Endothelial dysfunction and pulse wave reflection in women with Polycystic Ovarian Syndrome / Disfunção endotelial e reflexão de ondas de pulso em mulheres com Síndrome do Ovário Policístico

Background: Patients with polycystic ovarian syndrome (PCOS) have an increased prevalence of metabolic syndrome and traditional atherosclerotic risk factors, such as dyslipidemia, diabetes and hypertension. Endothelial function and vascular stiffness are surrogate markers of early atherosclerosis, able to predict cardiovascular events. Objective: To compare endothelial function and pulse wave reflection between women with PCOS and healthy controls. Methods: Observational and cross-sectional study that included women with PCOS, age between 18 and 40 years-old and body mass index between 25.0 and 35.0 kg/m2, and healthy controls. Rotterdan criteria was used to diagnose PCOS. Subjects underwent clinical and anthropometric evaluation, laboratory and hormonal assays and imaging tests to measure pulse wave velocity (PWV), augmentation index (AIx) and brachial artery flow-mediated vasodilation (FMD). Kolmogorov-Smirnov test showed normal distribution of most parameters. Unpaired Student t-test was used with significance level established at p < 0.05.Results: A total of 52 patients were included, 29 (56%) in PCOS group and 23 (44%) in control group. Clinical and laboratory parameters were similar between the groups. Women with PCOS had lower FMD (8.8 ± 1.0 vs 12.8 ± 1.2%, p = 0.021); PWV and AIx were similar between the groups (7.5 ± 0.2 vs 7.5 ± 0.3 m/s, p = 0.671 and 21.0 ± 1 vs. 20 ± 2%, p = 0.716, respectively). In the PCOS group, women with higher testosterone levels had higher AIx (25 ± 2 vs. 17 ± 3%, p = 0.045). Conclusions: PCOS women had endothelial dysfunction and those with higher testosterone levels had higher pulse wave reflection as compared with controls

Manifestações clínicas, bioquímicas, ultrassonográficas e metabólicas da síndrome dos ovários policísticos em adolescentes / Clinical manifestations, biochemical, ultrasonographic and metabolic of polycystic ovary syndrome in adolescents

OBJETIVO: Avaliar os parâmetros clínicos, ultrassonográficos, bioquímicos e as alterações metabólicas em adolescentes com síndrome dos ovários policísticos (SOP). MÉTODOS: Estudo retrospectivo realizado com 44 adolescentes entre 12 e 19 anos, com diagnóstico de SOP pelo Consenso de Rotterdam. As alterações metabólicas foram avaliadas de acordo com as recomendações da Federação Internacional de Diabetes, sendo consideradas: circunferência da cintura (CC) >percentil 90 (10-15 anos de idade) ou >80 cm (idade >16 anos); glicemia de jejum >100 mg/dL; triglicerídios >150 mg/dL; HDL <40 mg/dL, e pressão arterial >Hg 130/85 mm. RESULTADOS: A média de idade foi de 16,7±2,2 anos e da idade da menarca 11,8±1,4 anos. A irregularidade menstrual mais observada foi amenorreia (72,7%) seguida de oligomenorréia (27,3%); hirsutismo foi observado em 86,4% e acne em 56,8%. Ovários policisticos ao ultrassom observados apenas em 27,3%. A média do IMC foi de 30,3±6,6 kg/m². De acordo com o IMC, 52,3% das adolescentes eram obesas, 13,6% estavam com sobrepeso e 6,8% eram eutróficas. O aumento da circunferência da cintura (63,6%, 28/44) e a redução do HDL-C (34,1%, 15/44) foram as alterações metabólicas mais observadas. Triglicerídios aumentados foram observados em 27,3% (12/44), pressão arterial e aumento da glicemia de jejum alterada foram encontrados em 9,1% (4/44) e 4,5% (2/44) dos casos, respectivamente. Acantosis nigricans foi observada em 52,3% das adolescentes com SOP e a resistência insulinica encontrada em 62,8%. A sindrome metabólica foi identificada em seis adolescentes (13,6%), sendo todas obesas ou com sobrepeso. CONCLUSÃO: Entre as adolescentes com SOP do estudo, a irregularidade menstrual e o hirsutismo são as manifestações clínicas mais frequentes, enquanto os achados ultrassonográficos compatíveis com ovários policísticos são os menos prevalentes. A obesidade associada à resistência à insulina predispõe estas adolescentes à maior frequência de alterações metabólicas.

PURPOSE: To evaluate the clinical, ultrasonographic, biochemical and metabolic alterations of adolescents with polycystic ovary syndrome (PCOS). METHODS: Retrospective observational study conducted on 44 adolescents aged 12 to 19 years, diagnosed with PCOS according to the Rotterdam Consensus. Metabolic changes were assessed according to the recommendations of the International Diabetes Federation, considering: waist circumference (WC) >90th percentile (10-15 years of age) or >80 cm (age >16 years), fasting glucose >100 mg/dL, triglycerides >150 mg/dL, HDL <40 mg/dL, and blood pressure >Hg 130/85 mm. RESULTS: Mean age was 16.7±2.2 years and age at menarche was 11.8±1.4 years. The menstrual irregularity most frequently observed was amenorrhea (72.7%) followed by oligomenorrhea (27.3%); hirsutism was observed in 86.4% and acne in 56.8%. Polycystic ovaries were observed by ultrasound only in 27.3%. Mean BMI was 30.3±6.6 kg/m². According to BMI, 52.3% of adolescents were obese, 13.6% were overweight and 6.8% had a healthy weight. Increased waist circumference (63.6%, 28/44) and the reduction of HDL-C (34.1%, 15/44) were the metabolic changes most frequently observed. Increased triglycerides were observed in 27.3% (12/44) and increased blood pressure and impaired fasting glucose were found in 9.1% (4/44) and 4.5% (2/44) of cases, respectively. Acanthosis nigricans was observed in 52.3% and insulin resistance in 62.8% of the adolescents with PCOS. Metabolic syndrome was identified in six children (13.6%), all of them obese or overweight. CONCLUSION: In the adolescents with PCOS studied here, menstrual irregularity and hirsutism were the most common clinical manifestations, while the sonographic findings consistent with polycystic ovaries were less prevalent. Obesity associated with insulin resistance predisposes these adolescents to a higher frequency of metabolic disorders.

Evaluación de la sensibilidad a la insulina en el síndrome de ovarios poliquísticos / Evaluation of insulin-sensitivity in polycistic ovary syndrome

INTRODUCCIÓN: las mujeres con síndrome de ovarios poliquísticos tienen un aumento del riesgo de padecer resistencia a la insulina, dislipidemia, obesidad, hipertensión arterial y diabetes mellitus tipo 2; por lo tanto, tienen mayor probabilidad de desarrollar enfermedad cardiovascular.OBJETIVO: determinar la frecuencia y características de los trastornos de la sensibilidad a la insulina en un grupo de mujeres con síndrome de ovarios poliquísticos.MÉTODOS: se estudiaron 23 mujeres con este diagnóstico según los criterios de la Androgen Excess Society (AES), a las cuales se les realizaron determinaciones de glucemias e insulinemias basales y durante la prueba de tolerancia a la glucosa endovenosa de muestras múltiples. Se calcularon varios índices matemáticos de sensibilidad a la insulina e insulinorresistencia.RESULTADOS: 65 porciento de las mujeres tenían insulinorresistencia (índice HOMA-IR ³ 3,22). El análisis del área bajo la curva de insulinemia durante la prueba evidenció que las mujeres con insulinorresistencia tenían insulinemias mayores en estado basal y posestimulación; en ambos grupos las concentraciones fueron similares a las iniciales al final de la prueba. El área glucémica e insulinémica 0-10 y el área total de la insulinemia fueron significativamente mayores en las mujeres con insulinorresistencia. Todos los índices I0/G0, FIRI, ISI, Belfiore, BENNET y QUICKI tuvieron buena correlación con el HOMA-IR.CONCLUSIONES: la frecuencia de insulinorresistencia e hiperinsulinismo en las mujeres con síndrome de ovarios poliquísticos estudiadas fue alta y las estimaciones de insulinorresistencia en estado de ayuno pueden predecir la respuesta durante la estimulación endovenosa con glucosa(AU)

INTRODUCTION: women with polycistic ovary syndrome have a increasing risk of insulin resistance, dyslipidemia, obesity, hypertension and type 2 diabetes mellitus; thus, with higher likelihood to develop cardiovascular disease.OBJECTIVE: to determine the frequency and features of insulin sensitivity disorders in a group of women with polycistic ovary syndrome.METHODS: twenty three women with this diagnosis were studied according to the Androgen Excess Society (AES) criteria,underwent basal glycemia and insulinemia determinations and during frequently sampled intravenous glucose tolerance test). Several insulin sensitivity and insulin resistance mathematic indexes were calculated.RESULTS: sixty-five percent of women had insulin resistance (HOMA-IR ³ 3.22 rate). Analysis of area under the curve of insulin during the test revealed that women with insulin resistance had higher insulinemia rates in baseline state and post-stimulation;in both groups concentrations were similar to the initial ones at the end of test. Glycemia and insulinemia 0-10 areas and insulin area were higher in women with insulin resistance. All indexes including Io/Go, FIRI, ISI, Belfiore, BENNET and QUICKI had a good correlation with HOMA-IR.CONCLUSIONS: insulin resistance and hyperinsulinism frequency in women with policystic ovary syndrome was high and the fasting insulin resistance assessment may to predict the response during the glucose-intravenous stimulation(AU)

Evaluación de la sensibilidad a la insulina en el síndrome de ovarios poliquísticos / Evaluation of insulin-sensitivity in polycistic ovary syndrome

INTRODUCCIÓN: las mujeres con síndrome de ovarios poliquísticos tienen un aumento del riesgo de padecer resistencia a la insulina, dislipidemia, obesidad, hipertensión arterial y diabetes mellitus tipo 2; por lo tanto, tienen mayor probabilidad de desarrollar enfermedad cardiovascular. OBJETIVO: determinar la frecuencia y características de los trastornos de la sensibilidad a la insulina en un grupo de mujeres con síndrome de ovarios poliquísticos. MÉTODOS: se estudiaron 23 mujeres con este diagnóstico según los criterios de la Androgen Excess Society (AES), a las cuales se les realizaron determinaciones de glucemias e insulinemias basales y durante la prueba de tolerancia a la glucosa endovenosa de muestras múltiples. Se calcularon varios índices matemáticos de sensibilidad a la insulina e insulinorresistencia. RESULTADOS: 65 por ciento de las mujeres tenían insulinorresistencia (índice HOMA-IR ³ 3,22). El análisis del área bajo la curva de insulinemia durante la prueba evidenció que las mujeres con insulinorresistencia tenían insulinemias mayores en estado basal y posestimulación; en ambos grupos las concentraciones fueron similares a las iniciales al final de la prueba. El área glucémica e insulinémica 0-10 y el área total de la insulinemia fueron significativamente mayores en las mujeres con insulinorresistencia. Todos los índices I0/G0, FIRI, ISI, Belfiore, BENNET y QUICKI tuvieron buena correlación con el HOMA-IR. CONCLUSIONES: la frecuencia de insulinorresistencia e hiperinsulinismo en las mujeres con síndrome de ovarios poliquísticos estudiadas fue alta y las estimaciones de insulinorresistencia en estado de ayuno pueden predecir la respuesta durante la estimulación endovenosa con glucosa(AU)

INTRODUCTION: women with polycistic ovary syndrome have a increasing risk of insulin resistance, dyslipidemia, obesity, hypertension and type 2 diabetes mellitus; thus, with higher likelihood to develop cardiovascular disease. OBJECTIVE: to determine the frequency and features of insulin sensitivity disorders in a group of women with polycistic ovary syndrome. METHODS: twenty three women with this diagnosis were studied according to the Androgen Excess Society (AES) criteria,underwent basal glycemia and insulinemia determinations and during frequently sampled intravenous glucose tolerance test). Several insulin sensitivity and insulin resistance mathematic indexes were calculated. RESULTS: sixty-five percent of women had insulin resistance (HOMA-IR ³ 3.22 rate). Analysis of area under the curve of insulin during the test revealed that women with insulin resistance had higher insulinemia rates in baseline state and post-stimulation;in both groups concentrations were similar to the initial ones at the end of test. Glycemia and insulinemia 0-10 areas and insulin area were higher in women with insulin resistance. All indexes including Io/Go, FIRI, ISI, Belfiore, BENNET and QUICKI had a good correlation with HOMA-IR. CONCLUSIONS: insulin resistance and hyperinsulinism frequency in women with policystic ovary syndrome was high and the fasting insulin resistance assessment may to predict the response during the glucose-intravenous stimulation(AU)

Efectos de la mttformina en el sindrome de ovaro poliquistico asociado a insullino resistencia

Se presenta la experiencia clínica del uso de metformina (1,7 g día), por 4 meses, en 11 pacientes con (SOP) asociado a resistencia insulínica. Se determinaron los efectos clínicos, bioquímicos y hormonales luego de 4 meses de terapia. Cinco de las pacientes que deseaban embarazo, continuaron recibiendo la droga, hasta por un año. Se evaluó durante el tratamiento los síntomas clínicos, historia menstrual, hirsutismo; y los niveles séricos de gonadotrofinas, andrógenos, globulina ligante sexual, insulina basal y postsobrecarga de glucosa, perfil lipídico y volumen ovárico. Siete de 11 mujeres (63,3%) restablecieron la ciclicidad menstrual. Tres pacientes lograron embarazo entre el 5º y 7º mes de tratamiento (60%) una de ellas presentó un aborto a las 8 semanas. No se observaron cambios en el hirsutismo índice de masa corporal y presión arterial. Hubo una disminución significativa de los niveles plasmáticos de insulina tanto basal como postsobrecarga; de la testosterona libre y un incremento de SHBG. No hubo cambios en los niveles de gonadotrofinas, dehidroepiandosterona sulfato (DHEAS) perfil lipídico ni del volumen ovárico promedio. La droga fue bien tolerada, y la consideramos como una alternativa útil en pacientes obesas con (SOP) con alteraciones menstruales y o infertilidad, asociada a hiperinsulinemia y resistencia insulínica.

We present the clinical experience with the use of metformyn (1.7 g per day) for four months in eleven patients with PCO associated with insulin resistance. We determinate the clinical effects, biochemical and hormonal changes during four month of therapy. Five of the patients, who wanted to get pregnant, continued receiving the drug for a year. We evaluated the clinical feelings menstrual history, hyrsutism and the levels of serum gonadotrophin, sex hormone-binding globulin (SHBG) basal insulin and postcharge glucose, lipid profile and ovarian volume. Seven of the eleven women (63.3%) start again the menstrual cycle. Three patients became pregnant between the fifth and seventh month (60%), one of them have an abortion at eight-week. We didn't find changes in hirsutism, corporal mass and arterial pressure. The result was a significat disminution in plasmatic levels of basal insulin and post overcharge, of free testosterone and one increase of the SHBG. No changes in gonadotrophins, DHEAS, lipid profile levels and the average ovarian volume were seen. The drug have a good tolerance and we consider it a good and useful alternative in patient with over, weight and with PCO, menstrual changes and infertility, associated with hiperinsulinism and insulin resistance.