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Porto Alegre, Brazil

Spritzer P.M.,Gynecologic Endocrinology Unit | Spritzer P.M.,Federal University of Rio Grande do Sul
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2014

Polycystic ovary syndrome (PCOS) is a common condition in women at reproductive age associated with reproductive and metabolic dysfunction. Proposed diagnosed criteria for PCOS include two out of three features: androgen excess, menstrual irregularity, and polycystic ovary appearance on ultrasound (PCO), after other causes of hyperandrogenism and dysovulation are excluded. Based on these diagnostic criteria, the most common phenotypes are the "classic PCOS" - hyperandrogenism and oligomenorrhea, with or without PCO; the "ovulatory phenotype" - hyperandrogenism and PCO in ovulatory women; and the "non-hyperandrogenic phenotype", in which there is oligomenorrhea and PCO, without overt hyperandrogenism. The presence of obesity may exacerbate the metabolic and reproductive disorders associated with the syndrome. In addition, PCOS women present higher risk for type 2 diabetes and higher prevalence of cardiovascular risk factors that seems to be associated with the classic phenotype. The main interventions to minimize cardiovascular and metabolic risks in PCOS are lifestyle changes, pharmacological therapy, and bariatric surgery. Treatment with metformin has been shown to improve insulin sensitivity, lowering blood glucose and androgen levels. These effects are more potent when combined with lifestyle interventions. In conclusion, besides reproductive abnormalities, PCOS has been associated to metabolic comorbidities, most of them linked to obesity. Confounders, such as the lack of standard diagnostic criteria, heterogeneity of the clinical presentation, and presence of obesity, make management of PCOS difficult. Therefore, the approach to metabolic abnormalities should be tailored to the risks and treatment goals of each individual woman. © ABE&M todos os direitos reservados. Source

Ramos R.B.,Gynecologic Endocrinology Unit | Ramos R.B.,National Health Research Institute | Casanova G.K.,Gynecologic Endocrinology Unit | Casanova G.K.,National Health Research Institute | And 5 more authors.
Fertility and Sterility | Year: 2011

Objective: To test the association between polymorphisms rs9939609 T>A and rs8050136 A>C of the fat mass and obesity-associated (FTO) gene and metabolic and cardiovascular variables in postmenopause. Design: Cross-sectional study. Setting: University hospital. Patient(s): A total of 135 postmenopausal women (mean age 52 ± 4 years). Intervention(s): Anthropometric measurements and collection of blood samples. Main Outcome Measure(s): Blood pressure, metabolic variables, and FTO genotype. Result(s): The frequency of polymorphism rs9939609 was 43.7% for the wild TT genotype, 43.0% for TA, and 13.3% for AA. The frequency of the rs8050136 polymorphism was 12.6% for the wild AA genotype, 39.3% for AC, and 48.1% for CC. The polymorphic AA genotype of the SNP rs9939609 was associated with higher glucose levels and lipid accumulation product (LAP) index, whereas the wild AA genotype of the SNP rs8050136 was associated with higher LAP. Conclusion(s): The rs9939609 polymorphism in the FTO gene is related to abnormal glucose levels and with LAP, a surrogate marker of diabetes and cardiovascular risk in postmenopause. Further studies are needed in different ethnic backgrounds to confirm the clinical relevance of these associations. © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc. Source

Graff S.K.,Gynecologic Endocrinology Unit | Mario F.M.,Gynecologic Endocrinology Unit | Alves B.C.,Gynecologic Endocrinology Unit | Spritzer P.M.,Gynecologic Endocrinology Unit | And 2 more authors.
Fertility and Sterility | Year: 2013

Objective To compare glycemic index (GI) in the usual diet of polycystic ovary syndrome (PCOS) and control women and to investigate whether dietary GI is associated with body composition and anthropometric and metabolic variables across PCOS phenotypes. Design Cross-sectional study. Setting University hospital outpatient clinic. Patient(s) Sixty-one women with PCOS and 44 nonhirsute women with ovulatory cycles. Intervention(s) Metabolic work-up, biochemical and hormonal assays, assessment of body composition and rest metabolic rate, physical activity (pedometer), and food consumption (food frequency questionnaire). Main outcome measure(s) GI, glycemic load, dietary intake, and hormone and metabolic profile in PCOS versus control and in PCOS women stratified by tertiles of GI and PCOS phenotype. Result(s) Mean age was 23.7 ± 6.3 years. Participants with PCOS had higher body fat percentage, fasting insulin, insulin resistance, lipid accumulation product, and androgen levels compared with control women. PCOS and control women in the highest tertile of GI had higher body mass index and waist circumference than those in the lowest tertile. Dietary GI was higher in the classic PCOS group. Obesity and this more severe PCOS phenotype explained 28.3% of variance in dietary GI. Conclusion(s) Dietary GI is increased in the classic PCOS phenotype and associated with a less favorable anthropometric and metabolic profile. Obesity and classic PCOS phenotype are age-independent predictors of higher dietary GI. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc. Source

Lecke S.B.,Gynecologic Endocrinology Unit | Mattei F.,Gynecologic Endocrinology Unit | Mattei F.,Federal University of Rio Grande do Sul | Morsch D.M.,Gynecologic Endocrinology Unit | And 3 more authors.
Fertility and Sterility | Year: 2011

Objective: To determine leptin and adiponectin serum levels and gene expression in subcutaneous adipose tissue from women with polycystic ovary syndrome (PCOS) and nonhirsute, ovulatory women; and leptin/adiponectin (L/A) ratio. Design: Case-control study. Setting: University hospital gynecologic endocrinology unit. Patient(s): Thirty-one women with PCOS and 57 controls. Intervention(s): Anthropometric, hormonal, and metabolic assessment; subcutaneous adipose tissue biopsy. Main Outcome Measure(s): Leptin and adiponectin serum levels, L/A ratio, controlled by age, and gene expression in women with PCOS and controls, stratified by body mass index and variables associated with androgen excess and insulin resistance. Result(s): Serum leptin was higher in overweight/obese patients with PCOS than in all normal-weight control women. Adiponectin levels were similar in all subgroups. The L/A ratio was lower in normal-weight controls (1.80; range 0.94-3.72) than in overweight/obese controls (5.27; range 2.66-13.58) and patients with PCOS (7.73; range 3.81-15.04). Subcutaneous leptin messenger RNA was higher in overweight/obese women with PCOS than in normal-weight controls (2.316 [range 1.987-2.580] vs. 1.687 [range 1.518-2.212]). Adiponectin gene expression was similar in all groups. Positive correlations were found between serum and messenger RNA levels for both leptin and adiponectin. On multiple regression analysis, percentage of body fat contributed significantly to L/A ratio in PCOS, independently of body mass index and free androgen index. Conclusion(s): In PCOS, altered adipocyte secretion seems to relate to adiposity rather than to androgen excess. © 2011 by American Society for Reproductive Medicine. Source

Santos B.R.,Gynecologic Endocrinology Unit | Santos B.R.,Federal University of Rio Grande do Sul | Mascarenhas L.P.G.,Federal University of Parana | Satler F.,Gynecologic Endocrinology Unit | And 5 more authors.
Journal of Endocrinological Investigation | Year: 2012

Background: Evidence suggests that precocious pubarche (PP) girls may have higher risk of developing polycystic ovary syndrome (PCOS) at later ages. Vitamin D receptor (VDR) gene polymorphisms have been implicated in the risk of diabetes and PCOS, but little is known about the role of VDR in PP. Aim: To assess the frequencies of VDR gene ApaI, TaqI, BsmI, and FokI polymorphisms and to determine whether these variants are associated with sex hormone concentrations in patients with PP and controls from southern Brazil. Subjects and methods: Blood was collected from 36 girls with PP and 197 controls for genotyping of BsmI and FokI polymorphisms using real-time PCR and of ApaI e TaqI polymorphisms using restriction fragment length polymorphism. Hormone levels were also determined. Results: Genotype GG of the ApaI single nucleotide polymorphism (SNP) was more frequent in PP (30.6%) than in controls (16.2%) [odds ratio (OR): 2.269; confidence interval 95% (95%CI): 1.015-5.076; p=0.042]. This genotype was also associated with lower estradiol [35.30 (14.80-50.48) pg/ml vs 12.22 (6.49-23.69) pg/ml; p=0.025] and total testosterone levels (0.52 (0.39-0.84) ng/ml vs 0.20 (0.11-0.47) ng/ml; p=0.005) as compared with the TT + TG genotypes in girls with PP. The distribution of TaqI, BsmI, and Fokl SNP was similar in PP and controls, and no association was found between these polymorphisms and sex steroid levels. Conclusions: The ApaI SNP of the VDR gene was associated with PP in the studied population and may modulate ovarian steroid secretion in these girls. ©2012, Editrice Kurtis. Source

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