[Polycystic ovary syndrome of extra-ovarian origin. Review].
An established fact in the polycystic ovarian syndrome (POS) is an abnormal ovarian steroidogenesis. Though this suggest an intrinsic ovarian defect, the syndrome could also be influenced by factors outside the ovaries. Although of unknown etiology, the POS is one of the most frequent endocrine disorders in the gynecologic practice. The disorder is characterized by ultrasound findings of enlarged polycystic ovaries, hyperandrogenism, menstrual disorders, obesity and including the appearance of infertility. There are a series of mechanisms involved in the extraovarian androgen increase in patients with POS. Among these mechanisms are implicated those of central and peripheral origin, genetic factors and adrenocortical dysfunction. In the same way, the alterations produced could imply genetic, molecular biological, biochemical, physiological and endocrinological factors. Sometimes all these factors could interact at the same time. The high serum androgen level could stop the pituitary gonadotropin production, either as a direct mechanism or as a result of its peripheral conversion. The increased androgens also explain the manifestations of clinical acne, hirsutism, and the detention in follicular ovarian maturation. All these manifestations are related with the menstrual disorders, anovulation, and infertility that these patients develop. The characteristics of the extraovarian POS include the 17-hydroxyprogesterone elevation in response to the ACTH test and the dexamethasone suppression of adrenal androgens. It is possible to improve the ovarian function in some patients with POS. This could be achieved with clomiphene citrate associated with glucocorticoids to induce ovulation.
Terán Dávila
J
J
Servicio de Salud Reproductiva, Centro Colaborador del Programa Especial de Reproducción Humana de la Organización Mundial de la Salud, Maternidad Concepción Palacios, Caracas, Venezuela.
Teppa-Garrán
A D
AD
D042842:11-beta-Hydroxysteroid Dehydrogenases; D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D015096:3-Hydroxysteroid Dehydrogenases / Q000172:deficiency / Q000235:genetics; D000302:Adrenal Cortex / Q000378:metabolism; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications; D000308:Adrenocortical Hyperfunction / Q000150:complications; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000728:Androgens / Q000378:metabolism; D002395:Catecholamines / Q000502:physiology; D002996:Clomiphene / Q000627:therapeutic use; D003346:Corticotropin-Releasing Hormone / Q000502:physiology; D003348:Cortisone / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000378:metabolism; D012739:Gonadal Steroid Hormones / Q000378:metabolism; D006801:Humans; D006913:Hydroxysteroid Dehydrogenases / Q000172:deficiency / Q000235:genetics; D006946:Hyperinsulinism / Q000150:complications; D006966:Hyperprolactinemia / Q000150:complications; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007231:Infant, Newborn; D007247:Infertility, Female / Q000188:drug therapy / Q000209:etiology; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D008901:Mineralocorticoids / Q000378:metabolism; D009765:Obesity / Q000150:complications; D010053:Ovary / Q000378:metabolism; D010062:Ovulation Induction; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011085:Polycystic Ovary Syndrome / Q000209:etiology* / Q000235:genetics / Q000378:metabolism; D011555:Pseudopregnancy / Q000209:etiology; D013252:Steroid 11-beta-Hydroxylase / Q000235:genetics; D013254:Steroid 17-alpha-Hydroxylase / Q000235:genetics; D013256:Steroids / Q000378:metabolism*; D002787:Sterol Esterase / Q000172:deficiency / Q000235:genetics; D013315:Stress, Psychological / Q000150:complications / Q000378:metabolism
D000728:Androgens; D002395:Catecholamines; D005938:Glucocorticoids; D012739:Gonadal Steroid Hormones; D020738:Leptin; D008901:Mineralocorticoids; D013256:Steroids; D002996:Clomiphene; D019326:17-alpha-Hydroxyprogesterone; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D015096:3-Hydroxysteroid Dehydrogenases; D006913:Hydroxysteroid Dehydrogenases; D042842:11-beta-Hydroxysteroid Dehydrogenases; D013254:Steroid 17-alpha-Hydroxylase; D013252:Steroid 11-beta-Hydroxylase; D002787:Sterol Esterase; D003348:Cortisone