Resumo

VIVAS, CARLOS ARTURO; CASTANO TRUJILLO, PAOLA; GARCIA TRUJILLO, GABRIEL  e  OSPINA GUTIERREZ, MARTHA LILIANA. Polycystic ovary syndrome. Pathophysiology obese vs nonobese women. CES Med. [online]. 2011, vol.25, n.2, pp.169-180. ISSN 0120-8705.

Objective: To review the literature available about the difference between obese and nonobese women with polycystic ovary syndrome (POS) Background: POS is characterized by endocrine and metabolic abnormalities. The etiology of POS remains uncertain and its prevalence is 5-10 % in reproductive-age women. POS is diagnosed by the presence of oligovulation or anovulation, oligomenorrhea and hyperandrogenemia or hyperandrogenism. Clinical presentation depends on a genetic predisposition (associated with metabolic abnormalities) influenced by external factors such as obesity. Methods: Pubmed, Ovid and Medline databases were searched up using polycystic ovary syndrome, obese, nonobese as key words. Results: Insulin resistance is not a universal finding in women with POS (it is onlypresent in 60 % of them), its role in metabolic changes is evident. There is a great variability in insulin resistance levels in each patient with variable response to androgens production from ovaries. There is an increase in androgens, inhibition of insulin action and decrease in glucose uptake in the target organ. It is associated with lipid and lipoprotein abnormalities. In nonobese women with POS predominates an alteration in the hypothalamo-pituitary-adrenal axis while in obese women with POS there is more marked dysregulationin insulin sensitivity. In the obese women with POS plasmatic levels of sex hormone- binding globulin (SHBG) are significantly low. There are also diferences in levels of other substances such as luteinizing hormone (LH), delta4-androstenedione, dihidroepiandrosterone sulfate (DHEAS), dihidrotestosterone, insulin-like growth factor-I (IGF-I), low-density lipoproteins (LDL), and high density lipoprotein (HDL). Conclusion: there are metabolic and endocrine differences between obese and nonobese patients with POS, that should be considered to define treatment and prognosis.

Palavras-chave : Polycystic ovary syndrome; Obese; Nonobese; Physiopathology.

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