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2006, Número 1

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Rev Endocrinol Nutr 2006; 14 (1)


Síndrome de ovario poliquístico
Posición de la Sociedad Mexicana de Nutrición y Endocrinología

Morán C, Hernández M, Cravioto MC, Porias HL, Malacara JM, Bermúdez JA

Idioma: Español
Referencias bibliográficas: 131
Paginas: 7-12
Archivo PDF: 116.94 Kb.


RESUMEN

El síndrome de ovario poliquístico (SOP) es un trastorno endocrino y metabólico, heterogéneo en su presentación clínica, de probable origen genético, pero también influenciado por factores ambientales como la nutrición y la actividad física. El SOP es el problema endocrino más frecuente de la mujer en edad reproductiva, con una prevalencia aproximada de 6%. La etiología del SOP es desconocida, pero se han podido demostrar alteraciones de tipo neuroendocrino, caracterizadas por disfunción gonadotrópica, y anormalidades metabólicas, determinadas por resistencia a la insulina. El diagnóstico del SOP se basa en la presencia de oligoovulación o anovulación, hiperandrogenismo clínico o bioquímico, y la imagen de ovarios poliquísticos al ultrasonido. El tratamiento médico del SOP debe ser integral, teniendo en cuenta las alteraciones metabólicas y conjuntamente los motivos específicos de consulta de la paciente. En general, el pronóstico para la fertilidad y para el control de los síntomas clínicos como hirsutismo o acné es favorable. Sin embargo, las pacientes con SOP deben ser evaluadas a largo plazo para evitar en lo posible el desarrollo de enfermedades metabólicas como la diabetes mellitus.


REFERENCIAS (EN ESTE ARTÍCULO)

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

  2. Horton R, Neisler J. Plasma androgens in patients with the polycystic ovary syndrome. J Clin Endocr 1968; 28: 479-484.

  3. Rosenfield RL, Ehrlich EN, Cleary RE. Adrenal and ovarian contributions to the elevated free plasma androgen levels in hirsute women. J Clin Endocrinol 1972; 34: 92-98.

  4. Yen SSC, Vela P, Rankin J. Inappropriate secretion of follicle-stimulating hormone and luteinizing hormone in polycystic ovarian disease. J Clin Endocrinol 1970; 30: 435-442.

  5. Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab 1980; 50: 113-116.

  6. Matteini M, Cortrozzi G, Bufalini GN, Relli P, Lazzari T. Hyperinsulinism and insulin resistance in the polycystic ovary syndrome as tested with tolbutamide. Boll Soc Ital Biol Sper 1982; 58: 1455-1460.

  7. Chang RJ, Nakamura RM, Judd HL, Kaplan SA. Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab 1983; 57: 356-359.

  8. Shoupe D, Kumar DD, Lobo RA. Insulin resistance in polycystic ovary syndrome. Am J Obstet Gynecol 1983; 147: 588-592.

  9. Pasquali R, Casimirri F, Venturoli S, Paradisi R, Mattiolo R, Capelli M, Melchionda N, Labo G. Insulin resistance in patients with polycystic ovaries: its relationship to body weight and androgen levels. Acta Endocrinol 1983; 104: 110-116.

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

  11. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI. A Survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 1999; 84: 4006-4011.

  12. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endrocrinol Metab 2000; 85: 2434-2438.

  13. Moran C, Tapia MC, Hernandez E, Vazquez G, Garcia Hernandez E, Bermúdez JA. Etiological review of hirsutism in 250 patients. Arch Med Res 1994; 25: 311-314.

  14. Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR. Androgen excess in women: experience with over 1,000 consecutive patients. J Clin Endocrinol Metab 2004; 89: 453-462. Revista de Endocrinología y Nutrición 2006;14(1):7-12

  15. Moran C, Hernandez E, Ruiz JE, Fonseca ME, Bermudez JA, Zarate A. Upper body obesity and hyperinsulinemia are associated with anovulation. Gynecol Obstet Invest 1999; 47:1-5.

  16. 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.

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

  18. The Rotterdam ESHRE/SARM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25.

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

  20. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981; 140: 815-830.

  21. Hines G, Moran C, Huerta R, Folgman K, Azziz R. Facial and abdominal hair growth in hirsutism: a computerized evaluation. J Am Acad Dermatol 2001; 45: 846-850.

  22. Slayden SM, Moran C, Sams WM, Boots LR, Azziz R. Hyperandrogenemia in patients presenting with acne. Fertil Steril 2001; 75: 889-892.

  23. Romaguera J, Moran C, Diaz-Montes TP, Hines GA, Cruz RI, Azziz R. Prevalence of 21-hydroxylase-deficient nonclassic adrenal hyperplasia and insulin resistance among hirsute women from Puerto Rico. Fertil Steril 2000; 74: 59-62.

  24. Pache TD, Wladimiroff JW, Hop WCJ, Fauser BCJM. How to discriminate between normal and polycystic ovaries: transvaginal US study. Radiology 1992; 183: 421-423.

  25. Azziz R, Hincapie LA, Knochenhauer ES, Dewailly D, Fox L, Boots LR. Screening for 21-hydroxylase deficient nonclassic adrenal hyperplasia among hyperandrogenic women: a prospective study. Fertil Steril 1999; 72: 915-925.

  26. Moran C, Garcia-Hernandez E, Barahona E, Gonzalez S, Bermudez JA. Relationship between insulin resistance and gonadotropin dissociation in obese and nonobese women with polycystic ovary syndrome. Fertil Steril 2003; 80: 1466-1472.

  27. Dunaif A, Mandeli J, Fluhr H, Dobrjansky A. The impact of obesity and chronic hyperinsulinemia on gonadotropin release and gonadal steroid secretion in the polycystic ovary syndrome. J Clin Endocrinol Metab 1988; 66: 131-139.

  28. Holte J, Bergh T, Berne C, Lithell H. Serum lipoprotein lipid profile in women with the polycystic ovary syndrome: relation to anthropometric, endocrine and metabolic variables. Clin Endocrinol 1994; 41: 463-471.

  29. Moran C, Knochenhauer E, Boots LR, Azziz R. Adrenal androgen excess in hyperandrgenism: relation to age and body mass. Fertil Steril 1999; 71: 671-674.

  30. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992; 167: 1807-1812.

  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. Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv 2004; 59: 141-154.

  33. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1998; 83: 2694-2698.

  34. Ciaraldi TP, El-Roeiy A, Madar Z, Reichart D, Olefsky JM, Yen SSC. Cellular mechanism of insulin resistance in polycystic ovarian syndrome. J Clin Endocrinol Metab 1992; 75: 577-583.

  35. Dunaif A, Xia J, Book CB, Schenker E, Tang Z. Excessive insulin receptor serine phosphorylation in cultured fibroblasts and in skeletal muscle. A potential mechanism for

  36. insulin resistance in the polycystic ovary syndrome. J Clin Invest 1995; 96: 801-810.

  37. Moran C, Huerta R, Conway-Myers BA, Hines GA, Azziz R. Altered autophosphorylation of the insulin receptor in the ovary of a woman with polycystic ovary syndrome. Fertil Steril 2001; 75: 625-628.

  38. Nagamani M, Stuart CA, Van Dinh T. Steroid biosynthesis in the Sertoli-Leydig cell tumor: Effects of insulin and luteinizing hormone. Am J Obstet Gynecol 1989; 161: 1738-1743.

  39. Stuart CA, Prince MJ, Peters EJ, Meyer III WJ. Hyperinsulinemia and hyperandrogenemia: In vivo androgen response to insulin infusion. Obstet Gynecol 1987; 69: 921-925.

  40. Dale PO, Tanbo T, Vaaler S, Abyholm T. Body weight, hyperinsulinemia, and gonadotropin levels in the polycystic ovary syndrome: evidence of two distinct populations. Fertil Steril 1992; 58: 487-491.

  41. Fulghesu AM, Cucinelli F, Pavone V, Murgia F, Guido M, Caruso A, Mancuso S, Lanzone A. Changes in luteinizing hormone and insulin secretion in polycystic ovary syndrome. Hum Reprod 1999; 14: 611-617.

  42. Lunde O, Magnus P, Sandvik L, Hoglo S. Familial clustering in the polycystic ovary syndrome. Gynecol Obstet Invest 1989; 28: 23-30.

  43. Govind A, Obhrai MS, Clayton RN. Polycystic ovaries are inherited as an autosomal dominant trait: analysis of 29 polycystic ovary syndrome and 10 control families. J Clin Endocrinol Metab (en prensa); 84: 38-43.

  44. Vink JM, Sadrzadeh S, Lambalk CB, Boomsma DI. Heritability of polycystic ovary syndrome in Dutch twin-family study. J Clin Endocrinol Metab (en prensa).

  45. Urbaneck M, Legro RS, Driscoll D, Strauss JF, Dunaif A, Spielman RS. Searching for the polycystic ovary syndrome genes. J Pediatric Endocrinol Metab 2000; 13 (Suppl 5): 1311-1313.

  46. El Mkadem SA, Lautier C, Macari F, Molinari N, Lefebvre P, Renard E, Gris JC, Cros G, Daures JP, Bringer J, White MF, Grigorescu F. Role of allelic variants Gly972Arg of IRS-1 and Gly1057Asp of IRS-2 in moderate-to-severe insulin resistance of women with polycystic ovary syndrome. Diabetes 2001; 50: 2164-2168.

  47. Urbanek M, Woodroffe A, Ewens KG, Diamanti-Kandarakis E, Legro RS, Strauss JF, Dunaif A, Spielman RS. Candida12 Carlos Morán y cols. Síndrome de ovario poliquístico te gene region for polycystic ovary syndrome on chromosome 19p13.2. J Clin Endocrinol Metab 2005; 90: 6623-6629.

  48. Kiddy DS, Hamilton-Fairley D, Bush A, Short F, Anyaoku V, Reed MJ, Franks S. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol 1992; 36: 105-111.

  49. Velazquez EM, Mendoza S, Hamer T, Sosa F, Glueck CJ. Metformin therapy in poycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism 1994; 43: 647-654.

  50. Venturoli S, Marescalchi O, Colombo FM, Macrelli S, Ravaioli B, Bagnoli A, Paradisi R, Flamigni C. A prospective randomized trial comparing low dose flutamide, finasteride, ketokonazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. J Clin Endocrinol Metab 1999; 84: 1304-1310.

  51. Hammerstein J, Moltz L, Schwartz U. Antiandrogens in the treatment of acne and hirsutism. J Steroid Biochem 1983; 19: 591-597.

  52. Yucelten D, Erenus M, Gurbuz O, Durmusoglu F. Recurrence rate of hirsutism after 3 different antiandrogen therapies. J Am Acad Dermatol 1999; 41: 64-68.

  53. Muhn P, Krattenmacher R, Beier S, Elger W, Schillinger E. Drospirenone: a novel progestogen with antimineralocorticoid and antiandrogenic activity. Contraception 1995; 51: 99-110.

  54. Loy R, Seibel MM. Evaluation and therapy of polycystic ovary syndrome. Endocrinol Metab Clin NA 1988; 17: 785-813.

  55. Zarate A, Hernandez-Ayup S, Rios-Montiel A. Treatment of anovulation in the Stein-Leventhal syndrome. Analysis of 90 cases. Fertil Steril 1971; 22: 188-193.

  56. Stadtmauer L, Oehninger S. Management of infertility in women with polycystic ovary syndrome: a practical guide. Treat Endocrinol 2005; 4: 279-292.

  57. Nestler JE, Stovall D, Akhter N, Iuorno MJ, Jakubowicz DJ. Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril 2002; 77: 209-215.

  58. Glueck CJ, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first trimester spontaneous abortion: a pilot study. Fertil Steril 2001; 75: 46-52.

  59. Moran C, Romero ML, Hernandez T, Merino G, Bermudez JA. Ovulation induction with FSH in polycystic ovary syndrome without clomiphene citrate response. ARTA 1997; 9: 59-63.

  60. Casper RF, Mitwally MF. Aromatase inhibitors for ovualtion induction. J Clin Endocrinol Metab 2006; 91: 760-771.

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

  68. Horton R, Neisler J. Plasma androgens in patients with the polycystic ovary syndrome. J Clin Endocr 1968; 28: 479-484.

  69. Rosenfield RL, Ehrlich EN, Cleary RE. Adrenal and ovarian contributions to the elevated free plasma androgen levels in hirsute women. J Clin Endocrinol 1972; 34: 92-98.

  70. Yen SSC, Vela P, Rankin J. Inappropriate secretion of follicle-stimulating hormone and luteinizing hormone in polycystic ovarian disease. J Clin Endocrinol 1970; 30: 435-442.

  71. Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab 1980; 50: 113-116.

  72. Matteini M, Cortrozzi G, Bufalini GN, Relli P, Lazzari T. Hyperinsulinism and insulin resistance in the polycystic ovary syndrome as tested with tolbutamide. Boll Soc Ital Biol Sper 1982; 58: 1455-1460.

  73. Chang RJ, Nakamura RM, Judd HL, Kaplan SA. Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab 1983; 57: 356-359.

  74. Shoupe D, Kumar DD, Lobo RA. Insulin resistance in polycystic ovary syndrome. Am J Obstet Gynecol 1983; 147: 588-592.

  75. Pasquali R, Casimirri F, Venturoli S, Paradisi R, Mattiolo R, Capelli M, Melchionda N, Labo G. Insulin resistance in patients with polycystic ovaries: its relationship to body weight and androgen levels. Acta Endocrinol 1983; 104: 110-116.

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

  77. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI. A Survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 1999; 84: 4006-4011.

  78. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endrocrinol Metab 2000; 85: 2434-2438.

  79. Moran C, Tapia MC, Hernandez E, Vazquez G, Garcia Hernandez E, Bermúdez JA. Etiological review of hirsutism in 250 patients. Arch Med Res 1994; 25: 311-314.

  80. Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR. Androgen excess in women: experience with over 1,000 consecutive patients. J Clin Endocrinol Metab 2004; 89: 453-462. Revista de Endocrinología y Nutrición 2006;14(1):7-12

  81. Moran C, Hernandez E, Ruiz JE, Fonseca ME, Bermudez JA, Zarate A. Upper body obesity and hyperinsulinemia are associated with anovulation. Gynecol Obstet Invest 1999; 47:1-5.

  82. 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.

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

  84. The Rotterdam ESHRE/SARM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25.

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

  86. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981; 140: 815-830.

  87. Hines G, Moran C, Huerta R, Folgman K, Azziz R. Facial and abdominal hair growth in hirsutism: a computerized evaluation. J Am Acad Dermatol 2001; 45: 846-850.

  88. Slayden SM, Moran C, Sams WM, Boots LR, Azziz R. Hyperandrogenemia in patients presenting with acne. Fertil Steril 2001; 75: 889-892.

  89. Romaguera J, Moran C, Diaz-Montes TP, Hines GA, Cruz RI, Azziz R. Prevalence of 21-hydroxylase-deficient nonclassic adrenal hyperplasia and insulin resistance among hirsute women from Puerto Rico. Fertil Steril 2000; 74: 59-62.

  90. Pache TD, Wladimiroff JW, Hop WCJ, Fauser BCJM. How to discriminate between normal and polycystic ovaries: transvaginal US study. Radiology 1992; 183: 421-423.

  91. Azziz R, Hincapie LA, Knochenhauer ES, Dewailly D, Fox L, Boots LR. Screening for 21-hydroxylase deficient nonclassic adrenal hyperplasia among hyperandrogenic women: a prospective study. Fertil Steril 1999; 72: 915-925.

  92. Moran C, Garcia-Hernandez E, Barahona E, Gonzalez S, Bermudez JA. Relationship between insulin resistance and gonadotropin dissociation in obese and nonobese women with polycystic ovary syndrome. Fertil Steril 2003; 80: 1466-1472.

  93. Dunaif A, Mandeli J, Fluhr H, Dobrjansky A. The impact of obesity and chronic hyperinsulinemia on gonadotropin release and gonadal steroid secretion in the polycystic ovary syndrome. J Clin Endocrinol Metab 1988; 66: 131-139.

  94. Holte J, Bergh T, Berne C, Lithell H. Serum lipoprotein lipid profile in women with the polycystic ovary syndrome: relation to anthropometric, endocrine and metabolic variables. Clin Endocrinol 1994; 41: 463-471.

  95. Moran C, Knochenhauer E, Boots LR, Azziz R. Adrenal androgen excess in hyperandrgenism: relation to age and body mass. Fertil Steril 1999; 71: 671-674.

  96. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992; 167: 1807-1812.

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

  98. Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv 2004; 59: 141-154.

  99. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1998; 83: 2694-2698.

  100. Ciaraldi TP, El-Roeiy A, Madar Z, Reichart D, Olefsky JM, Yen SSC. Cellular mechanism of insulin resistance in polycystic ovarian syndrome. J Clin Endocrinol Metab 1992; 75: 577-583.

  101. Dunaif A, Xia J, Book CB, Schenker E, Tang Z. Excessive insulin receptor serine phosphorylation in cultured fibroblasts and in skeletal muscle. A potential mechanism for insulin resistance in the polycystic ovary syndrome. J Clin Invest 1995; 96: 801-810.

  102. Moran C, Huerta R, Conway-Myers BA, Hines GA, Azziz R. Altered autophosphorylation of the insulin receptor in the ovary of a woman with polycystic ovary syndrome. Fertil Steril 2001; 75: 625-628.

  103. Nagamani M, Stuart CA, Van Dinh T. Steroid biosynthesis in the Sertoli-Leydig cell tumor: Effects of insulin and luteinizing hormone. Am J Obstet Gynecol 1989; 161: 1738-1743.

  104. Stuart CA, Prince MJ, Peters EJ, Meyer III WJ. Hyperinsulinemia and hyperandrogenemia: In vivo androgen response to insulin infusion. Obstet Gynecol 1987; 69: 921-925.

  105. Dale PO, Tanbo T, Vaaler S, Abyholm T. Body weight, hyperinsulinemia, and gonadotropin levels in the polycystic ovary syndrome: evidence of two distinct populations. Fertil Steril 1992; 58: 487-491.

  106. Fulghesu AM, Cucinelli F, Pavone V, Murgia F, Guido M, Caruso A, Mancuso S, Lanzone A. Changes in luteinizing hormone and insulin secretion in polycystic ovary syndrome. Hum Reprod 1999; 14: 611-617.

  107. Lunde O, Magnus P, Sandvik L, Hoglo S. Familial clustering in the polycystic ovary syndrome. Gynecol Obstet Invest 1989; 28: 23-30.

  108. Govind A, Obhrai MS, Clayton RN. Polycystic ovaries are inherited as an autosomal dominant trait: analysis of 29 polycystic ovary syndrome and 10 control families. J Clin Endocrinol Metab (en prensa); 84: 38-43.

  109. Vink JM, Sadrzadeh S, Lambalk CB, Boomsma DI. Heritability of polycystic ovary syndrome in Dutch twin-family study. J Clin Endocrinol Metab (en prensa).

  110. Urbaneck M, Legro RS, Driscoll D, Strauss JF, Dunaif A, Spielman RS. Searching for the polycystic ovary syndrome genes. J Pediatric Endocrinol Metab 2000; 13 (Suppl 5): 1311-1313.

  111. El Mkadem SA, Lautier C, Macari F, Molinari N, Lefebvre P, Renard E, Gris JC, Cros G, Daures JP, Bringer J, White MF, Grigorescu F. Role of allelic variants Gly972Arg of IRS-1 and Gly1057Asp of IRS-2 in moderate-to-severe insulin resistance of women with polycystic ovary syndrome. Diabetes 2001; 50: 2164-2168.

  112. Urbanek M, Woodroffe A, Ewens KG, Diamanti-Kandarakis E, Legro RS, Strauss JF, Dunaif A, Spielman RS. Candida12 Carlos Morán y cols. Síndrome de ovario poliquístico te gene region for polycystic ovary syndrome on chromosome 19p13.2. J Clin Endocrinol Metab 2005; 90: 6623-6629.

  113. Kiddy DS, Hamilton-Fairley D, Bush A, Short F, Anyaoku V, Reed MJ, Franks S. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol 1992; 36: 105-111.

  114. Velazquez EM, Mendoza S, Hamer T, Sosa F, Glueck CJ. Metformin therapy in poycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism 1994; 43: 647-654.

  115. Venturoli S, Marescalchi O, Colombo FM, Macrelli S, Ravaioli B, Bagnoli A, Paradisi R, Flamigni C. A prospective randomized trial comparing low dose flutamide, finasteride, ketokonazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. J Clin Endocrinol Metab 1999; 84: 1304-1310.

  116. Hammerstein J, Moltz L, Schwartz U. Antiandrogens in the treatment of acne and hirsutism. J Steroid Biochem 1983; 19: 591-597.

  117. Yucelten D, Erenus M, Gurbuz O, Durmusoglu F. Recurrence rate of hirsutism after 3 different antiandrogen therapies. J Am Acad Dermatol 1999; 41: 64-68.

  118. Muhn P, Krattenmacher R, Beier S, Elger W, Schillinger E. Drospirenone: a novel progestogen with antimineralocorticoid and antiandrogenic activity. Contraception 1995; 51: 99-110.

  119. Loy R, Seibel MM. Evaluation and therapy of polycystic ovary syndrome. Endocrinol Metab Clin NA 1988; 17: 785-813.

  120. Zarate A, Hernandez-Ayup S, Rios-Montiel A. Treatment of anovulation in the Stein-Leventhal syndrome. Analysis of 90 cases. Fertil Steril 1971; 22: 188-193.

  121. Stadtmauer L, Oehninger S. Management of infertility in women with polycystic ovary syndrome: a practical guide. Treat Endocrinol 2005; 4: 279-292.

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