MECANISMOS FISIOPATOLÓGICOS E CONDUTAS TERAPÊUTICAS NA SÍNDROME DO OVÁRIO POLICÍSTICO: UMA REVISÃO BIBLIOGRÁFICA
DOI:
https://doi.org/10.47820/recima21.v5i4.5094Palavras-chave:
Síndrome do Ovário Policístico, Fisiopatologia, TerapêuticaResumo
Introdução: A Síndrome do Ovário Policístico (SOP) é uma condição endócrina complexa que afeta mulheres em idade reprodutiva, apresentando uma ampla gama de manifestações clínicas e metabólicas. Objetivo: analisar os mecanismos fisiopatológicos e condutas terapêuticas da SOP, fornecendo uma síntese atualizada da literatura científica. Metodologia: Trata-se de uma revisão bibliográfica, utilizando artigos presentes nas seguintes bases de dados: PubMed, Scopus e SciELO Foram incluídos artigos originais e revisões sistemáticas em inglês e português publicadas entre 2013 e 2024, que abordassem sobre mecanismos fisiopatológicos e condutas terapêuticas da SOP. Após a análise, foram selecionados 37 artigos para a confecção dessa revisão bibliográfica. Resultados e Discussão: A SOP é uma doença heterogênea caracterizada por hiperandrogenismo, ovulação disfuncional e morfologia dos ovários policísticos, acompanhada de anormalidades metabólicas, como resistência à insulina e obesidade. As abordagens terapêuticas para a SOP variam desde intervenções farmacológicas até modificações no estilo de vida. Os tratamentos farmacológicos visam normalizar os níveis hormonais, restaurar a ovulação e melhorar os sintomas clínicos, incluindo contraceptivos orais combinados, antiandrogênios e sensibilizadores de insulina, como a metformina.. Conclusão: A SOP continua sendo uma condição desafiadora para pacientes e profissionais de saúde, dada a sua complexidade fisiopatológica e as diversas manifestações clínicas.
Downloads
Referências
ABBOTT, David H.; DUMESIC, Daniel A.; LEVINE, Jon E. Hyperandrogenic origins of polycystic ovary syndrome–implications for pathophysiology and therapy. Expert review of endocrinology & metabolismo, v. 14, n. 2, p. 131-143, 2019. DOI: https://doi.org/10.1080/17446651.2019.1576522
AL KHALIFAH, Reem A. et al. Metformin or oral contraceptives for adolescents with polycystic ovarian syndrome: a meta-analysis. Pediatrics, v. 137, n. 5, 2016. DOI: https://doi.org/10.1542/peds.2015-4089
AL WATTAR, Bassel H. et al. Clinical practice guidelines on the diagnosis and management of polycystic ovary syndrome: a systematic review and quality assessment study. The Journal of Clinical Endocrinology & Metabolism, v. 106, n. 8, p. 2436-2446, 2021. DOI: https://doi.org/10.1210/clinem/dgab232
ALESI, Simon et al. Nutritional supplements and complementary therapies in polycystic ovary syndrome. Advances in Nutrition, v. 13, n. 4, p. 1243-1266, 2022. DOI: https://doi.org/10.1093/advances/nmab141
BANNIGIDA, Doddappa M.; NAYAK, B. Shivananda; VIJAYARAGHAVAN, R. Insulin resistance and oxidative marker in women with PCOS. Archives of physiology and biochemistry, v. 126, n. 2, p. 183-186, 2020. DOI: https://doi.org/10.1080/13813455.2018.1499120
BASKIND, N. Ellissa; BALEN, Adam H. Hypothalamic–pituitary, ovarian and adrenal contributions to polycystic ovary syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology, v. 37, p. 80-97, 2016. DOI: https://doi.org/10.1016/j.bpobgyn.2016.03.005
BRENNAN, Leah et al. Lifestyle and behavioral management of polycystic ovary syndrome. Journal of women's health, v. 26, n. 8, p. 836-848, 2017. DOI: https://doi.org/10.1089/jwh.2016.5792
COYLE, Christopher; CAMPBELL, Rebecca E. Pathological pulses in PCOS. Molecular and cellular endocrinology, v. 498, p. 110561, 2019. DOI: https://doi.org/10.1016/j.mce.2019.110561
CREE-GREEN, Melanie et al. Insulin resistance, hyperinsulinemia, and mitochondria dysfunction in nonobese girls with polycystic ovarian syndrome. Journal of the Endocrine Society, v. 1, n. 7, p. 931-944, 2017. DOI: https://doi.org/10.1210/js.2017-00192
DOMECQ, Juan Pablo et al. Lifestyle modification programs in polycystic ovary syndrome: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, v. 98, n. 12, p. 4655-4663, 2013. DOI: https://doi.org/10.1210/jc.2013-2385
FENICHEL, Patrick et al. Which origin for polycystic ovaries syndrome: genetic, environmental or both?. Annales d'endocrinologie, p. 176-185, 2017. DOI: https://doi.org/10.1016/j.ando.2017.04.024
FRANKS, S.; HARDY, K. Androgen action in the ovary. Front. Endocrinol., v. 9, p. 452, 2018. DOI: https://doi.org/10.3389/fendo.2018.00452
GANIE, Mohammad Ashraf et al. Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India. Indian Journal of Medical Research, v. 150, n. 4, p. 333-344, 2019. DOI: https://doi.org/10.4103/ijmr.IJMR_1937_17
HOMER, Michael V. et al. Individual 17-hydroxyprogesterone responses to hCG are not correlated with follicle size in polycystic ovary syndrome. Journal of the Endocrine Society, v. 3, n. 4, p. 687-698, 2019. DOI: https://doi.org/10.1210/js.2018-00339
IBÁÑEZ, Lourdes et al. An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Hormone research in paediatrics, v. 88, n. 6, p. 371-395, 2017. DOI: https://doi.org/10.1159/000479371
ILIE, Ioana R.; GEORGESCU, Carmen E. Polycystic ovary syndrome-epigenetic mechanisms and aberrant microRNA. Advances in clinical chemistry, v. 71, p. 25-45, 2015. DOI: https://doi.org/10.1016/bs.acc.2015.06.001
KIM, Joon Young et al. Impaired lipolysis, diminished fat oxidation, and metabolic inflexibility in obese girls with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, v. 103, n. 2, p. 546-554, 2018. DOI: https://doi.org/10.1210/jc.2017-01958
LI, Yan et al. Multi-system reproductive metabolic disorder: significance for the pathogenesis and therapy of polycystic ovary syndrome (PCOS). Life sciences, v. 228, p. 167-175, 2019. DOI: https://doi.org/10.1016/j.lfs.2019.04.046
LI, Yujing et al. Comparing the individual effects of metformin and rosiglitazone and their combination in obese women with polycystic ovary syndrome: a randomized controlled trial. Fertility and sterility, v. 113, n. 1, p. 197-204, 2020. DOI: https://doi.org/10.1016/j.fertnstert.2019.09.011
LIM, S. S. et al. Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta‐analysis and meta‐regression. Obesity reviews, v. 20, n. 2, p. 339-352, 2019. DOI: https://doi.org/10.1111/obr.12762
LIU, Yishan et al. The release of peripheral immune inflammatory cytokines promote an inflammatory cascade in PCOS patients via altering the follicular microenvironment. Frontiers in immunology, v. 12, p. 685724, 2021. DOI: https://doi.org/10.3389/fimmu.2021.685724
MANCINI, Antonio et al. Oxidative stress and low-grade inflammation in polycystic ovary syndrome: controversies and new insights. International Journal of Molecular Sciences, v. 22, n. 4, p. 1667, 2021. DOI: https://doi.org/10.3390/ijms22041667
MIZGIER, Małgorzata et al. Relation between inflammation, oxidative stress, and macronutrient intakes in normal and excessive body weight adolescent girls with clinical features of polycystic ovary syndrome. Nutrients, v. 13, n. 3, p. 896, 2021. DOI: https://doi.org/10.3390/nu13030896
O’REILLY, Michael W. et al. AKR1C3-mediated adipose androgen generation drives lipotoxicity in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, v. 102, n. 9, p. 3327-3339, 2017. DOI: https://doi.org/10.1210/jc.2017-00947
RUDDENKLAU, Amy; CAMPBELL, Rebecca E. Neuroendocrine impairments of polycystic ovary syndrome. Endocrinology, v. 160, n. 10, p. 2230-2242, 2019. DOI: https://doi.org/10.1210/en.2019-00428
SADEGHI, Hosna Mohammad et al. Polycystic ovary syndrome: a comprehensive review of pathogenesis, management, and drug repurposing. International journal of molecular sciences, v. 23, n. 2, p. 583, 2022. DOI: https://doi.org/10.3390/ijms23020583
SAMUEL, Varman T. et al. The pathogenesis of insulin resistance: integrating signaling pathways and substrate flux. The Journal of clinical investigation, v. 126, n. 1, p. 12-22, 2016. DOI: https://doi.org/10.1172/JCI77812
STEPTO, Nigel K. et al. Molecular mechanisms of insulin resistance in polycystic ovary syndrome: unraveling the conundrum in skeletal muscle?. The Journal of Clinical Endocrinology & Metabolism, v. 104, n. 11, p. 5372-5381, 2019. DOI: https://doi.org/10.1210/jc.2019-00167
SZCZUKO, Małgorzata et al. Nutrition strategy and life style in polycystic ovary syndrome—Narrative review. Nutrients, v. 13, n. 7, p. 2452, 2021. DOI: https://doi.org/10.3390/nu13072452
TEEDE, Helena J. et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction, v. 33, n. 9, p. 1602-1618, 2018.
WANG, Juan et al. Hyperandrogenemia and insulin resistance: The chief culprit of polycystic ovary syndrome. Life sciences, v. 236, p. 116940, 2019. DOI: https://doi.org/10.1016/j.lfs.2019.116940
Witchel, Selma Feldman et al. “Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls.” Journal of the Endocrine Society, v. 3, n. 8, p. 1545-1573, 14 jun. 2019. DOI: https://doi.org/10.1210/js.2019-00078
ZEIND, Caroline S. et al. Applied therapeutics: the clinical use of drugs. [S. l.]: Lippincott Williams & Wilkins, 2023.
ZHANG, Renjiao et al. Oxidative stress status in Chinese women with different clinical phenotypes of polycystic ovary syndrome. Clinical Endocrinology, v. 86, n. 1, p. 88-96, 2017. DOI: https://doi.org/10.1111/cen.13171
ZHAO, Han et al. Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. Journal of Ovarian Research, v. 16, n. 1, p. 9, 2023. DOI: https://doi.org/10.1186/s13048-022-01091-0
ZHU, Daiyu et al. Effects of metformin on pregnancy outcome, metabolic profile, and sex hormone levels in women with polycystic ovary syndrome and their offspring: a systematic review and meta-analysis. Annals of Translational Medicine, v. 10, n. 7, 2022. DOI: https://doi.org/10.21037/atm-22-909
ZHU, Jing-ling et al. Sex hormone-binding globulin and polycystic ovary syndrome. Clinica chimica acta, v. 499, p. 142-148, 2019. DOI: https://doi.org/10.1016/j.cca.2019.09.010
Downloads
Publicado
Licença
Copyright (c) 2024 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.
