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Abstract(s)
A Síndrome do Ovário Poliquístico (SOP) é a endocrinopatia das gónadas mais comum em mulheres em idade fértil. A Fisiopatologia da SOP parece associar-se a um provável ciclo vicioso em que o excesso de androgénios, derivado de uma hiperatividade das células da teca interna, favorece o aumento de peso e deposição de gordura abdominal, o que origina a resistência periférica à insulina e favorece o hiperinsulinismo compensatório. Em relação à fisiopatologia do hiperinsulinismo nesta síndrome parece haver um défice pós-recetor, ou seja, uma afeção da cascata de eventos intracelulares. A metformina foi associada a um aumento dos níveis de adiponectina e a um decréscimo dos níveis de leptina, o que sugere uma redução do índice de massa corporal (IMC), de insulinorresistência e foi também associada a uma diminuição dos níveis séricos de homocisteína. A combinação de metformina com estatinas pode melhorar os níveis séricos dos lípidos e da PCR, que além de marcador inflamatório é também biomarcador de risco cardiovascular. Apesar dos efeitos teratogénicos associados e o potencial aumento de peso, a utilização de metformina com pioglitazona, nesta síndrome, demonstrou um aumento da ação periférica da insulina. A metformina é também eficaz no tratamento da anovulação, contudo sem um aumento considerável no número de gravidezes com nado vivo: ao comparar o uso de metformina e de clomifeno, o primeiro comporta vantagens, principalmente a ausência de efeitos adversos endometriais e ováricos. O uso da metformina e vitamina D mostrou reduzir os níveis de testosterona. Usualmente identificado como fármaco a evitar durante a gravidez, foi também demostrada evidência crescente de segurança desta utilização, que tem demonstrado reduzir a taxa de aborto espontâneo e promover o controlo metabólico.
The Polycystic Ovary Syndrome (POS) is the most common gonadic endocrinopathy amongst fertile women. The POS is probably associated to a vicious circle in which the excess of androgens caused by a intern teca cells hyperactivity, promote weight gain and abdominal fat deposition, which originates peripheral insulinorresistance and consequent compensatory hyperinsulinism. Regarding the hyperinsulinism pathophysiology in this syndrome it appears to be a post-receptor deficit, in other words, a disturbance in the intracelular events cascade. Metformin has been associated with an increase in adiponectin levels and a decrease in leptine levels, which sugests a body mass index and insulinorresistance reduction and was also associated with a decrease in seric homocystein. The combination of metformin and statins may improve seric lipidogram and CRP, which is an inflamatory protein and also a cardiovascular risk biomark. Despite the associated teratogenic effect and the potencial weight gain, the prescription of metformin with pioglitazone in this syndrome has shown an increase in peripheral insulin action. Metformin is also effective in anovulation treatment, however, whithout a noticeable increase in alive new born pregnancies. Comparing the use of metformin and clomiphene, the first one carries advantages, mostly the absence of endometrial and ovaric side effects. It has been proved a reduction in testosterone levels with the use of metformin and vitamine D. Usually identified as a drug to avoid during pregnancy, it was also shown an increasing evidence regarding the safety of this usage, which has been associated with spontaneous aborption tax reduction and better metabolic control.
The Polycystic Ovary Syndrome (POS) is the most common gonadic endocrinopathy amongst fertile women. The POS is probably associated to a vicious circle in which the excess of androgens caused by a intern teca cells hyperactivity, promote weight gain and abdominal fat deposition, which originates peripheral insulinorresistance and consequent compensatory hyperinsulinism. Regarding the hyperinsulinism pathophysiology in this syndrome it appears to be a post-receptor deficit, in other words, a disturbance in the intracelular events cascade. Metformin has been associated with an increase in adiponectin levels and a decrease in leptine levels, which sugests a body mass index and insulinorresistance reduction and was also associated with a decrease in seric homocystein. The combination of metformin and statins may improve seric lipidogram and CRP, which is an inflamatory protein and also a cardiovascular risk biomark. Despite the associated teratogenic effect and the potencial weight gain, the prescription of metformin with pioglitazone in this syndrome has shown an increase in peripheral insulin action. Metformin is also effective in anovulation treatment, however, whithout a noticeable increase in alive new born pregnancies. Comparing the use of metformin and clomiphene, the first one carries advantages, mostly the absence of endometrial and ovaric side effects. It has been proved a reduction in testosterone levels with the use of metformin and vitamine D. Usually identified as a drug to avoid during pregnancy, it was also shown an increasing evidence regarding the safety of this usage, which has been associated with spontaneous aborption tax reduction and better metabolic control.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Keywords
Síndrome do ovário poliquístico Metformina Insulinorresistência Hiperandrogenismo Infertilidade Endocrinologia