Polymorphisms of the genes CTLA4, PTPN22, CD40, and PPARG and their roles in Graves' disease: susceptibility and clinical features.

PURPOSE: CTLA4, PTPN22, and CD40 are immune-regulatory genes strongly associated with GD, as well as PPARG, but their clinical significance in different populations is still uncertain. METHODS: We genotyped 282 Brazilian GD patients (234 women and 48 men, 39.80 ± 11.69 years old), including 144 patients with GO, and 308 healthy control individuals (246 women and 62 men, 36.86 ± 12.95 years old). RESULTS: A multivariate analysis demonstrated that the inheritance of the GG genotype rs3087243 of CTLA4 (OR = 2.593; 95% CI = 1.630-4.123; p < 0.0001) and the CC genotype of rs3789607 of PTPN22 (OR = 2.668; 95% CI = 1.399-5.086; p = 0.0029) consisted in factors independent of the susceptibility to GD. The inheritance of polymorphic genotypes of rs5742909 of CTLA4 was associated with older age at the time of diagnosis (42.90 ± 10.83 versus 38.84 ± 11.81 years old; p = 0.0105), with higher TRAb levels (148.17 ± 188.90 U/L versus 112.14 ± 208.54 U/L; p = 0.0229) and the need for higher therapeutic doses of radioiodine (64.23 ± 17.16 versus 50.22 ± 16.86; p = 0.0237). The inheritance of the CC genotype of rs1883832 CD40 gene was more frequent among women (69.65%) than men (52.00%; p = 0.0186). The polymorphic genotype of PPARG gene (rs1801282) was associated with TPOAb positivity (p = 0.0391), and the GG genotype of rs2476601 of PTPN22 gene was associated with positivity for both TgAb (p = 0.0360) and TPOAb (p < 0.0001). Both polymorphic genotypes rs2476601 and rs3789607 of the PTPN22 gene were more frequent among nonsmoking patients (p = 0.0102 and p = 0.0124, respectively). CONCLUSIONS: Our data confirm the important role of CTLA4 polymorphisms in GD susceptibility; demonstrate the role of PTPN22 polymorphisms in patients' clinical features; and suggest these genes may influence the severity of the disease.

THYROID ACROPACHY: A RARE MANIFESTATION OF GRAVES DISEASE IN JOINTS.

OBJECTIVE: The objective of this report was to describe a patient with Graves acropachy, a rare manifestation of Graves disease (GD) that is clinically defined by skin tightness, digital clubbing, small-joint pain, and soft tissue edema progressing over months or years with gradual curving and enlargement of the fingers. METHODS: The patient was evaluated regarding thyroid function (serum free T4 [FT4] and thyroid-stimulating hormone [TSH] quantifications) and autoimmunity biomarkers (thyroid receptor antibody [TRAb]) as well as radiographic investigation of the extremities. RESULTS: A 52-year-old man presented with a history of thyrotoxicosis and clinical signs of Graves orbitopathy. Laboratory tests showed suppressed TSH (0.01 UI/L; normal, 0.4 to 4.5 UI/L) and elevated serum FT4 (7.77 ng/dL; normal, 0.93 to 1.7 ng/dL), with high TRAb levels (40 UI/L; normal, <1.75 UI/L). A diagnosis of thyrotoxicosis due to GD was made and the patient was treated with methimazole. After the patient complained of swelling in hands and feet, X-ray evaluation was conducted and established the thyroid acropachy. CONCLUSION: We present a case of a patient with GD associated with worsening extrathyroid manifestations during orbitopathy, dermopathy, and developed acropachy in hands and feet.

Serum selenium and selenoprotein-P levels in autoimmune thyroid diseases patients in a select center: a transversal study.

OBJECTIVE: Selenium (Se) supplementation has been used to help prevent the progression of Graves' ophthalmopathy (GO) and autoimmune thyroid diseases (AITD) patients. We investigated Se serum and selenoprotein P (SePP) levels in Graves' disease (GD) with and without GO, Hashimoto's thyroiditis (HT) patients and in 27 control individuals (C). SUBJECTS AND METHODS: We studied 54 female and 19 male patients: 19 with GD without GO, 21 GD with GO, 14 with HT and 19 with HT+LT4. Se values were measured using graphite furnace atomic absorption spectrophotometry. Serum SePP levels were measured by ELISA. RESULTS: Median Se levels were similar among all groups; GD patients: 54.2 (46.5-61.1 µg/L), GO: 53.6 (43.5-60.0 µg/L), HT: 51.9 (44.6-58.5 µg/L), HT+LT4 54.4 (44-63.4) and C group patients: 56.0 (52.4-61.5 µg/L); P = 0.48. However, serum SePP was lower in GO patients: 0.30 (0.15-1.05 µg/mL) and in HT patients: 0.35 (0.2-1.17 µg/mL) compared to C group patients: 1.00 (0.564.21 µg/mL) as well as to GD patients: 1.19 (0.62-2.5 µg/mL) and HT+LT4 patients: 0.7 (0,25-1.95); P = 0.002. Linear regression analysis showed a significant relationship between SePP and TPOAb values (r = 0.445, R2 = 0.293; P < 0.0001). Multiple regression analysis found no independent variables related to Se or SePP. CONCLUSION: A serum Se concentration was lower than in some other countries, but not significantly among AITD patients. The low serum SePP levels in GO and HT patients seems to express inflammatory reactions with a subsequent increase in Se-dependent protein consumption remains unclear.

Frequency of obesity and related risk factors among school children and adolescents in a low-income community. A cross-sectional study.

CONTEXT AND OBJECTIVE: The frequency of obesity at an early age may contribute to atherosclerosis and cardiovascular disease (CVD) in adults. This study measured the frequency of obesity and cardiovascular risk factors in children and adolescents aged 6 to 17 years. DESIGN AND SETTING: Cross-sectional study in a school located in a region of low income and socioeconomic status in Santa Rita do Sapucai, Minas Gerais, Brazil. METHODS: A total of 175 students were classified using body mass index (BMI) and their waist circumference, blood pressure, number of hours of sedentary behavior and school meals were evaluated. Serum concentrations of fasting blood glucose, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were analyzed. RESULTS: 37.2% of the students had BMI above the 85th percentile and had significantly lower age, higher prevalence of hypertension, higher serum TC, LDL-C and TG, and greater waist circumference than those with BMI below the 85th percentile. Hypertension was observed in 2.9% of the students; 5.1% presented impaired glucose tolerance, 40% had two risk factors for atherosclerosis and 26.9% had three risk factors. A sedentary lifestyle was significantly less prevalent among subjects with BMI above the 85th percentile and was significantly correlated with serum TC and LDL-C. The school meals were hypoglycemic, hyperproteic and hyperlipidemic. CONCLUSION: One third of the children and adolescents had weights greater than or equal to the age-adjusted weight, and this was associated with greater waist circumference, hypertension and prevalence of dyslipidemia.

High serum TSH levels are associated with depression in the elderly.

In order to investigate the association between elevated serum TSH levels and depression in the elderly, we conducted a population-based study of 451 over 60-year-old outpatients of a general University Hospital. Patients were divided into Group I (GI) (248 individuals) with high serum TSH levels, but otherwise no important condition or disease, and Group II (GII) (203 patients) with no previous diagnosis of thyroid or mood disease, referred to the hospital because of nonthyroidal severe diseases. All patients were clinically examined and classified according to DMS-IV for mood disturbance and had serum TSH, free T4 levels and antithyroid antibodies measured. High serum TSH levels (11.6+/-14.8 mU/l) were observed in 65/203 (32%) patients of GII. Among these patients, 42/65 (65%) had normal free T4 concentrations (1.23+/-0.98 ng/dl), no clinical manifestation of hypothyroidism and thus were considered to present subclinical hypothyroidism. Depression was observed in 24 cases from GI (9.7%) and 29 from GII (14.3%) and was frequent in the subclinical hypothyroid patients (49%). Our results suggest that mood disturbances are frequent in the elderly with elevated serum TSH levels, but they do not differ in the primary hypothyroid and the nonthyroidal sick patients.

[Subclinical thyroid disease: subclinical hypothyroidism and hyperthyroidism]. / Disfunções mínimas da tiróide: hipotiroidismo subclínico e hipertiroidismo subclínico.

Subclinical hypothyroidism (SHT) and subclinical hyperthyroidism (SCH) are defined as normal serum free T4 and T3 levels associated with elevated (SHT) or subnormal (SCH) serum TSH levels, respectively. Symptoms and signs of thyroid dysfunction are scarce. The prevalence is low. In SHT, total cholesterol and LDL-C are modestly elevated and levothyroxine may influence the lipids levels. There is decreased cardiac contractility and increased peripheral vascular resistance that improve with treatment. SCH is associated with atrial fibrillation, increased cardiac contractility and left ventricular mass, diastolic and systolic dysfunction that can be reversed with beta-adrenergic antagonists. Bone density is reduced in SCH. Depression, panic disorders and alterations in cognitive testing are frequent in SHT. Treatment of SHT is recommended for serum TSH levels greater than 8 mU/L and presence of thyroid antibodies. Endogenous SCH should be treated for serum TSH levels less than 0.1 mU/L, in the presence of symptoms and in elderly patents.

[Evaluation of body weight in patients with Graves' disease during the treatment with methimazole]. / Avaliação do peso corporal em pacientes com doença de Graves durante o tratamento com metimazol.

OBJECTIVE: To evaluate weight change during hyperthyroidism treatment, and to correlate it with IL-6 and TNF-alpha concentrations. SUBJECTS AND METHODS: Forty two patients were included. Body weight (BW), body mass index (BMI), clinical and laboratory characteristics were recorded. IL-6 and TNF-alpha were determined before treatment with methimazole (MMI) and in euthyroidism. RESULTS: BW was 59.62 ± 11.5 kg in hyperthyroidism, and 69.91 ± 14.4 kg in euthyroidism (p < 0.001). BMI increased from 23.1 ± 3.8 kg/m(2) to 27 kg/m(2) ± 4.7 during treatment (p < 0.0001). Before treatment, 66.6% subjects had BMI < 25 kg/m(2) and 33.3%, BMI > 25 kg/m(2). In euthyroidism, 38% of patients had BMI < 25 kg/m(2) and 62%, BMI > 25 kg/m(2) (p = 0.01). In euthyroidism, we found a significant reduction in IL-6 and TNF-alpha concentrations, but no correlation between IL-6 and TNF-alpha, and BW or BMI. CONCLUSION: An important increase in BW and BMI was observed during hyperthyroidism treatment, and IL-6 and TNF-alpha alterations were only related with return to euthyroidism.

Serum selenium and selenoprotein-P levels in autoimmune thyroid diseases patients in a select center: a transversal study

ABSTRACT Objective: Selenium (Se) supplementation has been used to help prevent the progression of Graves' ophthalmopathy (GO) and autoimmune thyroid diseases (AITD) patients. We investigated Se serum and selenoprotein P (SePP) levels in Graves' disease (GD) with and without GO, Hashimoto's thyroiditis (HT) patients and in 27 control individuals (C). Subjects and methods: We studied 54 female and 19 male patients: 19 with GD without GO, 21 GD with GO, 14 with HT and 19 with HT+LT4. Se values were measured using graphite furnace atomic absorption spectrophotometry. Serum SePP levels were measured by ELISA. Results: Median Se levels were similar among all groups; GD patients: 54.2 (46.5-61.1 μg/L), GO: 53.6 (43.5-60.0 μg/L), HT: 51.9 (44.6-58.5 μg/L), HT+LT4 54.4 (44-63.4) and C group patients: 56.0 (52.4-61.5 μg/L); P = 0.48. However, serum SePP was lower in GO patients: 0.30 (0.15-1.05 μg/mL) and in HT patients: 0.35 (0.2-1.17 μg/mL) compared to C group patients: 1.00 (0.564.21 μg/mL) as well as to GD patients: 1.19 (0.62-2.5 μg/mL) and HT+LT4 patients: 0.7 (0,25-1.95); P = 0.002. Linear regression analysis showed a significant relationship between SePP and TPOAb values (r = 0.445, R2 = 0.293; P < 0.0001). Multiple regression analysis found no independent variables related to Se or SePP. Conclusion: A serum Se concentration was lower than in some other countries, but not significantly among AITD patients. The low serum SePP levels in GO and HT patients seems to express inflammatory reactions with a subsequent increase in Se-dependent protein consumption remains unclear.

Frequency of obesity and related risk factors among school children and adolescents in a low-income community. A cross-sectional study / Frequência de obesidade e fatores de risco relacionados em escolares e adolescentes em uma comunidade de baixa renda. Um estudo transversal

CONTEXT AND OBJECTIVE: The frequency of obesity at an early age may contribute to atherosclerosis and cardiovascular disease (CVD) in adults. This study measured the frequency of obesity and cardiovascular risk factors in children and adolescents aged 6 to 17 years. DESIGN AND SETTING: Cross-sectional study in a school located in a region of low income and socioeconomic status in Santa Rita do Sapucai, Minas Gerais, Brazil. METHODS: A total of 175 students were classified using body mass index (BMI) and their waist circumference, blood pressure, number of hours of sedentary behavior and school meals were evaluated. Serum concentrations of fasting blood glucose, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were analyzed. RESULTS: 37.2% of the students had BMI above the 85th percentile and had significantly lower age, higher prevalence of hypertension, higher serum TC, LDL-C and TG, and greater waist circumference than those with BMI below the 85th percentile. Hypertension was observed in 2.9% of the students; 5.1% presented impaired glucose tolerance, 40% had two risk factors for atherosclerosis and 26.9% had three risk factors. A sedentary lifestyle was significantly less prevalent among subjects with BMI above the 85th percentile and was significantly correlated with serum TC and LDL-C. The school meals were hypoglycemic, hyperproteic and hyperlipidemic. CONCLUSION: One third of the children and adolescents had weights greater than or equal to the age-adjusted weight, and this was associated with greater waist circumference, hypertension and prevalence of dyslipidemia. .

CONTEXTO E OBJETIVO: A frequência de obesidade em idade precoce pode contribuir para a aterosclerose e doença cardiovascular (DCV) em adultos. Este estudo mediu a frequência de obesidade e fatores de risco cardiovascular em crianças e adolescentes com idades entre 6 e 17 anos. TIPO DE ESTUDO E LOCAL: Estudo transversal em escola localizada numa região de baixa renda e baixo nível socioeconômico em Santa Rita do Sapucaí, Minas Gerais, Brasil. MÉTODOS: Um total de 175 alunos foi classificado pelo índice de massa corporal (IMC) e foram aferidas circunferência da cintura, pressão arterial, horas de sedentarismo e alimentação escolar. Realizaram-se dosagens séricas de glicemia de jejum, colesterol total (CT), triglicerídeos (TG), lipoproteína de baixa densidade (LDL-C) e lipoproteína de alta densidade (HDL-C). RESULTADOS: 37,2% dos alunos tinham IMC acima do percentil 85 e apresentaram idade significativamente menor, prevalência mais alta de hipertensão, CT sérico, LDL-C e TG elevados e maior circunferência abdominal em comparação com aqueles com IMC abaixo do percentil 85. Observou-se hipertensão em 2,9% dos estudantes, 5,1% apresentavam tolerância à glicose diminuída, 40% tinham dois fatores de risco para aterosclerose, e 26,9% tinham três fatores de risco. O sedentarismo foi significativamente menor em indivíduos com IMC acima do percentil 85 e foi significativamente correlacionado com as concentrações séricas de CT e LDL-C. A merenda escolar estava hipoglicêmica, hiperproteica e hiperlipídica. CONCLUSÃO: Um terço das crianças e adolescentes avaliados tinham pesos iguais ou superiores ao peso ajustado à idade, e isso foi associado a maiores circunferência abdominal, hipertensão e prevalência de dislipidemia. .

Herpesvirus type 7 infection may play an important role in individuals with a genetic profile of susceptibility to Graves' disease.

OBJECTIVE: An inherited profile of genes related to the response to aggressive environmental factors such as viruses and chemicals may be related to an increased susceptibility to Graves' disease (GD). DESIGN AND METHODS: This prospective case-control study was designed to examine the relationship between human herpesviruses (HHV) infection, determined by circulating DNA; tumour protein p53 (TP53) apoptotic ability; and detoxification system genes, and GD. We studied 280 confirmed GD patients paired to 284 controls with respect to environmental exposure. Exclusion criteria included medications that could interfere with thyroid function evaluation and a recent history of viral and bacterial infections. RESULTS: A stepwise regression analysis adjusted for age, gender, and ethnicity established the inheritance of glutathione S-transferase pi 1 (GSTP1) (odds ratio (OR)=3.423; 95% confidence interval (CI)=2.120-5.527; P<0.001) and cytochrome P450, family 1, subfamily A, polypeptide 1 (CYP1A1) variants (OR=1.649; 95% CI=1.012-2.686; P=0.0445) as significant risk factors for the disease. HHV-7 infection was much more common in GD patients (64.64%) than in controls (38.73%; chi(2), P<0.0001), and it increased the risk for GD more than three times (OR=3.133; 95% CI=1.959-5.011; P<0.0001). The inheritance of less efficient Pro/Pro TP53 gene variants significantly increased the risk of GD development (OR=5.196; 95% CI=2.112-12.783; P<0.0001) and also favored HHV-7 infection (OR=2.835; 95% CI=1.100-7.310; P=0.0275). In addition, 72TP53 variants augmented the risk of GD relapse (OR=1.860; 95% CI=1.015-3.410; P=0.0446). CONCLUSIONS: We suggest that an inherited genetic profile involving TP53 may favor HHV-7 infection and maintenance, which, in turn, may initiate and perpetuate GD autoimmune process.

Avaliação do peso corporal em pacientes com doença de Graves durante o tratamento com metimazol / Evaluation of body weight in patients with Graves' disease during the treatment with methimazole

OBJETIVO: Avaliar a alteração de peso durante o tratamento do hipertiroidismo e correlacioná-la com IL-6 e TNF-alfa. SUJEITOS E MÉTODOS: Quarenta e dois pacientes foram incluídos. Peso corporal (PC), índice de massa corpórea (IMC), características clínicas e laboratoriais foram registrados. IL-6 e TNF-alfa foram determinados antes do tratamento com metimazol (MMI) e no estado de eutiroidismo. RESULTADOS: O PC foi de 59,62 ± 11,5 kg no estado de hipertiroidismo e de 69,91 ± 14,4 kg no estado de eutiroidismo (p < 0,001). O IMC aumentou de 23,1 ± 3,8 kg/m² para 27 ± 4,7 kg/m² durante o tratamento (p < 0,0001). Antes da terapia, 66,6% tinham IMC < 25 kg/m² e 33,3%, IMC > 25 kg/m². No estado de eutiroidismo, 38% dos pacientes apresentavam IMC < 25 kg/m² e 62%, IMC > 25 kg/m² (p = 0,01). No estado de eutiroidismo, encontrou-se significativa diminuição nos valores de IL-6 e TNF-alfa, mas nenhuma correlação entre IL-6 e TNF-alfa com PC ou IMC. CONCLUSÃO: Um importante aumento no PC e IMC foi observado durante o tratamento do hipertiroidismo e alterações de IL-6 e TNF-alfa relacionam-se somente com o retorno ao eutiroidismo.

OBJECTIVE: To evaluate weight change during hyperthyroidism treatment, and to correlate it with IL-6 and TNF-alpha concentrations. SUBJECTS AND METHODS: Forty two patients were included. Body weight (BW), body mass index (BMI), clinical and laboratory characteristics were recorded. IL-6 and TNF-alpha were determined before treatment with methimazole (MMI) and in euthyroidism. RESULTS: BW was 59.62 ± 11.5 kg in hyperthyroidism, and 69.91 ± 14.4 kg in euthyroidism (p < 0.001). BMI increased from 23.1 ± 3.8 kg/m² to 27 kg/m² ± 4.7 during treatment (p < 0.0001). Before treatment, 66.6% subjects had BMI < 25 kg/m² and 33.3%, BMI > 25 kg/m². In euthyroidism, 38% of patients had BMI < 25 kg/m² and 62%, BMI > 25 kg/m² (p = 0.01). In euthyroidism, we found a significant reduction in IL-6 and TNF-alpha concentrations, but no correlation between IL-6 and TNF-alpha, and BW or BMI. CONCLUSION: An important increase in BW and BMI was observed during hyperthyroidism treatment, and IL-6 and TNF-alpha alterations were only related with return to euthyroidism.

Management of amiodarone-induced thyrotoxicosis in Latin America: an electronic survey.

OBJECTIVE: To assess diagnostic and therapeutic approaches to amiodarone-induced thyrotoxicosis (AIT) among members of the Latin American Thyroid Society (LATS). METHODS: LATS members responded to an online questionnaire that presented an index case (a 62-year-old man on amiodarone, with thyrotoxic symptoms and a nodular goitre) and a variant (same patient, no goitre). RESULTS: About 25% of invited members responded to the questionnaire. Most respondents lived in iodine-sufficient areas and observed that amiodarone-induced hypothyroidism (AIH) is more common than AIT. Nearly all assessed TSH, and the most used combination of tests was TSH and free T4 (37%). Thyroid autoimmunity was assessed by about 90%. Interleukin-6 (IL-6) was useful to 80%. Additional tests ordered for the index case were: radioactive iodine uptake (RAIU; 57%), echo-colour Doppler sonography (ECDS; about 50%) and fine-needle aspiration biopsy (FNAB; 44%). For the variant, ECDS and RAIU were judged unhelpful by 16%. Most defined the index case as type I AIT and the variant as type II AIT, but 16% in LATS suggested a mixed form in the index case. As initial treatment, nearly all used thionamides in the index case [with potassium perchlorate (KClO(4)) in one-third], while glucocorticoids were indicated to the variant by 66%. Only about 5% considered amiodarone withdrawal unnecessary. If initial strategy is ineffective in type I AIT, KClO(4) (half) or glucocorticoids (a third) are added; in type II, glucocorticoids are indicated by most. Once euthyroidism is restored, ablative therapy is prescribed by a third of respondents for type I AIT. CONCLUSIONS: There are several points of disagreement among thyroidologists regarding AIT management, mainly in the radiological evaluation and the approach to the already stabilized patient if amiodarone needs to be restarted.

Dislipidemias e diabetes mellitus: fisiopatologia e tratamento / Dyslipidemia and diabetes mellitus: pathophysiology and treatment

Inúmeros estudos demonstram que o diabetes mellitus é um fator de risco para doenças cardiovasculares. Sua associação à dislipidemia aumenta em duas a quatro vezes o risco de desenvolvimento de doenças cardiovasculares. Este artigo retrata a fisiopatologia da dislipidemia a partir de uma revisão bibliográfica, assim como as intervenções terapêuticas farmacológicas e não farmacológicas a serem adotadas, a fim de realizar-se prevenção das complicações cardiovasculares.

A number of studies have shown that diabetes mellitus is a risk factor for cardiovascular diseases. When associated with dyslipidemia, the risk of developing cardiovascular diseases rises two- to fourfold. This article shows the pathophysiology of dyslipidemia based on a bibliographic review, as well as the pharmacological and nonpharmacological therapeutic interventions that can be used to prevent cardiovascular complications.

Disfunções mínimas da tiróide: hipotiroidismo subclínico e hipertiroidismo subclínico / Subclinical thyroid disease: subclinical hypothyroidism and hyperthyroidism

Hipotiroidismo subclínico (SHT) e hipertiroidismo subclínico (SCH) são definidos pelas concentrações normais de T4 e T3 livres séricos associadas com valores de TSH elevado (SHT) ou suprimido (SCH). As prevalências são baixas e sintomas e sinais de disfunção tiroideana escassos. No SHT, colesterol total e LDL-C estão ligeiramente elevados, e tratamento com levotiroxina pode influir nos valores dos lipídeos. Ocorre diminuição da contratilidade do miocárdio e aumento da resistência vascular periférica, que melhoram com o tratamento. Fibrilação atrial é mais freqüente no SCH, e há aumento do índice de massa do ventrículo esquerdo, da contratilidade cardíaca, disfunção diastólica e indução de batimentos atriais ectópicos que regridem com uso de beta-bloqueadores. No SCH, ocorre diminuição da densidade óssea. Depressão, doença do pânico e alterações de testes cognitivos são freqüentes no SHT. O tratamento do SHT é indicado com TSH sérico maior do que 8mU/L e presença de anticorpos antitiroideanos, e do SCH endógeno, quando existem sintomas, em idosos ou concentração de TSH menor do que 0,1mU/L.

Síndrome dos ovários policísticos: a importância da avaliação endócrino-metabólica / Polycystic ovary syndrome: the importance of endocrino-metabolic evaluation

A fisiopatologia multifatorial da síndrome dos ovários policísticos (SOP) encontra-se estabelecida, assim como sua associação com a resistência insulina (RI) e, conseqüentemente, com a síndrome metabólica (SM). Entretanto, a avaliação da SM e do risco cardiovascular (RCV) inerente a este estado tem sido dificultado pela multiplicidade de critérios que definem a SM e pela dificuldade de diagnóstico laboratorial da RI incluso nos critérios. O objetivo deste artigo é revisar, de forma acessível à prática clínica, os critérios diagnósticos atuais para a SOP, associada ou não à SM, possibilitando o embasamento para opções terapêuticas que permitam não apenas tratar a anovulação crônica, como também reduzir o risco cardiovascular das mulheres com SOP.

The multifactorial pathophysiology of the Polycystic Ovary Syndrome is established, as well as its association with insulin resistance and consequently with the Metabolic Syndrome. On the other hand, the evaluation of the Metabolic Syndrome and Cardiovascular risk (CV), inherent to this illness, has been made difficult due to the multiplicity of criteria that define the Metabolic Syndrome and the difficulty of the insulin resistance laboratorial diagnosis, which is included in those criteria. The purpose of this article is to review, in an accessible form the clinic practice, the current diagnosis criteria of the Polycystic Ovary Syndrome, whether associated or not with the Metabolic Syndrome, making possible to set the basis for the therapeutical options that allows not only the chronic anovulation treatment, but also to reduce the cardiovascular risk for women with polycystic ovary syndrome.