Prevalência da síndrome dos ovários policísticos em pacientes tratadas com análogo de GNRH para bloqueio puberal
Data
2022-06-14
Autores
Sá, Andreza Maria Reis de 
Orientadores
Spinola-Castro, Angela
Tipo
Dissertação de mestrado
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Resumo
Objetivos: Avaliar a prevalência da síndrome dos ovários policísticos (SOP) em pacientes tratadas com análogo de GnRH (GnRHa) de acordo com os critérios diagnósticos propostos pelo National Institutes of Health (NIH), European Society for Human Reproduction and Embryology (ESHRE) e American Society for Reproductive Medicine (ASRM) no Consenso de Rotterdam 2004 e Androgen Excess Society (AES). Correlacionar as características clínicas pregressas ao início do tratamento com GnRHa e o desenvolvimento do hiperandrogenismo clínico e da SOP. Métodos: Vinte e seis adolescentes e adultas jovens com antecedente de bloqueio puberal com GnRHa, pelo diagnóstico de puberdade precoce idiopática (80,7%) e pacientes tratadas por baixa estatura em puberdade (19,2%). As pacientes foram transversalmente avaliadas, durante a fase folicular do ciclo menstrual, de acordo com: variáveis clínicas, variáveis antropométricas (peso e estatura), composição corporal (massa gorda %) pela absorciometria por feixe duplo de raio-X (DXA), perfil metabólico e hormonal (andrógenos por espectometria de massas em tandem). Para o diagnóstico da SOP nas adolescentes foram adaptados os critérios de oligomenorréia, sendo considerados ciclos de duração menor que 21 dias ou a partir de 45 dias. A morfologia ovariana policística (MOP) foi definida pelo volume ovariano acima de 12ml, não sendo avaliada a contagem de folículos ovarianos, conforme sugerido por consenso internacional. Resultados: A idade no momento do estudo foi 17,6 ± 5,8 anos, sendo 6 ± 6,1 anos após a menarca. As pacientes foram divididas em 2 grupos: adolescentes e adultas, mas as características clínicas no início do tratamento não diferiram entre os grupos. A prevalência de obesidade pelo z IMC e de resistência insulínica pela análise do HOMA-IR, foi semelhante à da população geral, enquanto a frequência de acantose nigricans foi aumentada e a de acne foi diminuída. Hiperandrogenismo clínico foi evidenciado em 34,6% das pacientes, a oligomenorréia em 26,9%, o hiperandrogenismo laboratorial em 11,5% e a MOP em 23,1% das pacientes estudadas. Conclusões: A prevalência da SOP foi 23% utilizando-se os critérios de Rotterdam e 19,2% utilizando-se os critérios diagnósticos propostos pelo NIH e AES. Não houve correlação estatística entre as variáveis clínicas pregressas ao início do tratamento com GnRHa e o desenvolvimento de hiperandrogenismo clínico ou da SOP.
Objective: The purpose of this study was to assess the prevalence of polycystic ovary syndrome (PCOS) in patients treated with gonadotropin releasing hormone analogue (GnRHa)according to diverse criteria as follows, National Institutes of Health (NIH), Rotterdam criteria 2004 by European Society for Human Reproduction and Embryology (ESHRE) and American Society for Reproductive Medicine (ASRM) and Androgen Excess Society criteria (AES). To correlate clinical features before treatment with GnRHa and clinical hyperandrogenism or PCOS. Methods: It was a transversal study, with twenty-six adolescents and young women treated with GnRHa for idiopathic precocious puberty (80,7%) or short stature entering puberty (19,2%). All the patients were evaluated at follicular phase of menstrual cycle and the following variables were investigated: clinical and auxological characteristics, body composition (fat mass %) by dual energy X-ray absorptiometry (DXA), biochemical analysis, androgens analysis by tandem mass spectometry. The diagnosis of PCOS in adolescents was adapted. Oligomenorrhea was considered as cycle length <21 days or >45 days, polycystic ovary morphology (PCOM) was defined by ovarian volume above 12ml and the follicule counts was not considerated. Results: Patients were evaluated at the mean age of 17,6 ± 5,8 years and gynecologic age was 6 ± 6,1 years. They were separated into two groups: adolescents and young women, but the clinical features at diagnosis was not different between groups. The prevalence of obesity by z IMC and of insulin resistance was similar to general population. The frequency of acanthosis nigricans was higher and of acne was lower comparing to general population. Clinical hyperandrogenism was seen in 34,6% of patients, 26,9% showed menstrual irregularity, 11,5% had biochemical hyperandrogenism and 23,1% presented PCOM. Conclusions: The prevalence of PCOS was 23% based in Rotterdam criteria and 19,2% according to NIH and AES criteria. There was no correlation between clinical features before treatment with GnRHa and clinical hyperandrogenism or PCOS.
Objective: The purpose of this study was to assess the prevalence of polycystic ovary syndrome (PCOS) in patients treated with gonadotropin releasing hormone analogue (GnRHa)according to diverse criteria as follows, National Institutes of Health (NIH), Rotterdam criteria 2004 by European Society for Human Reproduction and Embryology (ESHRE) and American Society for Reproductive Medicine (ASRM) and Androgen Excess Society criteria (AES). To correlate clinical features before treatment with GnRHa and clinical hyperandrogenism or PCOS. Methods: It was a transversal study, with twenty-six adolescents and young women treated with GnRHa for idiopathic precocious puberty (80,7%) or short stature entering puberty (19,2%). All the patients were evaluated at follicular phase of menstrual cycle and the following variables were investigated: clinical and auxological characteristics, body composition (fat mass %) by dual energy X-ray absorptiometry (DXA), biochemical analysis, androgens analysis by tandem mass spectometry. The diagnosis of PCOS in adolescents was adapted. Oligomenorrhea was considered as cycle length <21 days or >45 days, polycystic ovary morphology (PCOM) was defined by ovarian volume above 12ml and the follicule counts was not considerated. Results: Patients were evaluated at the mean age of 17,6 ± 5,8 years and gynecologic age was 6 ± 6,1 years. They were separated into two groups: adolescents and young women, but the clinical features at diagnosis was not different between groups. The prevalence of obesity by z IMC and of insulin resistance was similar to general population. The frequency of acanthosis nigricans was higher and of acne was lower comparing to general population. Clinical hyperandrogenism was seen in 34,6% of patients, 26,9% showed menstrual irregularity, 11,5% had biochemical hyperandrogenism and 23,1% presented PCOM. Conclusions: The prevalence of PCOS was 23% based in Rotterdam criteria and 19,2% according to NIH and AES criteria. There was no correlation between clinical features before treatment with GnRHa and clinical hyperandrogenism or PCOS.
Descrição
Citação
SA, A.M.R. Prevalência da síndrome dos ovários policísticos em pacientes tratadas com análogo de GNRH para bloqueio puberal. São Paulo, 2022. 97 f. Dissertação (Mestrado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). São Paulo, 2022.