MECANISMOS FISIOPATOLÓGICOS Y MANEJO TERAPÉUTICO EN EL SÍNDROME DE OVARIO POLIQUÍSTICO: UNA REVISIÓN BIBLIOGRÁFICA
DOI:
https://doi.org/10.47820/recima21.v5i4.5094Palabras clave:
Síndrome del Ovario Poliquístico, Fisiopatología, TerapéuticaResumen
Introducción: El Síndrome de Ovario Poliquístico (SOP) es una afección endocrina compleja que afecta a mujeres en edad reproductiva, presentando una amplia gama de manifestaciones clínicas y metabólicas. Objetivo: analizar los mecanismos fisiopatológicos y abordajes terapéuticos del SOP, proporcionando una síntesis actualizada de la literatura científica. Metodología: Se trata de una revisión bibliográfica, utilizando artículos presentes en las siguientes bases de datos: PubMed, Scopus y SciELO, se incluyeron artículos originales y revisiones sistemáticas en inglés y portugués publicados entre 2013 y 2024, que abordaron mecanismos fisiopatológicos y abordajes terapéuticos del SOP. Luego del análisis, se seleccionaron 37 artículos para elaborar esta revisión bibliográfica. Resultados y Discusión: El SOP es una enfermedad heterogénea caracterizada por hiperandrogenismo, ovulación disfuncional y morfología de ovario poliquístico, acompañada de anomalías metabólicas como resistencia a la insulina y obesidad. Los enfoques terapéuticos para el síndrome de ovario poliquístico van desde intervenciones farmacológicas hasta modificaciones del estilo de vida. Los tratamientos farmacológicos tienen como objetivo normalizar los niveles hormonales, restaurar la ovulación y mejorar los síntomas clínicos, incluidos anticonceptivos orales combinados, antiandrógenos y sensibilizadores de insulina como la metformina. Conclusión: El síndrome de ovario poliquístico sigue siendo una condición desafiante para pacientes y profesionales de la salud, dada su complejidad fisiopatológica y diversas manifestaciones clínicas.
Descargas
Referencias
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
Descargas
Publicado
Número
Sección
Categorías
Licencia
Derechos de autor 2024 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
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.
