Diagnóstico y manejo del síndrome de ovario poliquístico: una perspectiva dermatológica
Palabras clave:
síndrome de ovario poliquístico, acné, hirsutismo, resistencia a la insulina, trastornos menstruales, alopecia androgénicaResumen
El síndrome de ovario poliquístico afecta 5% a 10% de las mujeres en edad fértil. Es un síndrome heterogéneo caracterizado por anovulación crónica hiperandrogénica, secundaria a una disfunción ovárica intrínseca. Aunque las pacientes afectadas se ven muy perturbadas por las manifestaciones cutáneas, que incluyen acné, hirsutismo, alopecia y acanthosis nigricans, el síndrome de ovario poliquístico puede tener implicaciones mucho más serias que las encontradas en la piel; con frecuencia causa irregularidades menstruales e infertilidad y, además, está agravado por una hiperinsulinemia resistente a la insulina, con el consecuente riesgo de diabetes mellitus y síndrome metabólico.
En este artículo se discuten las manifestaciones cutáneas del síndrome de ovario poliquístico, los diagnósticos diferenciales, la aproximación diagnóstica y las opciones terapéuticas.
Biografía del autor/a
Ana María Rivas
Médica cirujana, RIII en Dermatología, Universidad Pontificia Bolivariana, Medellín, Colombia
Luz Adriana Vásquez
Médica dermatóloga, Hospital Pablo Tobón Uribe, Medellín, Colombia
María Isabel Arredondo
Médica dermatóloga, Hospital Pablo Tobón Uribe, Medellín, Colombia
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2. Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004;89:453-62.
3. Rosenfield RL. What every physician should know about polycystic ovary syndrome. Dermatol Ther. 2008;21:354-61.
4. Lee AT, Zane LT. Dermatologic manifestations of polycystic ovary syndrome. Am J Clin Dermatol. 2007;8:201-19.
5. Stein I, Leventhal M. Amenorrhoea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181-5.
6. Zawadski J, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. En: Dunaif A, Givens J, Haseltine F, editors. Polycystic ovary syndrome. Boston, MA: Blackwell Scientific; 1992 p. 377-84.
7. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41-7.
8. Lowe P, Kovacs G, Howlett D. Incidence of polycystic ovaries and polycystic ovary syndrome amongst women in Melbourne, Australia. Aust NZJ Obstet Gynaecol. 2005:45:17-9.
9. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006;91:4237-45.
10. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456-88.
11. Nisenblat V, Norman RJ. Androgens and polycystic ovary syndrome. Curr Opin Endocrinol Diabetes Obes. 2009;16:224-31.
12. Nam MM, Strauss JF. Genetics of polycystic ovarian syndrome. Clin Obstet Gynecol. 2007;50:188-204.
13. Urbanec M. The genetics of the polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab. 2007;3:103-11.
14. Unluturk U, Harmanci A, Kocaefe C, Yildiz BO. The genetic basis of the polycystic ovary syndrome: a literature review including discussion of PPARgamma. PPAR Res. 2007; 2007:1-23.
15. Diamanti-Kandarakis E. Polycystic ovarian syndrome: pathophysiology, molecular aspects and clinical implications. Expert Rev Mol Med. 2008;10:1-21.
16. Taylor AE, McCourt B, Martin KA, Anderson EJ, Adams JM, Schoenfeld D, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1997;82:2248-56.
17. Blank SK, McCartney CR, Helm KD, Marshall JC. Neuroendocrine effects of androgens in adult polycystic ovary syndrome and female puberty. Semin Reprod Med. 2007;25:352-9.
18. Sagnella F, Apa R, Guido M, Villa P, Spadoni V, Miceli F, Lanzone A. Suppression and recovery of gonadotropin and steroid secretion by a gonadotropin-releasing hormone receptor antagonist in healthy women with normal ovulation versus women with polycystic ovary syndrome in the early follicular phase. Fertil Steril. 2009;91:1857-63.
19. Yildiz BO, Azziz R. The adrenal and polycystic ovary syndrome. Rev Endocr Metab Disord. 2007;8:331-42.
20. Carmina E, Lobo RA. Prevalence and metabolic characteristics of adrenal androgen excess in hyperandrogenic women with different phenotypes. J Endocrinol Invest. 2007;30:111-6.
21. Moran C, Renteria JL, Moran S, Herrera J, Gonzalez S, Bermudez JA. Obesity differentially affects serum levels of androstenedione and testosterone in polycystic ovary syndrome. Fertil Steril. 2008;90:2310-7.
22. Qu J, Wang Y, Wu X, Gao L, Hou L, Erkkola R. Insulin resistance directly contributes to androgenic potential within ovarian theca cells. Fertil Steril. 2009;91:1990-7.
23. Baillargeon JP, Carpentier A. Role of insulin in the hyperandrogenemia of lean women with polycystic ovary syndrome and normal insulin sensitivity. Fertil Steril. 2007;88:886-93.
24. van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J. Polycystic ovaries in adolescents and the relationship with menstrual cycle patterns, luteinizing hormone, androgens, and insulin. Fertil Steril. 2000;74:49-58.
25. van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J. Endocrine features of polycystic ovary syndrome in a random population sample of 14-16 year old adolescents. Hum Reprod. 1999;14:2223-9.
26. Mastorakos G, Lambrinoudaki I, Creatsas G. Polycystic ovary syndrome in adolescents: current and future treatment options. Paediatr Drugs. 2006;8:311-8.
27. Hart R. PCOS and infertility. Panminerva Med. 2008;50:305-14.
28. Navaratnarajah R, Pillay OC, Hardiman P. Polycystic ovary syndrome and endometrial cancer. Semin Reprod Med. 2008;26:62-71.
29. Diamanti-Kandarakis E, Panidis D. Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS. Clin Endocrinol (Oxf). 2007;67:735-42.
30. Shumak SL. Even lean women with PCOS are insulin resistant. BMJ. 2009;338:b954.
31. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22:141-6.
32. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003;101:995-1007.
33. Al Robaee A, Al-Zolibani A, Al Shobaili HA, Aslam M. Update on hirsutism. Acta Dermatovenerol Alp Panonica Adriat. 2008;17:103-19.
34. Fassnacht M, Schlenz N, Schneider SB, Wudy SA, Allolio B, Arlt W. Beyond adrenal and ovarian androgen generation: increased peripheral 5 alpha-reductase activity in women with polycystic ovary syndrome. J Clin Endocrinol Meta. 2003;88:2760-6.
35. Archer JS, Chang RJ. Hirsutism and acne in polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18:737-54.
36. Hatch R, Rosefield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol. 1981;140:815-30.
37. Falsetti L, Gambera A, Andrico S, Sartori E. Acne and hirsutism in polycystic ovary syndrome: clinical, endocrine-metabolic and ultrasonographic differences. Gynecol Endocrinol. 2002;16:275-84.
38. Karrer-Voegeli S, Rey F, Reymond MJ, Meuwly JY, Gaillard RC, Gomez F. Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of patients investigated for hyperandrogenism. Medicine (Baltimore). 2009;88:32-45.
39. Walton S, Cunliffe WJ, Keczkes K, Early AS, McGarrigle HH, Katz M, Reese RA. Clinical, ultrasound and hormonal markers of androgenicity in acne vulgaris. Br J Dermatol. 1995;133:249-53.
40. Timpatanapong P, Rojanasakul A. Hormonal profiles and prevalence of polycystic ovary syndrome in women with acne. J Dermatol. 1997;24:223-9.
41. Henze C, Hinney B,WuttkeW. Incidence of increased androgen levels patients suffering from acne. Dermatology (Switzerland). 1998;196:53-4.
42. Thiboutot D, Gilliland K, Light J, Lookingbill D. Androgen metabolism in sebaceous glands from subjects with and without acne. Arch Dermatol. 1999;135:1041-5.
43. Seirafi H, Farnaghi F, Vasheghani-Farahani A, Alirezaie NS, Esfahanian F, Firooz A, Ghodsi SZ. Assessment of androgens in women with adult-onset acne. Int J Dermatol. 2007;46:1188-91.
44. Carmina E, Rosato F, Jannì A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab. 2006;91:2-6.
45. Futterweit W, Dunaif A, Yeh HC, Kingsley P. The prevalence of hyperandrogenism in 109 consecutive female patients with diffuse alopecia. J Am Acad Dermatol. 1988;19:831-6.
46. Paus R, Olsen EA, Messenger AG. Hair Growth Disorders. En: Wolff K, Goldsmith LA, Katz ST, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick´s Dermatology in General Medicine. Seventh edition. New York: McGraw Hill; 2008. p. 753-77.
47. Olsen EA, Hordinsky M, Roberts JL, Whiting DA. Dermatologic Consortium for Women's Health. Female pattern hair loss. J Am Acad Dermatol. 2002;47:795.
48. Higgins SP, Freemark M, Prose NS. Acanthosis nigricans: a practical approach to evaluation and management. Dermatol Online J. 2008;14:2.
49. Panidis D, Skiadopoulos S, Rousso D, Ioannides D, Panidou E. Association of acanthosis nigricans with insulin resistance in patients with polycystic ovary syndrome. Br J Dermatol. 1995;132:936-41.
50. Rosenfield RL. Clinical practice. Hirsutism [Comment in: N Engl J Med 2006;354:1533-5; author’s reply 1533-5]. N Engl J Med. 2005;353:2578-88.
51. Bulun SE, Adashi EY. The physiology and pathology of the female reproductive system. En: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams’ textbook of endocrinology. Tenth edition. Philadelphia: Saunders; 2002. p. 587-664.
52. Balen A. The pathophysiology of polycystic ovary syndrome: trying to understand PCOS and its endocrinology. Best Pract Res Clin Obstet Gynaecol. 2004;18:685-706.
53. Lowenstein EJ. Diagnosis and management of the dermatologic manifestations of the polycystic ovary syndrome. Dermatol Ther. 2006;19:210-23.
54. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1998;83:2694-8.
55. Porter MB. Polycystic ovary syndrome: the controversy of diagnosis by ultrasound. Semin Reprod Med. 2008;26:241-51.
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Cómo citar
1.
Rivas AM, Vásquez LA, Arredondo MI. Diagnóstico y manejo del síndrome de ovario poliquístico: una perspectiva dermatológica. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 15 de febrero de 2019 [citado 16 de abril de 2024];18(2):78-90. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/196
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2019-02-15
Cómo citar
1.
Rivas AM, Vásquez LA, Arredondo MI. Diagnóstico y manejo del síndrome de ovario poliquístico: una perspectiva dermatológica. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 15 de febrero de 2019 [citado 16 de abril de 2024];18(2):78-90. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/196
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