RESUMO
OBJECTIVE: Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects one in every 15 women worldwide. This disorder is mainly characterized by increased levels of male hormones (androgens), acne, and hirsutism, and can lead to long-term insulin resistance, miscarriage, or even infertility in women. PCOS is a disorder that can be treated with natural and allopathic remedies that work against the PCOS mechanism. The present study reviews previous studies on the treatment of PCOS using natural drugs. METHODS: The data in this study were collected from articles published in reputable databases including ScienceDirect, PubMed, Google Scholar, and SID in the field of medicinal plants from 1990 to 2021. RESULTS: A review of the literature showed that plants such as aloe vera and chamomile improve fertility by increasing the number of ovarian follicles. Besides, Vitex agnus-castus and octane reduce hirsutism by reducing testosterone and androgen levels. It was also shown that liquorice, ginseng, cinnamon, and de chiro Inositol improve the adverse effects of diabetes caused by PCOS by lowering lipid and blood glucose levels. Moreover, Stachys lavandulifolia and fennel are effective in changing endometrial tissue parameters in PCOS by reducing estrogen and hyperplasia. CONCLUSIONS: Various studies have shown that herbal medicines can improve PCOS symptoms in women with minimal side effects but a longer treatment cycle.
Assuntos
Terapias Complementares , Infertilidade , Síndrome do Ovário Policístico , Feminino , Humanos , Síndrome do Ovário Policístico/terapia , Hirsutismo/tratamento farmacológico , Hirsutismo/etiologia , Infertilidade/complicações , Terapias Complementares/efeitos adversosRESUMO
Clinical case: a girl of 7 ½ years who consulted for early pubarche without thelark, with a percentile size of 75 for a genetic target size in the 10th percentile, overweight with a 90th percentile BMI, and normal blood pressure. The biochemical study showed high levels of androgens: testosterone: 7.2 ng/dL, androstenedione of 5.1 ng / ml, 17OHP: 15 ng / dL with low normal DHEAS (0.26 ug/ml), Plasma Renin Activity normal low: 0.22 ng/mL/h. Initial imaging study showed a bone age of 10 years 6 months and normal abdominal and pelvic ultrasound. Molecular study showed no pathogenic variants in the CYP21A2 gene (21 Hydroxylase). With a probable diagnosis of non-classical congenital adrenal hyperplasia (HSRNC) and no known mutation, he started treatment with hydrocortisone (12 mg/m2). At 8.7 years, pubertal development begins and braking begins with LHRH analogues, which are administered for 18 months. Despite the treatment, signs of virilization and elevation of androgens (testosterone up to 130 ng/ml) are progressively accentuated, which do not diminish when trying different corticosteroid schemes. MRI of the abdomen and pelvis shows the normal adrenal glands and a solid nodular image of 2.1 x 1.6 cm in the right ovary (Figure 2), later demonstrated with pelvic ultrasound (Figure 2). Right laparoscopic oophorectomy was performed, whose biopsy demonstrated a Leydig cell tumor. One month after surgery, all androgenic levels were normalized, so the gradual suspension of corticosteroids began. Conclusion: Although HSRNC is the most frequent pathological cause of early pubarche, when it is associated with progressive clinical and biochemical hyperandrogenism despite adequate treatment and without pathogenic variants in the CYP21A2 gene, even with high levels of 17OHP, other causes should be considered, specifically, androgen producing tumors.
Caso clínico: niña de 7½ años que consulta por pubarquia precoz sin telarquia, con talla en percentil 75 para una talla objetivo genético en percentil 10, sobrepeso con IMC percentil 90 y presión arterial normal. El estudio bioquímico mostró niveles elevados de andrógenos: testosterona: 7,2 ng/dL, androstenediona de 5,1 ng/ml, 17OHP: 15 ng/dL con DHEAS normal baja (0,26 ug/ml), Actividad de Renina Plasmática normal baja: 0.22 ng/ mL/h. Estudio de imágenes inicial mostró una edad ósea de 10 años 6 meses y ecografía abdominal y pelviana normales. Estudio molecular no mostró variantes patogénicas en el gen CYP21A2 (21 Hidroxilasa). Con diagnosticó probable de hiperplasia suprarrenal congénita no clásica (HSRNC) y sin mutación conocida,inició el tratamiento con hidrocortisona (12 mg/m2). A los 8.7 años comienza desarrollo puberal y se inicia frenación con análogos de LHRH, los cuales se administran por 18 meses. A pesar del tratamiento se acentúan progresivamente los signos de virilización y hayelevación de los andrógenos (testosterona hasta 130 ng/ml), que no disminuyen intentando diferentes esquemas de corticoides. Se realiza RM de abdomen y pelvis que muestra las glándulas suprarrenales normales y una imagen nodular sólida de 2.1 x 1.6 cm en el ovario derecho (Figura 2), demostrada posteriormente con Ecografía pelviana (Figura 2). Se realiza ooforectomía derecha por vía laparoscópica, cuya biopsia demostró un tumor de células de Leydig. Un mes después de la cirugía, se normalizan todos los niveles androgénicos por lo que se inició la suspensión gradual de los corticoides. Conclusión: Aunque la HSRNC es la causa patológica más frecuente de la pubarquia precoz, cuando se asocia con un hiperandrogenismo clínico y bioquímico progresivo a pesar de un tratamiento adecuado y sin variantes patógenicas en el gen CYP21A2, incluso con niveles elevados de 17OHP, otras causas deben ser consideradas, específicamente tumores productores de andrógenos.
Assuntos
Humanos , Feminino , Criança , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico , Puberdade Precoce/etiologia , Tumor de Células de Leydig/complicações , Tumor de Células de Leydig/diagnóstico , Testosterona/análise , Hiperandrogenismo/etiologia , Hiperplasia Suprarrenal Congênita/diagnóstico , 17-alfa-Hidroxiprogesterona/análise , Hirsutismo/etiologia , Androgênios/análise , Androstenodiona/análiseAssuntos
Acantose Nigricans/etiologia , Doenças Autoimunes/diagnóstico , Hirsutismo/etiologia , Resistência à Insulina , Receptor de Insulina/imunologia , Acantose Nigricans/patologia , Adulto , Autoanticorpos/sangue , Doenças Autoimunes/complicações , Feminino , Humanos , Hiperglicemia/etiologia , Hiperinsulinismo/etiologiaRESUMO
We evaluated the association of hirsutism and oligomenorrhea (persistent menstrual cycles > 45 days) as screening criteria for the detection of biochemical hyperandrogenism (BH) and polycystic ovaries (PCOM) during adolescence and determined which androgens, granulosa cell hormone, ultrasonographic parameters have the best association with polycystic ovary syndrome (PCOS). Hirsute girls with oligomenorrhea (N = 26 Hirs/Oligo group) and non-hirsute girls with regular cycles (N = 63, C group) were studied. Prevalence of BH and PCOM, diagnostic performance of androgens and ultrasound parameters for PCOS diagnosis were analyzed. BH and PCOM prevalence were higher in the Hirs/Oligo girls than in the C girls (76.9% versus 25.5%; 92.3% versus 33.3%, respectively; p < 0.0001). A complete PCOS phenotype (Hirs/Oligo with BH and PCOM) was observed in 73.1% of the Hirs/Oligo group. The presence of both BH and PCOM was observed in 7.9% of the C group. The parameters with the best diagnostic performance were free androgen index ≥6.1, testosterone ≥2.4 nmol/L, follicle number ≥12 and ovarian volume ≥10 ml anti-Müllerian hormone (AMH) exhibited a low diagnostic accuracy. Hirsutism and persistent menstrual cycle over 45 days are highly associated with BH and PCOM suggesting that the presences of both criteria are necessary for the diagnosis of PCOS during adolescence.
Assuntos
Hirsutismo/etiologia , Oligomenorreia/etiologia , Síndrome do Ovário Policístico/diagnóstico , Adolescente , Feminino , Humanos , Síndrome do Ovário Policístico/complicações , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence of polycystic ovary syndrome (PCOS) according to the three major diagnostic criteria previously described in an unselected group of women from Spain and to identify the most common phenotypes of the disease. MATERIAL AND METHOD: An observational, transversal prevalence study was carried out between July 1 2014 and October 31 2014. All participants received a questionnaire and underwent a physical and trans-vaginal ultrasound examination. Blood samples were also collected for analysis of metabolic markers and hormones. PCOS was diagnosed according to three major criteria: NIH, Rotterdam and AE-PCOS criteria. Following diagnosis women with PCOS were assigned to one of four phenotypes. RESULTS: A total of 242 women were involved in the study. The prevalence for each major criteria was as follows: National Institute of Health (NIH) criteria had a prevalence of 1 4.88%, Rotterdam criteria had a prevalence of 29.34% and Androgen Excess and PCOS Society criteria presented a prevalence of 17.36%. The prevalence for each phenotype was: A, 40.85%; B, 25.35%; C, 8.45%; and D, 25.35%. PCOS women had more prevalence of hirsutism (36.61 %), infertility (25.35%), obesity (21.1 2%) and metabolic syndrome (11 .26%) than controls (7.01%, 6.43%, 5.84% and 2.33% respectively). CONCLUSION: There is a rise in the prevalence of PCOS in Caucasian population with the classic phenotype (oligo-anovulation, hyperandrogenism, polycystic ovaries) being the most common presentation of the syndrome.
Assuntos
Hirsutismo/epidemiologia , Infertilidade Feminina/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Adulto , Anovulação/epidemiologia , Anovulação/etiologia , Estudos Transversais , Feminino , Hirsutismo/etiologia , Humanos , Hiperandrogenismo/epidemiologia , Hiperandrogenismo/etiologia , Infertilidade Feminina/etiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Obesidade/etiologia , Fenótipo , Síndrome do Ovário Policístico/fisiopatologia , Prevalência , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
El Síndrome de Ovario Poliquístico es un trastorno endocrino común que afecta a mujeres en edad reproductiva que puede causar problemas metabólicos y deterioro psicosocial importante. Las manifestaciones dermatológicas más frecuentes del hiperandrogenismo incluyen acné, hirsutismo y alopecia, cuyo reconocimiento es esencial para hacer un diagnóstico precoz. Las modalidades de tratamiento incluyen terapia hormonal con el objetivo de modular la producción de andrógenos y su acción, así como tratamientos no hormonales dirigidos a condiciones dermatológicas específicas.
Polycystic ovarian syndrome is a common endocrine disorder that affects women of reproductive age, which can cause metabolic, reproductive and psychosocial impairment. The most common skin manifestations of hyperandrogenism are acne, hirsutism and alopecia, whose recognition is essential for early diagnosis. There are several treatment modalities, including hormonal therapy in order to modulate androgen production and their effects, as well as other non hormonal treatments targeted to specific dermatologic conditions.
Assuntos
Humanos , Acne Vulgar/diagnóstico , Alopecia/diagnóstico , Hirsutismo/diagnóstico , Síndrome do Ovário Policístico/complicações , Acne Vulgar/etiologia , Acne Vulgar/terapia , Alopecia/etiologia , Alopecia/terapia , Hirsutismo/etiologia , Hirsutismo/terapiaRESUMO
Hirsutism is defined as excessive terminal hair growth in androgen-dependent areas of the body in women, which grows in a typical male distribution pattern. Hirsutism is a common clinical problem in women, and the treatment depends on the cause. The condition is often associated with a loss of self-esteem. Hirsutism reflects the interaction between circulating androgen concentrations, local androgen concentrations, and the sensitivity of the hair follicle to androgens. Polycystic ovary syndrome and idiopathic hirsutism are the most common causes of the condition. A woman's history and, physical examination are particularly important in evaluating excess hair growth. The vast majority of women with hirsutism have the idiopathic variety, and the diagnosis is made by exclusion. Serum testosterone level>200 ng/dL is highly suggestive of adrenal or ovarian tumor. Treatment of hirsutism should be based on the degree of excess hair growth presented by the patient and in the pathophysiology of the disorder. Treatment includes lifestyle therapies, androgen suppression, peripheral androgen blockage, and cosmetic treatments. The current review discusses deï¬nition, pathogenesis, physiopathology, differential diagnosis, diagnostic strategies, and treatment.
Assuntos
Folículo Piloso/fisiologia , Hirsutismo , Síndrome do Ovário Policístico/complicações , Androgênios/sangue , Feminino , Hirsutismo/diagnóstico , Hirsutismo/etiologia , Hirsutismo/terapia , Humanos , Hiperandrogenismo/complicações , Estilo de Vida , Ilustração Médica , Exame Físico/métodos , Fatores Sexuais , Saúde da MulherRESUMO
Pseudoacromegaly is a extremely rare condition previously described and characterized by acromegaloid changes, tissue overgrowth, without elevations in insulin-like growth factor or growth hormone as seen in Acromegaly. We present the case of a young female seen initially with acromegaloid features and a pituitary microadenoma. After work-up the patient was diagnosed as insulin-mediated pseudoacromegaly. Only a few cases of pseudoacromegaly has been reported and should always be considered when evaluating patients for acromegaloid features with negative biochemical and hormonal levels.
Assuntos
Acromegalia/diagnóstico , Neoplasias Hipofisárias/complicações , Complicações na Gravidez/diagnóstico , Acantose Nigricans/etiologia , Acromegalia/complicações , Adulto , Bromocriptina/efeitos adversos , Bromocriptina/uso terapêutico , Cabergolina , Diagnóstico Diferencial , Ergolinas/uso terapêutico , Feminino , Gastroenteropatias/induzido quimicamente , Hirsutismo/etiologia , Hormônio do Crescimento Humano/sangue , Humanos , Hiperprolactinemia/etiologia , Insulina/sangue , Resistência à Insulina , Fator de Crescimento Insulin-Like I/análise , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/metabolismo , Gravidez , Complicações Neoplásicas na Gravidez , Prognatismo/etiologia , Prolactinoma/complicações , Prolactinoma/tratamento farmacológico , Prolactinoma/metabolismoRESUMO
OBJECTIVES: Successful surgery does not always resolve all the clinical consequences of hypercortisolism in patients with Cushing's disease (CD). Our purpose was to integrally evaluate a group of CD patients cured by pituitary surgery and look for the persistence of CD symptoms, signs, and comorbidities. METHODS: We performed clinical and biochemical evaluations of 29 CD patients (2 males) cured by pituitary surgery. All patients underwent early (median 12 months) and late (median 58 months) postoperative evaluations. We sought information regarding hypercortisolism-related symptoms and signs, as well as metabolic, cardiovascular, reproductive, and psychologic comorbidities. RESULTS: The prevalence of obesity dropped from 72.4% at diagnosis to 31% at early evaluation but increased again to 44.8% at the late evaluation. Diabetes was present in 14 patients (48.3%) at diagnosis and persisted in 9 at the late evaluation. Hypertriglyceridemia was present in 58.6% and 55.1% of patients at diagnosis and at the late follow-up, respectively. The prevalence of hypercholesterolemia was 79.3% at diagnosis, decreased to 55.1% at the early evaluation, and increased to 65.5% at the late evaluation. Menstrual abnormalities were originally present in 15 of 20 women, and 8 of the 15 had recovered normal periods when seen at the last evaluation. Among the 24 patients with depression at diagnosis, 11 and 6 still exhibited mood abnormalities at the early and late evaluations, respectively. CONCLUSIONS: In a variable proportion of patients, the cardiovascular, metabolic, and emotional comorbidities of CD persist after long-term remission, irrespective of the initial degree of hypercortisolism.
Assuntos
Síndrome de Cushing/cirurgia , Depressão/epidemiologia , Fadiga/epidemiologia , Hirsutismo/prevenção & controle , Hipertensão/prevenção & controle , Hipófise/cirurgia , Acne Vulgar/epidemiologia , Acne Vulgar/prevenção & controle , Adolescente , Adulto , Estudos de Coortes , Comorbidade , Síndrome de Cushing/epidemiologia , Síndrome de Cushing/metabolismo , Síndrome de Cushing/fisiopatologia , Depressão/prevenção & controle , Fadiga/prevenção & controle , Feminino , Seguimentos , Hirsutismo/epidemiologia , Hirsutismo/etiologia , Humanos , Hidrocortisona/sangue , Hidrocortisona/metabolismo , Hidrocortisona/urina , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipopotassemia/epidemiologia , Hipopotassemia/prevenção & controle , Masculino , Distúrbios Menstruais/epidemiologia , Distúrbios Menstruais/etiologia , Distúrbios Menstruais/prevenção & controle , México/epidemiologia , Pessoa de Meia-Idade , Hipófise/metabolismo , Prevalência , Adulto JovemRESUMO
El síndrome de Cushing secundario a tumor suprarrenal es una patología infrecuente en el embarazo. Su presencia se traduce en un aumento significativo de la morbimortalidad materna y fetal. Muchas de sus características clínicas son enmascaradas por los cambios propios de una gestación fisiológica, lo que dificulta el diagnóstico. En este contexto las manifestaciones dermatológicas pueden ser de gran utilidad en la sospecha clínica precoz. Se presenta el caso de una paciente de 26 años de edad que en el segundo trimestre de embarazo inicia un cuadro caracterizado por acné inflamatorio severo e hirsutismo. La gestación se interrumpe a las 35 semanas por síndrome hipertensivo del embarazo y rotura prematura de membranas. Durante el puerperio consulta al dermatólogo presentando aún las lesiones descritas, además de estrías violáceas gruesas en abdomen, facie de luna, obesidad centrípeta y máculas purpúricas en zonas de presión. Se diagnóstica síndrome de Cushing. El estudio confirmatorio y etiológico dirigido evidenció un adenoma de corteza suparrenal. El diagnóstico de laboratorio es difícil debido a los cambios físicos y de laboratorio habituales del embarazo que pueden mimetizar los hallazgos propios de la enfermedad. Los hallazgos dermatológicos pueden ser de gran valor para un diagnóstico y tratamiento precoz. Las lesiones dermatológicas secundarias al hipercortisolismo fueron de difícil manejo...
Cushing's syndrome secondary to adrenal tumor is a rare pathology in pregnancy. Its presence results in a significant increase in maternal and fetal morbimortality. Many of its clinical features are masked by the typical changes of a physiological pregnancy, which make difficult the diagnosis. Indeed, skin manifestations may be useful in early clinical suspicion. We report a case of a 26 year old in the second trimester with severe inflammatory acne and hirsutism. The pregnancy is interrupted at 35 weeks for pregnancy-induced hypertension syndrome and premature rupture ovular membranes. During the puerperium, patient consulted a dermatologist presenting still the injuries described, as well as thick purple striae throughout the abdomen, moon face, truncal obesity and purpuric macules in pressure zones. Cushing's syndrome is diagnosed. The study showed a cortex suprarenal adenoma. Laboratory diagnosis is difficult because the pregnancy physical changes and routine laboratory findings that can mimic the disease themselves. Dermatological findings may be valuable for diagnosis and early treatment. The skin lesions secondary to hypercortisolism were difficult to manage...