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Amanda Hertz

Introduo

A sndrome dos ovrios policsticos


(SOP) a endocrinopatia mais
comum na fase reprodutiva da
mulher; com prevalncia entre 4 e
12%.
A ocorrncia familiar freqente,
principalmente quando h
parentesco de primeiro grau (20 a
60%)1,
Introduo

A patogense da SOP est


relacionada com resistncia
perifrica da insulina
( hiperinsulinemia)
SOP no necessariamente esta
relacionada a obesidade
Diminuio da SHBG, aumento da
testosterona livre e LH/FSH>3 so
caracactersticos da SOP
Sndrome do Ovrio Polcsticos
MANIFESTAES CLNICAS

Hirsutismo,
acne, alopcia Oligo-
anovulao

Obesidade
Clnica:
SOP- Critrios de Diagnstico
European Society of Human Reproduction and
Embryology/American Society of Reproductive consensus
workshop group-Roterdo 2003

Necessrios 2 dos seguintes critrios:

Excesso de andrognios (evidncia clnica ou


laboratorial)

Irregularidade menstrual (oligo-/anovulao)

Ovrios policsticos (ecografia: 12 folculos de 2


9mm e/ou volume ovrico > 10 mL)
Excluso de outras causas de excesso de andrognios
(hiperplasia congnita da supra-renal, Cushing, tumor do
ovrio ou da supra-renal)
Laboratrio da SOP

LH/FSH >3
Testosterona Total
Testosterona livre
Prolactina
17 (OH) progesterona
Glicemia de jejum
Insulina de jejum>_17.3
Homa-IR (>3)
Tratamento

A escolha do tratamento depender do


quadro clnico e laboratorial
Terapia medicamentosa associada a
uma dieta com baixo ndice glicmico
de carboidratos e exerccios fsicos
O objetivo do tratamento da SOP na
dermatologia reduzir a concentrao
de andrgenos para atenuar seus
efeitos na pele e unidade pilossebcea
Tratamento

ACO: tratamento predominante para


reduo do hiperandrogenismo e das
irregularidades menstruais em
mulheres que no desejam engravidar.
O efeito antiandrognico devido a
supresso do LH e assim diminuio da
produo de andrgenos nos ovrios,
aumento da produo heptica de
SHBG e diminuio da testosterona livre
Tratamento
Os progestgenos dos ACO possuem
atividade andrognica variada:
Norgestimato,desogestrel e gestodeno tem
baixo potencial androgenico enquanto que
levonogestrel e norgestrel so considerados
de alta atividade andrognica,
ACO de escolhas
35mcg de etinil estradiol + 2 mg de
acetato de ciproterona(Diane 35)
Drospirenona 3 mg+30 mcg de Etinil-
estradiol.Homburg R. Polycystic ovary syndrome. Best Pract
Res Clin Obstet Gynaecol. 2008; 22: 261-74.
Tratamento
a Drosperinona um derivado da
Espironolactona. 1mg de Drosperinoma
equivale a 8 mg de Espironolactona e a dose
de 3mg DSP que equivale a
aproximadamenate a 25 mg de
Espironolactona . O estrogenio de todas as
pilulas contraceptivas o Etinilestradiol que
varia de 50 a 15 mcg

Tromboembolismo ??
Yasmin and venous thromboembolism: new case
reports.
Lpez M, Vay A, Martnez Triguero ML, Contreras MT,
Todol J, Ricart A, Laiz B.
Haemorheology and Thrombosis Unit, Department of Clinical
Pathology, La Fe University Hospital, Valencia, Spain.
It is not yet known whether Yasmin involves a higher
thrombotic risk compared with other contraceptives. We
present a serie of eight new cases of women who developed
thrombotic events early after starting on Yasmin who were
sent to our Thrombosis and Hemostasis Unit for a
thrombophilia work-up in the last five years. Only two of them
were heterozygous carriers of the prothrombin G20210A
mutation and three were obese while none of them were
smoker. These new cases provide information about the
characteristics of the thrombotic events and the concomitant
risk factors, indicating that this pill may not be as safe as had
been previously thought, and suggest that new studies
regarding safety profile of Yasmin are required to explain the
association with venous thrombotic events.
Risk of thromboembolism in women taking
ethinylestradiol/drospirenone and other oral contraceptives. Obstet
Gynecol. 2007 Sep;110(3):587-93.
Seeger JD, Loughlin J, Eng PM, Clifford CR, Cutone J, Walker AM.

OBJECTIVE: The oral contraceptive ethinylestradiol 0.03 mg/drospirenone 3 mg


contains a progestin component that differs from other oral contraceptives.
Case reports and prescription event monitoring suggested that
ethinylestradiol/drospirenone might be associated with an elevated risk of
thromboembolism. We sought to estimate the association between
ethinylestradiol/drospirenone and risk of thromboembolism relative to the
association among other oral contraceptives. METHODS: We identified
ethinylestradiol/drospirenone initiators and a twofold larger group of other oral
contraceptive initiators between June 2001 and June 2004 within a U.S. health
insurer database. The comparison group was selected to have demographic and
health care characteristics preceding oral contraceptive initiation that were
similar to ethinylestradiol/drospirenone initiators. Thromboembolism during the
follow-up of the cohorts was identified through claims for medical services, and
only medical record-confirmed cases were included in analyses. The primary
(as-matched) analysis used proportional hazards regression, whereas a
secondary (as-treated) analysis accounted for changes in oral contraceptives
during follow-up using Poisson regression. RESULTS: The 22,429
ethinylestradiol/drospirenone initiators and 44,858 other oral contraceptive
initiators were followed for an average of 7.6 months, and there were 18 cases
of thromboembolism in ethinylestradiol/drospirenone initiators and 39 in the
comparators (rate ratio 0.9, 95% confidence interval 0.5-1.6). More than 9,000
women would need to be prescribed oral contraceptives to observe a difference
of one case of thromboembolism. Results of the as-treated analysis were similar
Tratamento
Antiandrgenos:
Indicao:Hirsutismo. Antagonistas
competitivos nos receptores de
andrognio, revertendo a ao de
tranformar os plos velus em fios de
cabelos terminais.
Resultado 9-12ms.
Associar anticoncepao (risco de virilizao
incompleta dos fetos machos)
Acetato de ciproterona( 25/50mg nos
primeiros 10d do ciclo)
Espironolactona(100/200mg dia)
Finasterida ( 5mg/dia)
Tratamento

Agentes sensibilizantes da insulina:


Metformina: reduz a resistencia a insulina
seguida por uma diminuio de androgenos
ovarianos (1500-2500 mg/dia)
Tiozalinedionas(troglitazona,pioglitazona,
rosiglitazona):
Troglitazona retirada por efeito hepatotxico
Pioglitazona: aumento de peso
*ambos diminuiram igualmente o grau de
hirsutismo,concentraes sricas de
testosterona livre Ortega-Gonzalez C, Luna S, Hernandez L,
Crespo G, Aguayo P, Arteaga-Troncoso G, et al. Responses of serum androgen
and insulin resistance to metformin and pioglitazone in obese, insulin-resistant
women with polycystic ovary syndrome. J Clin Endocrinol Metab.
2005;90(3):1360-5.
Obrigada!