrome. Circulation 2004;109:433-438.

  44. Diamanti-Kandarakis E, Spina G, Kouli C, Migdalis I. Increased Endothelin-1 levels in women with polycystic ovary syndrome and the beneficial effect of metformin therapy. J Clin Endocrinol Metab 2001;86:4666-4673.

  45. Shroff R, Kerchner A, Maifeld M, Van Beek EJR, Jagasia D, Dokras A. Young obese women with polycystic ovary syndrome have evidence of early coronary atherosclerosis. J Clin Endocrinol Metab 2007;92:4609-4614.

  46. Talbott EO, Guzick DS, Sutton-Tyrrell K, McHugh-Pemu KP, Zborowski JV, Remsberg KE, et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol 2000;20:2414-2421.

  47. Lakhani K, Seifalian AM, Hardiman P. Impaired carotid viscoelastic properties in women with polycystic ovaries. Circulation 2002;106:81-85.

  48. Vryonidou A, Papatheodorou A, Tavridou A, Terzi T, Loi V Vatalas IA, et al. Association of hyperandrogenemic and metabolic phenotype with carotid intima-media thickness in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90(5):2740-2746.

  49. Dunaif A. Drug insight: insulin-sensitizing drugs in the treatment of polycystic ovary syndrome-a reappraisal. Nat Clin Pract Endocrinol Metab 2008;4(5):272-283.

  50. Goh HH, Loke DFM, Ratnam SS. The impact of long-term testosterone replacement therapy on lipid and lipoprotein profiles in women. Maturitas 1995;21:65-70.

  51. Oh JY, Barrett-Connor E, Wedick NM, Wingard DL. Endogenous sex hormones and the development of type 2 diabetes in older men and women: The Rancho Bernardo Study. Diabetes Care 2002; 25(1):55-60.

  52. Wu FCW, Von Eckardstein A. Androgens and Coronary Artery Disease. Endocrine Reviews 2003;24(2):183-217.

  53. Goldberg RB, Rabin D, Alexander N, Doelle GC, Getz GS. Suppresion of plasma testosterone leads to an increase in serum total and High Density Lipoprotein cholesterol and apoproteins A-I and B. J Clin Endocrinol Metab 1985;60:203-206.

  54. LaCroix AZ, Yano K, Reed DM. Dehydroepiadrosterone sulfate, incidence of myocardial infarction, and extent of atherosclerosis in men. Circulation 1992;86:1529-1535.

  55. Bernini GP, Sgro M, Moretti A, Argenio GF, Barlascini CO, Cristofani R, et al. Endogenous androgens and carotid intimal-medial thickness in women. J Clin Endocrinol Metab 1999;84:2008-2012.

  56. English KM, Steed RP, Diver MJ, Jones TH, Channer KS. Low dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina. Circulation 2000;102:1906-1911.

  57. Carmina E, Chu MC, Longo RA, Rini GB, Lobo RA. Phenotypic variation in hyperandrogenemic women influences the findings of abnormal metabolic and cardiovascular risk parameters. J Clin Endocrinol Metab 2005;90(5):25452549.

  58. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: Implications, etiology and management. Am J Obstet Gynecol 1981;140(7):815-830.

  59. Cela E, Robertson C, Rush K, Kousta E, White DM, Wilson H, et al. Prevalence of polycystic ovaries in women with androgenic alopecia. Eur J Clin Endocrinol 2003;149:439-442.

  60. Yildiz BO. Assessment, diagnosis and treatment of a patient with hirsutism. Nat Clin Pract Endocrinol Metab 2008;4(5):294-300.

  61. Ferriman D, Gallwey JD. Clinical assessmen of body hair growth in women. J Clin Endocrinol Metab 1961;21:1440-1447.

  62. Collet C, Lecomte P, Guilloteau D, Lejeune B, Lecomte C, Besnard JC. Luteinizing hormone measurement in polycystic ovary syndrome: a practical approach. Eur J Endocrinol 1999;141:225-230.

  63. Kalro BN, Loucks TL, Berga SL. Neuromodulation in polycystic ovary syndrome. Obstet Gynecol Clin North Am 2001;28:35-62.

  64. Ming-I H, Tsan-Hon L, So-Jung L, Hung-Wen S, Chien-Hua W, Chun-Sen H. Inappropiate gonadotropin secretion in polycystic ovary síndrome. Fertil Steril. 2009;91(4):1168-1174.

  65. Deligeoroglou E, Athanasopoulos N, Tsimaris P, Dimopoulos KD, Vrachnis N, Creatsas G. Evaluation and management of adolescent amenorrea. Ann N Y Acad Sci. 2010;1205:23-32.

  66. Franks S. Morphology of the polycystic ovary syndrome. Boston: Blackwell;1992:19-28.

  67. Clayton RN, Orden V, Hodgkinson J, Worswick L, Rodin DA, Dyer S, et al. How common are polycystic ovaries in normal women and what is their significance for the fertility of the population. Clin Endocrinol 1992;37;127-134.

  68. American Diabetes Association. Executive Summary: Standards of Medical Care in Diabetes-2009. Diabetes Care 2009;32(S1):S6-S12.

  69. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from casting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-419.

  70. Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, et al. Homeostasis Model Assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity. Diabetes Care 2000;23:57-63.

  71. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 1979;237(3):E214-E223.

  72. Salley KES, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Position statement: Glucose intolerance in polycystic ovary syndrome -A position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007;92:4546-4556.

  73. Hamilton-Fairley D, Taylor A. Anovulation. BMJ 2003;327:546-549.

  74. Zulian E, Sartorato P, Benedini S, Baro G, Armanini D, Mantero F. Spironolactone in the treatment of polycystic ovary syndrome: effects on clinical features, insulin sensitivity and lipid profile. J Endocrinol Invest 2005;28(1):49-53.

  75. Norman RJ, Davies MJ, Lord J, Moran LJ. The role of lifestyle modification in polycystic ovary syndrome. Trends Endocrinol Metab 2002;13:251-257.

  76. Tang T, Glanville J, Hayden CJ, White D, Barth JH, Balen AH. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo- controlled, double-blind multicentre study. Hum Reprod 2006;21(1):80-89.

  77. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walter EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.

  78. Klein S, Serrad NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, et al. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Am J Clin Nutr 2004;80:257-263.

  79. Moran LJ, Brinkworth GD, Norman RJ. Dietary Therapy in Polycystic Ovary Syndrome. Sem Reprod Med. 2008;26(1):85-92.

  80. Jayagopal V, Kilpatrick ES, Holding S, Jennings PE, Atkin SL. Orlistat is as Beneficial as Metformin in the Treatment of Polycystic Ovarian Syndrome. J Clin Endocrinol Metab 2005;90:729-733.

  81. Legro RS. Polycystic ovary syndrome and cardiovascular disease: a premature association? Endocr Rev 2003;24:302-312.

  82. Diamanti-Kandarakis E, Baillargeon JP, Iuorno MJ, Jakubowicz DJ, Nestler JE. A modern medical quandary: Polycystic ovary syndrome, insulin resistance, and oral contraceptive pills. J Clin Endocrinol Metab 2003;88(5):1927-1932.

  83. De Leo V, La Marca A, Petraglia F. Insulin-lowering agents in the management of polycystic ovary syndrome. Endocr Rev 2003;24:633-667.

  84. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walter EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.

  85. Lord JM, Flight IHK, Norman RJ. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ 2003;327:1-6.

  86. Palomba S, Pasquali R, Orio F, Nestler JE. Clomiphene citrate, metformin or both as first-step approach in treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS): a systematic approach of head-to-head randomized controlled studies and meta-analysis. Clin Endocrinol 2009;70:311-321.

  87. Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab 2002;87:524-529.

  88. Romualdi D, Constantini B, Selvaggi L, Giuliani M, Cristello F, Macrì F, et al. Metformin improves endothelial function in normoinsulinemic PCOS patients: a new prospective. Hum Reprod 2008;23(9):2127-2133.

  89. Kelly CJG, Gordon D. The effect of metformin on hirsutism in polycystic ovary syndrome. Eur J Endocrinol 2002;147:217-221.

  90. Harborne L. Fleming R, Lyall H, Saltar N, Norman J. Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab 2003;88:4116-4123.

  91. Lemieux S, Lewis GF, Ben-Cherit A, Steiner G, Greenblatt EM. Correction of hyperandrogenemia by laparoscopic ovarian cautery in women with polycystic ovarian syndrome is not accompanied by improved insulin sensitivity or lipid-lipoprotein levels. J Clin Endocrinol Metab 1999;84:4278-4282.

  92. Bayram N, van Wely M, Kaaijk EM, Bossuyt PMM, van der Veen F. Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial. BMJ 2004;328:1-5.




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