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Vol. 53. Núm. S1.
Resistencia a la insulina y síndrome del ovario poliquístico (SOP)
Páginas 41-55 (Septiembre 2006)
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Vol. 53. Núm. S1.
Resistencia a la insulina y síndrome del ovario poliquístico (SOP)
Páginas 41-55 (Septiembre 2006)
Resistencia a la insulina y síndrome del ovario poliquístico (SOP)
Acceso a texto completo
Resistencia a la insulina, obesidad y síndrome metabólico en el síndrome del ovario poliquístico
Insulin resistance, obesity and metabolic syndrome in polycystic ovary syndrome
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5124
A. Gambineri
Autor para correspondencia
gambineri@orsola-maipighi.med.unibo.it

Correspondencia: Dra. A. Gambineri. U.O. di Endocrinologia.Dipt. Medicina Interna, Osp. S. Orsola-Malpighi. Via Massarenti, 9. 40138 Bolonia. Italia.
, R. Pasquali
Endocrinology Unit. Department of Internal Medicine. S. Orsola-Malpighi Hospital. University of Bologna. Bolonia. Italia
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En la última década, se acepta, en general, que la resistencia a la insulina y la hiperinsulinemia se hallan presentes de un modo inconstante en la mayoría de mujeres con el síndrome del ovario poliquístico (SOP). Además, la obesidad puede afectar a más de la mitad de estas mujeres. La obesidad ejerce una profunda influencia en el fenotipo del SOP y se asocia con una mayor gravedad de la resistencia a la insulina, el hiperandrogenismo y los trastornos de la fertilidad. Asimismo, la asociación entre el SOP y la obesidad predispone a las mujeres a desarrollar intolerancia a la glucosa, y al síndrome metabólico, en comparación con la población general. Sin embargo, las diferencias existentes en distintos países en cuanto a las tasas de prevalencia de la intolerancia a la glucosa o del síndrome metabólico en las mujeres con SOP sugieren que los factores ambientales son importantes para determinar la susceptibilidad individual a desarrollar estas anomalías metabólicas.

Palabras clave:
SOP
Obesidad
Fenotipo abdominal
Resistencia a la insulina
Trastornos metabólicos

It has been widely recognized in the last decade that insulin resistance and hyperinsulinemia are inconsistently present in the majority of women with polycystic ovary syndrome (PCOS). In addition, obesity may affect more than half of these women. Obesity has a profound impact on the PCOS phenotype, being associated with a more severe insulin resistant state, hyperandrogenism and fertility disorders. Moreover, the association between obesity (particularly the abdominal phenotype) and PCOS renders affected women more susceptible to develop glucose intolerance and the metabolic syndrome in comparison with the general population. However, the presence of differences in the prevalence rate of glucose intolerance states or the metabolic syndrome within PCOS women in different countries suggests that environmental factors are important in determining individual susceptibility to develop these metabolic abnormalities.

Key words:
PCOS
Obesity
Abdominal phenotype
Insulin resistance
Metabolic disorders
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Bibliografía
[1.]
A. Gambineri, C. Pelusi, V. Vicennati, U. Pagotto, R. Pasquali.
Obesity and the polycystic ovary syndrome.
Int J Obes Relat Metab Dis, 26 (2002), pp. 883-896
[2.]
A. Dunaif.
Insulin resistance and the polycystic ovary syndrome: mechanisms and implications for pathogenesis.
Endocr Rev, 18 (1997), pp. 774-800
[3.]
L. Poretsky, N.A. Cataldo, Z. Rosenwaks, L.C. Giudice.
The insulin-related ovarian regulatory system in health and disease.
Endocr Rev, 20 (1999), pp. 535-582
[4.]
T. Apridonidze, P. Essah, M.J. Iourno, J.E. Nestler.
Prevalence and characteristics of the metabolic syndrome in women with PCOS.
J Clin Endocrinol Metab, 90 (2005), pp. 1929-1935
[5.]
D.A. Ehrmann.
Polycystic ovary syndrome.
N Engl J Med, 352 (2005), pp. 1223-1236
[6.]
D.A. Ehrmann, J. Sturis, M.M. Byrne, T. Karrison, R.L. Rosenfield, K.S. Polonsky.
Insulin secretory defects in polycystic ovary syndrome. Relationship to insulin sensitivity and family history of non-insulin-dependent diabetes mellitus.
J Clin Invest, 96 (1995), pp. 520-527
[7.]
C.N. Wijeyartne, A.H. Balen, J.H. Barth, P.E. Belchetz.
Clinical manifestation and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference?.
Clin Endocrinol (Oxf), 57 (2002), pp. 343-350
[8.]
H. Beck Nielsen, F. Alford, O. Hother-Nielsen.
Insulin resistance in glucose disposal and production in man with specific reference to metabolic syndrome and type 2 diabetes.
Insulin resistance, pp. 155-178
[9.]
R.N. Bergman, D.T. Finegood, M. Ader.
Assessment of insulin sensitivity in vivo.
Endocr Rev, 6 (1985), pp. 45-86
[10.]
D.r. Mattews, J.P. Hosker, A.S. Rudenski, B.A. Naylor, D.F. Treacher, R.C. Turner.
Homeostasis model assessment: insulin resistance and B-cell function from fasting plasma glucose and insulin concentrations in man.
Diabetologia, 28 (1985), pp. 412-419
[11.]
A. Katz, S.S. Nambi, K. Mater, A.D. Baron, D.A. Follman, G. Sullivan, et al.
Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans.
J Clin Endocrinol Metab, 85 (2000), pp. 2402-2410
[12.]
A. Dunaif, D.T. Finegood.
β-cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome.
J Clin Endocrinol Metab, 81 (1996), pp. 942-947
[13.]
G.M. Reaven.
The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals.
Endocrinol Metab Clin North Am, 33 (2004), pp. 283-303
[14.]
E. Carmina, R. Lobo.
Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome.
Fertil Steril, 82 (2004), pp. 661-665
[15.]
E. Diamanti-Kandarakis, C. Kouli, K. Alexandraki, G. Spina.
Failure of mathematical indices to accurately assess insulin resistance in lean, overweight, or obese women with polycystic ovary syndrome.
J Clin Endocrinol Metab, 89 (2004), pp. 1273-1276
[16.]
J.R. Azziz, L.A. Sánchez, E.S. Knochenhauer, C. Moran, J. Lazenby, K.C. Stephens, et al.
Androgen excess in women: experience with over 1000 consecutive patients.
J Clin Endocrinol Metab, 89 (2004), pp. 453-462
[17.]
V.D. Lewy, K. Danadian, S.F. Witchel, S. Arslanian.
Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome.
J Pediatr, 138 (2001), pp. 38-44
[18.]
G. Gennarelli, R. Roveri, F. Novi, J. Holte, F. Bongiovanni, A. Revelli, et al.
Preserved insulin sensitivity and β-cell activity, but decreased glucose effectiveness in normal weight women with polycystic ovary syndrome.
J Clin Endocrinol Metab, 90 (2005), pp. 3381-3386
[19.]
L.C. Morin Papunen, I. Vahkonen, R.M. Koivunen, A. Ruokonen, J.S. Tapanainen.
Insulin sensitivity, insulin secretion and metabolic and hormonal parameters in healthy women and women with polycystic ovary syndrome.
Hum Reprod, 15 (2004), pp. 1266-1274
[20.]
J. Holte, C. Bergh, L. Berglund, H. Litthell.
Enhanced early phase insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome.
J Clin Endocrinol Metab, 78 (1994), pp. 1052-1058
[21.]
J. Vrbikova, D. Cibula, K. Dvorakova, S. Stanicka, G. Sindelka, M. Hill, et al.
Insulin sensitivity in women with polycystic ovary syndrome.
J Clin Endocrinol Metab, 89 (2004), pp. 2942-2945
[22.]
D. Cibula.
Is insulin resistance an essential component of PCOS?.
Hum Reprod, 19 (2004), pp. 757-759
[23.]
R. Pasquali, A. Gambineri, B. Anconetani, V. Vicennati, D. Colitta, E. Caramelli, et al.
The natural history of the metabolic syndrome in young women with the polycystic ovary syndrome and the long-term effect of oestrogenprogestagen treatment.
Clin Endocrinol (Oxf), 50 (1999), pp. 517-527
[24.]
A. Gambineri, C. Pelusi, E. Manicardi, V. Vicennati, M. Cacciari, A.M. Morselli-Labate, et al.
Glucose intolerance in a large cohort of Mediterranean women with polycystic ovary syndrome. Phenotype and associated factors.
Diabetes, 53 (2004), pp. 2353-2358
[25.]
J. Holte, T. Bergh, C. Berne, L. Wide, H. Lithell.
Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome.
J Clin Endocrinol Metab, 80 (1995), pp. 2586-2593
[26.]
I.F. Stein, M.L. Leventhal.
Amenorrhea associated with bilateral polycystic ovaries.
Am J Obstet Gynecol, 29 (1935), pp. 181-191
[27.]
J. Rogers, G.W. Mitchell.
The relation of obesity to menstrual disturbances.
N Engl J Med, 247 (1952), pp. 53-56
[28.]
A.J. Hartz, P.N. Barboriak, A. Wong, K.P. Katayama, A.A. Rimm.
The association of obesity with infertility and related menstrual abnormalities in women.
Int J Obesity Rel Metab Dis, 3 (1979), pp. 57-77
[29.]
C. Pelusi, R. Pasquali.
Polycystic ovary syndrome in adolescents. Pathophysiology and treatment implication.
Treat Endocrinol, 2 (2003), pp. 215-230
[30.]
J.K. Lake, C. Power, T.J. Cole.
Women's reproductive health: the role of body mass index in early and adult life.
Int J Obesity Rel Metab Dis, 21 (1997), pp. 432-438
[31.]
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.
Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).
Hum Reprod, 19 (2004), pp. 41-47
[32.]
Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. Br J Obstet Gynecol. 2006. En prensa.
[33.]
R.A. Lobo, M. Gysler, C.M. March, U. Goebelman, D.R. Mischell Jr.
Clinical and laboratory predictors of clomiphene response.
Fertil Steril, 37 (1982), pp. 168-174
[34.]
J.E. Nestler, D.J. Jakubowicz, W.S. Evans, R. Pasquali.
Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome.
N Engl J Med, 25 (1998), pp. 1876-1880
[35.]
V. De Leo, A. La Marca, F. Petraglia.
Insulin-lowering agents in the management of polycystic ovary syndrome.
Endocr Rev, 24 (2003), pp. 633-637
[36.]
M. Filicori, C. Flamigni, P. Dellai.
Treatment of anovulation with pulsatile gonadotropin-releasing hormone: prognostic factors and clinical results in 600 cycles.
J Clin Endocrinol Metab, 79 (1994), pp. 1215-1220
[37.]
D.M. White, D.W. Polson, D. Kiddy, P. Sagle, H. Watson, C. Gilling-Smith, et al.
Induction of ovulation with low-dose gonadotropins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women.
J Clin Endocrinol Metab, 81 (1996), pp. 3821-3824
[38.]
P. Fedorcsák, P.O. Dale, R. Storeng, T. Tanbo, T. Abyholm.
The impact of obesity and insulin resistance on the outcome of IVF or ICSI in women with polycystic ovarian syndrome.
Hum Reprod, 16 (2001), pp. 1086-1091
[39.]
D.A. Ehrmann, R.B. Barnes, R.L. Rosenfield, M.K. Cavaghan, J. Imperial.
Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome.
Diabetes Care, 22 (1999), pp. 141-146
[40.]
R.S. Legro, A.R. Kunselman, W.C. Dodson, A. Dunaif.
Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women.
J Clin Endocrinol Metab, 84 (1999), pp. 165-169
[41.]
S. Weerakiet, C. Srisombut, P. Bunnag, S. Sangtong, N. Chuangsoongnoen, A. Rojanasakul.
Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome.
Int J Gynaecol Obstet, 75 (2001), pp. 177-184
[42.]
R.S. Legro, C.L. Gnatuk, A.R. Kunselman, A. Dunaif.
Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study.
J Clin Endocrinol Metab, 90 (2005), pp. 3236-3242
[43.]
J. Kishore, M.B.B.S. Harjai.
Potential new cardiovascular risk factors: left ventricular hypertrophy, homocysteine, lipoprotein(a), triglycerides, oxidative stress, and fibrinogen.
Ann Int Med, 131 (1999), pp. 376-386
[44.]
Z.T. Bloomgarden.
Inflammation and insulin resistance.
Diabetes Care, 26 (2003), pp. 1922-1926
[45.]
E. Diamanti-Kandarakis, T. Paterakis, K. Alexandraki, C. Piperi, A. Aessopos, I. Katsikis, et al.
Indices of low-grade chronic inflammation in polycystic ovary syndrome and the beneficial effect of metformin.
Hum Reprod, (2006),
[46.]
M.A. Kirschner, E. Samojlik, M. Drejka, E. Szmal, G. Schneider, N. Ertel.
Androgen estrogen metabolism in women with upper body versus lower body obesity.
J Clin Endocrinol Metab, 70 (1990), pp. 473-479
[47.]
B.R. Kurtz, J.R. Givens, S. Koinindir, M.D. Stevens, J.G. Karas, J.B. Bitte, et al.
Maintenance of normal circulating levels of Δ4androstenedione and dehydroepiandrosterone in simple obesity despite increased metabolic clearance rate: evidence for a servo-control mechanism.
J Clin Endocrinol Metab, 64 (1987), pp. 1261-1267
[48.]
R. Azziz.
Reproductive endocrinologic alterations in female asymptomatic obesity.
Fertil Steril, 52 (1989), pp. 703-725
[49.]
S.S.C. Yen.
The polycystic ovary syndrome.
Clin Endocrinol (Oxf), 12 (1980), pp. 177-208
[50.]
R. Pasquali, F. Casimirri.
The impact of obesity on hyperandrogenism and polycystic ovary syndrome in premenopausal women.
Clin Endocrinol (Oxf), 39 (1993), pp. 1-16
[51.]
R.V. Considine, M.K. Sinha, M.L. Heiman, A. Kriauciunas, T.W. Stephens, M.R. Nyce.
Serum immunoreactive leptin concentrations in normalweight and obese humans.
N Engl J Med, 334 (1996), pp. 292-295
[52.]
G. Wiesner, M. Vaz, G. Collier, D. Seals, D. Kaye, G. Jennings, et al.
Leptin is released from the human brain. Influence of adiposity and gender.
J Clin Endocrinol Metab, 84 (1999), pp. 2270-2274
[53.]
S.K. Agarwal, K. Vogel, S.R. Weitsman, D.A. Magoffin.
Leptin antagonizes the insulin-like growth factor-I augmentation of steroidogenesis in granulosa and theca cells of the human ovary.
J Clin Endocrinol Metab, 84 (1999), pp. 1072-1076
[54.]
P.S. Duggal, K.H. Van Der Hoek, C.R. Milner, N.K. Ryan, D.T. Armstrong, D.A. Magoffin, et al.
The in vivo and in vitro effects of exogenous leptin on ovulation in rat.
Endocrinology, 141 (2000), pp. 1971-1976
[55.]
B.L. Wajchenberg.
Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome.
Endocr Rev, 21 (2000), pp. 697-738
[56.]
R. Pasquali, V. Vicennati.
The abdominal obesity phenotype and insulin resistance are associated with abnormalities of the hypothalamic-pituitary-adrenal axis in humans.
Horm Metab Res, 32 (2000), pp. 521-525
[57.]
H. Masuzaki, J. Paterson, H. Shinyama, N.M. Morton, J.J. Mullins, J.R. Seckl, et al.
A transgenic model of visceral obesity and the metabolic syndrome.
Science, 294 (2001), pp. 2166-2170
[58.]
World Heath Organization.
Definition, diagnosis and classification of diabetes mellitus and its complications.
Part 1: diagnosis and classification of diabetes mellitus, Department of Noncommunicable Disease Surveillance, (1999),
[59.]
B. Balkau, M.A. Charles, Comment on the provisional report from the WHO consultation.
European Group for the Study of Insulin Resistance (EGIR).
Diab Med, 16 (1999), pp. 442-443
[60.]
Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.
[61.]
International Diabetes Federation. The IDF worldwide definition of the metabolic syndrome [citado 18 May 2005]. Disponible en: http://www.cdc.gov/nchs/about/major/nhanes/nhanes/99-02.htm
[62.]
C.J. Glueck, R. Papanna, P. Wang, N. Goldemberg, L. Sieve-Smith.
Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome.
Metabolism, 52 (2003), pp. 908-915
[63.]
D.A. Ehrmann, D.R. Liljenquist, K. Kasza, R. Azziz, R.S. Legro, M.N. Ghazzi, For the PCOS/Troglitazone Study Group.
Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome.
J Clin Endocrinol Metab, 91 (2006), pp. 48-53
[64.]
E. Carmina, N. Napoli, R.A. Longo, G.B. Rini, R.A. Lobo.
Metabolic syndrome in polycystic ovary sindrome (PCOS): lower prevalence in southern Italy than in the USA and the influence of criteria for the diagnosis of PCOS.
Eur J Endocrinol, 154 (2006), pp. 141-145
[65.]
S. Kohronen, M. Hippelainen, M. Vanhala, S. Heinonen, L. Niskanen.
The androgenic sex hormone profile is an essential feature of metabolic syndrome in premenopausal women: a controlled community-based study.
Fertil Steril, 79 (2003), pp. 1327-1334
[66.]
R. Kahn, E. Ferranini, J. Buse, M. Stern.
The metabolic syndrome: time for a critical rappraisal. Joint statement from the American Diabetes Association and the European Association for the study of Diabetes.
Diabetes Care, 28 (2005), pp. 2289-2304
[67.]
K.L. Cheal, F. Abbasi, C. Lamendola, T. McLaughlin, G.M. Reaven, E.S. Ford.
Relationship to insulin resistance of the Adult Treatment Panel III Diagnostic Criteria for Identification of the Metabolic Syndrome.
Diabetes, 53 (2004), pp. 1195-1200
[68.]
M.S. Greenfield, L. Doberne, F. Kraemer, T. Tobey, G.M. Reaven.
Assessment of insulin resistance with insulin suppression test and the euglycemic clamp.
Diabetes, 30 (1981), pp. 387-392
[69.]
R. Pasquali, A. Gambineri.
Insulin resistance: definition and epidemiology in normal women and PCOS women.
Insulin resistance and polycystic ovarian syndrome: pathogenesis, evaluation, and treatment,
Copyright © 2006. Sociedad Española de Endocrinología y Nutrición
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