Palabras clave
síndrome de ovarios poliquísticos
hiperandrogenismo ovárico funcional
hiperandrogenismo suprarrenal funcional
gonadotropinas hipofisarias
infertilidad
hiperandrogenismo ovárico funcional
hiperandrogenismo suprarrenal funcional
gonadotropinas hipofisarias
infertilidad
Cómo citar
Orrego, A. (2019). Acercamiento actualizado a la fisiopatología, clasificación y genética del síndrome de ovarios poliquísticos. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(2), 101–106. https://doi.org/10.53853/encr.6.2.484
Resumen
El síndrome de ovario poliquístico (SOP) parece surgir como un rasgo complejo que resulta de la interacción de diversos factores genéticos y ambientales. Una de las principales hipótesis es que el SOP resulta del hiperandrogenismo ovárico funcional (HOF) debido a la desregulación de la secreción de andrógenos. Hay una contribución de los andrógenos suprarrenales como la DHEA, que se metabolizan en el ovario a androstenediona y testosterona. Los factores hereditarios incluyen PCOM, hiperandrogenemia, resistencia a la insulina y defectos secretores de la insulina. Los factores ambientales incluyen la exposición prenatal a andrógenos y el crecimiento fetal deficiente, mientras que la obesidad adquirida es un factor posnatal importante. Un síndrome metabólico de resistencia a la insulina relacionada con la obesidad y/o intrínseca ocurre en aproximadamente la mitad de las pacientes con SOP, y el hiperinsulinismo compensatorio tiene efectos selectivos de tejido, que incluyen agravación del hiperandrogenismo. La variedad de vías involucradas y la falta de un hilo común atestiguan la naturaleza multifactorial y la heterogeneidad del síndrome. Conocer la base fundamental del trastorno es necesario para corregir de manera óptima los niveles de andrógenos, la ovulación y la homeostasis metabólica, y también para resolver los problemas de ginecología y obstetricia.
Citas
1. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005; 352: 1223-1236.
2. Lauritsen MP, Bentzen JG,Pinborg A, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Millerian hormone. Hum Reprod. 2014:29:791-801.
3. Stein IF, Leventhal MI. Amcnorrhea associated with bilateral polycistic ovaries. Am J Obstet Gynecol. 1935;29:181-191.
4. Azziz R, Adashi E Y. Stein and Leventhal: 80 years on. Am J Obstet gynecol. 1935; 29: 181-191.
5. Goldzieher MW, Green JA, The Polycystic Ovary. I. Clinical and histologic features. J Clin Endocrinol Metab. 1962;22:325-338.
6. Mcarthur JW, Ingersoll FM, Worcester J. The urinary excretion of intersticial-cell and follicle-stimulating hormone activity by women with disease of the repoductive system. J Clin Endocrinol Metab. 1958;18:1202-1215.
7. Yen SS, Vela P, Rankin J. Inappropiate secretion of follicle-stimulating hormone in polycystic ovarian disease. J Clin Endocrinol Metab. 1970;30:435-442.
8. Rosenfield RL, Ehrlich EN,Cleary R.Adrenal and ovarian contribution to the elevated free plasma androgens levels in hirsute women. J Clin Endocrinol Metab. 1972;34:92-98.
9. Futterweit W, Deligdisch L, Histopathological of effects exogenously administered testoterone in 19 female to male transsexuals.J Clin Endocrinol Metab 1986;62:16-21.
10. Franks S. Polycystic ovary syndrome: a changing perspective. Clin Endocrinol. 1989;31:87-120.
11. Hernandez ER, Resnick CE, Holtzclaw WD, et al. Insulin as a regulator of androgens biosynthesis by cultured rat ovarian cells: celular mechanism (s) underlying physiological pharmacological hormonal actions Endocrinology. 1988;122:2034
12. Cara JF, Rosenfield RL, Insulinlike growth factor 1 and insulin potentiate luteinizing hormone-Induced androgen synthesis by rat ovarian theca-intersticial cells. Endocrinology. 1998;123:733-739.
13. Barnes RB, Rosenfield RI, Bursteins S, et al. Pituitary-ovarian responses to nafarelin testing in the polycystic ovary syndrome. N Engl Med 1989;320:559-565.
14. Ronsenfield RL, Ehrman AD. The pathogenesis of polycystic ovary syndromre (PCOS): the hypothesis of PCOS as funcional ovary hyperandrogenism revisited. Endocrine Review. 2016;37:467-520.
15. Zawadzki J,Dunaif A. Diagnostic criteria for polycystic ovary syndrome: toward a rational approach. In Dunaif A,Givens J, Haseltine F, et al. Polycystic ovary syndrome. Cambridge, MA; Blackwell Scientific Publications. 1992:377-384.
16. Balen AH, Laven JS, Tan SL, et al. Ultrasound assessment of the polycystic ovary. International Consensus Definitions. Hum Reprod uptodate. 2003:9;505-514.
17. Rotterdam. ESHRE/ASRM- Sponsored PCOS Consensus Workshop Group. Revised 2003 consesus on diagnostic criteria and long-term health risks related to polycystic ovary síndrome. Fertil Steril 2004,81:29-25
18. Azziz R, Carmina E, Dewaily D, et al. The androgen excess and PCOS Society criteria for the polycytic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456- 488.
19. Rosenfield RL. The polycystic ovary sundrome spectrum. J pediatr Adolesc Gynecol. 201;28:412-419.
20. Martin KA, Chang RJ, Ehrmann DA, et al.Evaluation and treatment of hirsutism in premenopausal women. An Endocrine Society Clinical Practice Guideline. J Clin Endocrin Metab. 2008;93:1105-1120.
21. Lauritsen MP, Pinborg A,Loft et al. Revised Criteria for PCOS in WHO Group II anovulatory infertility-a revival of hypothalamic amenorrea?. Clin Endocrinol.2015;82:584-591.
22. Burger HG, Hale GE, Robertson DM. et al. A review of hormonal changes during the menopausal transition: focus of finding from the Melbourne Women`s Midlife health project. Hum Reprod uptodate. 2007;13:59-565.
23. Fauser BC, Tarlatzis BC,RW, et al. Consersus on Women`s health aspect of polycysctic ovary syndrome (PCOS): the Amsterdam ESHRE/ARM. Sponsored 3rd PCOS consensus Workshop Group. Fertil Steril. 2012;87:28-38-e25.
24. Miller WL, Auchus RJ. The molecular biology, biochemistry and physiology of human steroidogenesis and its disorders. Endocr Rev. 2011;32:81-151.
25. Dorfman RI, Forchielli, Gut M. Androgens biosynthesis and related studies. Rec Prog Horm Res. 1963;19:251-273.
26. Axelrod LR, Goldzieher JW. The polycystic ovary III.Steroid bosynthesis in nomal and polycystic ovarian tissue. J Clin Endocrinol. 1962;22;431-440.
27. Nelson VL, Qin KN, Rosenfield RL, et al. The bochemical basis for increased testosterona production in theca cell propagated from patients with polycystic ovary syndrome. J Clin Endocrinol Metab.1988;67:379-383.
28. Prizant H,Glincher N, Sen A. Androgens actions in the ovary: Balance is key. J Endocrinol. 2014,222:R141-R151.
29. Hirschfeld-Cytron, Barnes RB, Ehrmann DA, et al. Characterization of funcionally typical and atypical types of polycystic ovary syndrome. J Clin Endocrinal Metab. 2009;94:1587- 1594.
30. McCartney CR, Bellows AB, Grindrich MK, et al. Exagerated 17-Hidroxyprogesterone response to intravenous infusión of recombinant human LH in women with polycystic ovary syndrome. Am J Physiol Endocrinol Metab. 2004;286:E902-E908.
31. Ronsenfield RL. Polycistic ovary syndrome and insulin-resistance hyperinsulinemia. J Am Acad Dermatol. 2001;45:S095-S104.
2. Lauritsen MP, Bentzen JG,Pinborg A, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Millerian hormone. Hum Reprod. 2014:29:791-801.
3. Stein IF, Leventhal MI. Amcnorrhea associated with bilateral polycistic ovaries. Am J Obstet Gynecol. 1935;29:181-191.
4. Azziz R, Adashi E Y. Stein and Leventhal: 80 years on. Am J Obstet gynecol. 1935; 29: 181-191.
5. Goldzieher MW, Green JA, The Polycystic Ovary. I. Clinical and histologic features. J Clin Endocrinol Metab. 1962;22:325-338.
6. Mcarthur JW, Ingersoll FM, Worcester J. The urinary excretion of intersticial-cell and follicle-stimulating hormone activity by women with disease of the repoductive system. J Clin Endocrinol Metab. 1958;18:1202-1215.
7. Yen SS, Vela P, Rankin J. Inappropiate secretion of follicle-stimulating hormone in polycystic ovarian disease. J Clin Endocrinol Metab. 1970;30:435-442.
8. Rosenfield RL, Ehrlich EN,Cleary R.Adrenal and ovarian contribution to the elevated free plasma androgens levels in hirsute women. J Clin Endocrinol Metab. 1972;34:92-98.
9. Futterweit W, Deligdisch L, Histopathological of effects exogenously administered testoterone in 19 female to male transsexuals.J Clin Endocrinol Metab 1986;62:16-21.
10. Franks S. Polycystic ovary syndrome: a changing perspective. Clin Endocrinol. 1989;31:87-120.
11. Hernandez ER, Resnick CE, Holtzclaw WD, et al. Insulin as a regulator of androgens biosynthesis by cultured rat ovarian cells: celular mechanism (s) underlying physiological pharmacological hormonal actions Endocrinology. 1988;122:2034
12. Cara JF, Rosenfield RL, Insulinlike growth factor 1 and insulin potentiate luteinizing hormone-Induced androgen synthesis by rat ovarian theca-intersticial cells. Endocrinology. 1998;123:733-739.
13. Barnes RB, Rosenfield RI, Bursteins S, et al. Pituitary-ovarian responses to nafarelin testing in the polycystic ovary syndrome. N Engl Med 1989;320:559-565.
14. Ronsenfield RL, Ehrman AD. The pathogenesis of polycystic ovary syndromre (PCOS): the hypothesis of PCOS as funcional ovary hyperandrogenism revisited. Endocrine Review. 2016;37:467-520.
15. Zawadzki J,Dunaif A. Diagnostic criteria for polycystic ovary syndrome: toward a rational approach. In Dunaif A,Givens J, Haseltine F, et al. Polycystic ovary syndrome. Cambridge, MA; Blackwell Scientific Publications. 1992:377-384.
16. Balen AH, Laven JS, Tan SL, et al. Ultrasound assessment of the polycystic ovary. International Consensus Definitions. Hum Reprod uptodate. 2003:9;505-514.
17. Rotterdam. ESHRE/ASRM- Sponsored PCOS Consensus Workshop Group. Revised 2003 consesus on diagnostic criteria and long-term health risks related to polycystic ovary síndrome. Fertil Steril 2004,81:29-25
18. Azziz R, Carmina E, Dewaily D, et al. The androgen excess and PCOS Society criteria for the polycytic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456- 488.
19. Rosenfield RL. The polycystic ovary sundrome spectrum. J pediatr Adolesc Gynecol. 201;28:412-419.
20. Martin KA, Chang RJ, Ehrmann DA, et al.Evaluation and treatment of hirsutism in premenopausal women. An Endocrine Society Clinical Practice Guideline. J Clin Endocrin Metab. 2008;93:1105-1120.
21. Lauritsen MP, Pinborg A,Loft et al. Revised Criteria for PCOS in WHO Group II anovulatory infertility-a revival of hypothalamic amenorrea?. Clin Endocrinol.2015;82:584-591.
22. Burger HG, Hale GE, Robertson DM. et al. A review of hormonal changes during the menopausal transition: focus of finding from the Melbourne Women`s Midlife health project. Hum Reprod uptodate. 2007;13:59-565.
23. Fauser BC, Tarlatzis BC,RW, et al. Consersus on Women`s health aspect of polycysctic ovary syndrome (PCOS): the Amsterdam ESHRE/ARM. Sponsored 3rd PCOS consensus Workshop Group. Fertil Steril. 2012;87:28-38-e25.
24. Miller WL, Auchus RJ. The molecular biology, biochemistry and physiology of human steroidogenesis and its disorders. Endocr Rev. 2011;32:81-151.
25. Dorfman RI, Forchielli, Gut M. Androgens biosynthesis and related studies. Rec Prog Horm Res. 1963;19:251-273.
26. Axelrod LR, Goldzieher JW. The polycystic ovary III.Steroid bosynthesis in nomal and polycystic ovarian tissue. J Clin Endocrinol. 1962;22;431-440.
27. Nelson VL, Qin KN, Rosenfield RL, et al. The bochemical basis for increased testosterona production in theca cell propagated from patients with polycystic ovary syndrome. J Clin Endocrinol Metab.1988;67:379-383.
28. Prizant H,Glincher N, Sen A. Androgens actions in the ovary: Balance is key. J Endocrinol. 2014,222:R141-R151.
29. Hirschfeld-Cytron, Barnes RB, Ehrmann DA, et al. Characterization of funcionally typical and atypical types of polycystic ovary syndrome. J Clin Endocrinal Metab. 2009;94:1587- 1594.
30. McCartney CR, Bellows AB, Grindrich MK, et al. Exagerated 17-Hidroxyprogesterone response to intravenous infusión of recombinant human LH in women with polycystic ovary syndrome. Am J Physiol Endocrinol Metab. 2004;286:E902-E908.
31. Ronsenfield RL. Polycistic ovary syndrome and insulin-resistance hyperinsulinemia. J Am Acad Dermatol. 2001;45:S095-S104.
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