Avaliação dos distúrbios metabólicos e hormonais relacionados à apneia obstrutiva do sono, esteatose hepática não alcoólica e ao eixo hipotálamo-hipófise-adrenal em mulheres portadoras da síndrome dos ovários policísticos

Abstract

Artigo 1 Obstructive Sleep Apnea Predisposes to Nonalcoholic Fatty Liver Disease in Patients with Polycystic Ovary Syndrome OBJECTIVE: Some studies have shown a higher prevalence of nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) in patients with polycystic ovary syndrome (PCOS). The objective of this study was to assess NAFLD in PCOS women with and without OSA. A possible role of high serum androgen levels in the development of OSA in PCOS women was also investigated. METHODS: Biochemical, hormonal and polysomnography parameters were determined in 38 premenopausal PCOS patients. NAFLD was evaluated by ultrasound. Testosterone was measured by an immunoassay. RESULTS: Serum androgen levels and the prevalence of NAFLD (83.3% vs. 26.9%; P<.001) were higher in patients with OSA than those without OSA. The mean apnea-hypopnea index (AHI) was higher in patients with NAFLD than in those without NAFLD (16.87events [ev]/h vs. 1.57ev/h; P<.002). On multivariate logistic regression where body mass index &#8805; 30 kg/m², homeostasis model assessment for insulin resistance &#8805;2.7, and OSA (AHI &#8805;5ev/h) were independent variables, only OSA was an independent an independent predictor of NAFLD (odds ratio [OR], 7.63; P=.044). Free testosterone levels &#8805;1.07ng/dL were also independently associated with OSA (OR, 8.18; P=.023). CONCLUSION: In PCOS women, the occurrence of OSA strongly predisposes to the development of nonalcoholic fatty liver disease and also a worse metabolic profile; hence, treatment of OSA might be beneficial for NAFLD. Artigo 2 Adrenocortical Production is Associated to Higher Levels of Luteinizing Hormone in Non Obese Women with Polycystic Ovary Syndrome OBJECTIVE: Insulin resistance (IR) and ovarian and adrenal hyperandrogenism are a common finding in women with polycystic ovary syndrome (PCOS).The aim of the present study was to access possible differences in insulin resistance, gonadotropins, and androgens production in obese and nonobese PCOS women. STUDY DESIGN: We studied 37 PCOS women (16 nonobese and 21 obese) and 18 nonobese controls. Fasting glucose, insulin, androgens, and gonadotropins levels were determined. Salivary cortisol was measured basal and in the morning after dexamethasone (DEX) 0.25mg. RESULTS: Nonobese PCOS women showed higher basal salivary cortisol and serum dehydroepiandrosterone sulfate and luteinizing hormone (LH) levels than controls and obese PCOS. These hormones levels did not differ between the obese and control groups. After DEX administration no differences were found between the three groups. In PCOS women, salivary cortisol levels showed negative correlation with BMI (&#119903; = &#8722;0.52; &#119875; = 0.001) and insulin (&#119903; = &#8722;0.47; &#119875; = 0.003) and positive correlation with LH (&#119903; = 0.40; &#119875; = 0.016). CONCLUSION: Our results show an increased adrenocortical production in nonobese PCOS women, not related to IR and associated with a normal hypothalamicpituitary-adrenal suppression. Higher LH levels might be involved in this event.