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Authors
Advisor(s)
Abstract(s)
Introdução: A síndrome de ovários poliquísticos é a patologia endócrina mais comum em
mulheres em idade reprodutiva. Apresenta-se como uma doença reprodutiva e endócrina,
com impacto multissistémico, caracterizando-se por amenorreia, resistência à insulina,
obesidade, hiperandrogenismo, infertilidade e maior predisposição para patologia
depressiva e ansiosa. A longo prazo, pode promover o desenvolvimento de Diabetes Mellitus
tipo 2, doenças cardiovasculares e cancro do endométrico. A síndrome de ovários
poliquísticos não se apresenta de igual forma em todas as mulheres, o que aliado a um
desconhecimento da sua etiologia resulta na inexistência de um tratamento curativo
aprovado. Por consequência, surge a necessidade de um melhor esclarecimento da
complexidade desta síndrome e da interação entre os seus múltiplos fatores,
nomeadamente o hiperandrogenismo, a resistência à insulina e a obesidade, procurando
possíveis biomarcadores associados.
Objetivos: Clarificar e reunir as informações até à data sobre a complexidade da síndrome
de ovários poliquísticos; Demonstrar a relação entre hiperandrogenismo, a resistência à
insulina e a obesidade e a sua pertinência na génese da síndrome de ovários poliquísticos;
Identificar possíveis biomarcadores que possam ajudar num diagnóstico mais sensível e
preciso; Expor as opções terapêuticas utilizadas na atualidade na síndrome de ovários
poliquísticos; Despertar o interesse da comunidade científica para o esclarecimento
etiológico da síndrome de ovários poliquísticos, para que seja possível praticar um
tratamento dirigido; Sensibilizar os profissionais de saúde e a comunidade científica para o
peso global na qualidade de vida das mulheres com síndrome de ovários poliquísticos.
Metodologia: A pesquisa bibliográfica foi realizada através dos motores de busca PubMed,
Elsevier, Socus e Web of Sciense. Os artigos científicos foram selecionados de acordo com a
sua pertinência em relação ao tema, dando preferência aos publicados nos últimos dez anos.
Foram ainda utilizados livros específicos da área de estudo.
Conclusão: A síndrome de ovários poliquísticos é uma patologia endócrina e reprodutiva
que afeta muitas mulheres, com implicações na saúde física e mental. É multifatorial e
poligénica. A desregulação do eixo hipotálamo-hipófise-gónadas e o aumento da atividade
enzimática ao nível da glândula suprarrenal podem oferecer uma explicação para o
aparecimento desta síndrome. Acrescem fatores genéticos e ambientais que podem
determinar ou aumentar a predisposição para o desenvolvimento da mesma. Verificou-se
uma estreita relação entre o hiperandrogenismo, a resistência à insulina e a obesidade, existindo um ciclo vicioso potenciador entre eles. Assim, este trabalho permitiu concluir que
o hiperandrogenismo é o principal desregulador metabólico e reprodutivo. No entanto, não
poderá ser o único fator etiológico, uma vez que mulheres sem hiperandrogenismo
desenvolvem a síndrome. Para um diagnóstico mais sensível e específico, a análise dos
níveis da hormona anti-mulleriana pode ser inserida nos critérios de diagnóstico e utilizada
na prática clínica. Apresento a proposta da criação de um programa integrado de consultas
médicas entre as várias especialidades específico para as mulheres com síndrome de ovários
poliquísticos. A designação “síndrome de ovários poliquísticos” não abrange a
complexidade da síndrome, focando-se apenas nos ovários e na existência de quistos, que
são na verdade folículos, e que não estão presentes em todos os fenótipos e, por isso,
proponho a sua retificação.
Introduction: Polycystic ovary syndrome is the most common endocrine pathology in women of reproductive age. It presents itself as a reproductive and endocrine disease, with multisystemic impact, characterized by amenorrhoea, insulin resistance, obesity, hyperandrogenism, infertility and increased predisposition to depression and anxiety. In the long term, it may promote the development of Type 2 Diabetes Mellitus, cardiovascular diseases and endometrial cancer. Polycystic ovary syndrome does not present equally in all women, which, combined with a lack of knowledge about its aetiology, results in the inexistence of an approved curative treatment. Consequently, the need arises for a better clarification of the complexity of this syndrome and of the interaction between its multiple factors, namely hyperandrogenism, insulin resistance and obesity, looking for possible associated biomarkers. Objectives: To clarify and bring together the information to date on the complexity of polycystic ovary syndrome; To demonstrate the relationship between hyperandrogenism, insulin resistance and obesity and its relevance in the genesis of polycystic ovary syndrome; To identify possible biomarkers that can help in a more sensitive and accurate diagnosis; To expose the therapeutic options currently used in polycystic ovary syndrome; To awaken the interest of the scientific community in the etiological clarification of polycystic ovary syndrome, so that it is possible to practice a targeted treatment; To raise awareness of health professionals and the scientific community for the overall burden on the quality of life of women with polycystic ovary syndrome. Methodology: The literature search was conducted using the PubMed, Elsevier, Socus and Web of Sciense search engines. The scientific articles were selected according to their relevance to the topic, giving preference to those published in the last ten years. Specific books on the area of study were also used. Conclusion: Polycystic ovary syndrome is an endocrine and reproductive disease that affects many women, with implications on physical and mental health. It is multifactorial and polygenic. Dysregulation of the hypothalamic-pituitary-gonadal axis and increased enzyme activity at the level of the adrenal gland may offer an explanation for the onset of this syndrome. In addition, genetic and environmental factors may determine or increase the predisposition to its development. There is a close relationship between hyperandrogenism, insulin resistance and obesity, and a vicious circle between them. This study concluded that hyperandrogenism is the main metabolic and reproductive dysregulator. However, it may not be the only etiological factor, since women without hyperandrogenism develop the syndrome. For a more sensitive and specific diagnosis, the analysis of anti-mullerian hormone levels can be inserted in the diagnostic criteria and used in clinical practice. I propose the creation of an integrated programme of medical consultation between the various specialities specifically for women with polycystic ovary syndrome. To conclude, the designation "polycystic ovary syndrome" does not cover the complexity of the syndrome, focusing only on the ovaries and the existence of cysts, which are actually follicles, and which are not present in all phenotypes.
Introduction: Polycystic ovary syndrome is the most common endocrine pathology in women of reproductive age. It presents itself as a reproductive and endocrine disease, with multisystemic impact, characterized by amenorrhoea, insulin resistance, obesity, hyperandrogenism, infertility and increased predisposition to depression and anxiety. In the long term, it may promote the development of Type 2 Diabetes Mellitus, cardiovascular diseases and endometrial cancer. Polycystic ovary syndrome does not present equally in all women, which, combined with a lack of knowledge about its aetiology, results in the inexistence of an approved curative treatment. Consequently, the need arises for a better clarification of the complexity of this syndrome and of the interaction between its multiple factors, namely hyperandrogenism, insulin resistance and obesity, looking for possible associated biomarkers. Objectives: To clarify and bring together the information to date on the complexity of polycystic ovary syndrome; To demonstrate the relationship between hyperandrogenism, insulin resistance and obesity and its relevance in the genesis of polycystic ovary syndrome; To identify possible biomarkers that can help in a more sensitive and accurate diagnosis; To expose the therapeutic options currently used in polycystic ovary syndrome; To awaken the interest of the scientific community in the etiological clarification of polycystic ovary syndrome, so that it is possible to practice a targeted treatment; To raise awareness of health professionals and the scientific community for the overall burden on the quality of life of women with polycystic ovary syndrome. Methodology: The literature search was conducted using the PubMed, Elsevier, Socus and Web of Sciense search engines. The scientific articles were selected according to their relevance to the topic, giving preference to those published in the last ten years. Specific books on the area of study were also used. Conclusion: Polycystic ovary syndrome is an endocrine and reproductive disease that affects many women, with implications on physical and mental health. It is multifactorial and polygenic. Dysregulation of the hypothalamic-pituitary-gonadal axis and increased enzyme activity at the level of the adrenal gland may offer an explanation for the onset of this syndrome. In addition, genetic and environmental factors may determine or increase the predisposition to its development. There is a close relationship between hyperandrogenism, insulin resistance and obesity, and a vicious circle between them. This study concluded that hyperandrogenism is the main metabolic and reproductive dysregulator. However, it may not be the only etiological factor, since women without hyperandrogenism develop the syndrome. For a more sensitive and specific diagnosis, the analysis of anti-mullerian hormone levels can be inserted in the diagnostic criteria and used in clinical practice. I propose the creation of an integrated programme of medical consultation between the various specialities specifically for women with polycystic ovary syndrome. To conclude, the designation "polycystic ovary syndrome" does not cover the complexity of the syndrome, focusing only on the ovaries and the existence of cysts, which are actually follicles, and which are not present in all phenotypes.
Description
Keywords
Biomarcadores Hiperandrogenismo Obesidade Resistência à
Insulina Síndrome de Ovários Poliquísticos