Desafíos en el diagnóstico y tratamiento del síndrome de ovarios poliquísticos en la adolescencia

Tania Espinosa Reyes, Juliette Navarrete Cabrera, Cecilia Pérez Gesen, Wendy Valdés Gómez, Yadenis Bioti Torres

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Resumen

Introducción: En la última década han sido ampliamente discutidos los criterios a emplear en el diagnóstico del síndrome de ovarios poliquísticos en la adolescencia. La fisiología de esta compleja etapa de la vida hace que los profesionales, tanto en la práctica clínica como la investigación, intenten consenso para evitar los subregistros y el sobrediagnóstico de esta condición.

Objetivo: Describir peculiaridades clínicas, bioquímicas e imagenológicas para el diagnóstico de esta entidad en la adolescencia.

Métodos: Se realizó una revisión bibliográfica con la información extraída de las bases de datos electrónicas, Google Scholar, Pubmed, LILACS, BIREME y SciELO. La evidencia obtenida se resumió por contenidos temáticos.

Conclusiones: El conocimiento detallado de la fisiología del aparato reproductor femenino, así como la exclusión de otras causas de hiperandrogenismo clínico permitirán hacer un diagnóstico de síndrome de ovarios poliquísticos de mayor certeza en las adolescentes.

Palabras clave: síndrome de ovarios poliquísticos; adolescencia; aparato reproductor femenino.

Referencias

Lozano A. Teoría de Teorías sobre la Adolescencia. Última Década. 2014 [acceso: 31/10/2022];22(40):11-36. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-22362014000100002&lng=es&nrm=iso

World Health Organization The second decade: improving adolescent health and development. WHO. 1998 [acceso: 31/10/2022]. Disponible en: http://whqlibdoc.who.int/hq/1998/WHO_FRH_ADH_98.18_Rev.1.pdf

Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol. 2011;24:223-7. DOI: https://doi.org/10.1016/j.jpag.2011.03.002

Gill H, Tiwari P, Dabadghao P. Prevalence of polycystic ovary syndrome in young women from North India: a community-based study. Indian J Endocr Metab. 2012;16:389-92. DOI: https://doi.org/10.4103/2230-8210.104104

Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011;7:219-31. DOI: https://doi.org/10.1038/nrendo.2010.217

Wild RA, Carmina E, Diamanti Kandarakis E. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95:2038-49. DOI: https://doi.org/10.1210/jc.2009-2724

Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181-91. DOI: https://doi.org/10.1016/j.ajog.2015.12.013

Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565-92. DOI: https://doi.org/10.1210/jc.2013-2350

Sebastian MR, Wiemann CM, Bacha F, Alston Taylor SJ. Diagnostic evaluation, comorbidity screening, and treatment of polycystic ovary syndrome in adolescents in 3 specialty clinics. J Pediatr Adolesc Gynecol. 2018;31(4):367-71. DOI: https://doi.org/10.1016/j.jpag.2018.01.007

Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-18. DOI: https://doi.org/10.1016/j.fertnstert.2018.05.004

Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31(12):2841-55. DOI: https://doi.org/10.1093/humrep/dew218

Christensen SB, Black MH, Smith N, Martínez MM, Jacobsen SJ, Porter AH, et al. Prevalence of polycystic ovary syndrome in adolescents. Fertil Steril. 2013;100(2):470-7. DOI: https://doi.org/10.1016/j.fertnstert.2013.04.001

Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibanez L, et al. The diagnosis of polycystic ovary syndrome during adolescence. Hormone Res Paed. 2015;83:376-89. DOI: https://doi.org/10.1159/000375530

Ibanez L, Oberfield SE, Witchel S, Auchus RJ, Chang RJ, Codner E, et al. An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Hormone Res Paed. 2017;88(6):371-95. DOI: https://doi.org/10.1159/000479371

Fields EL, Trent ME. Treatment Considerations for the Cardiometabolic Signs of Polycystic Ovary Syndrome: A Review of the Literature Since the 2013 Endocrine Society Clinical Practice Guidelines. JAMA Pediatr. 2016;170:502-7. DOI: https://doi.org/10.1001/jamapediatrics.2015.4866

Rosenfield RL. The diagnosis of polycystic ovary syndrome in adolescents. Pediatrics. 2015;136(6):1154-65. DOI: https://doi.org/10.1542/peds.2015-1430

Dumesic DA, Oberfield SE, Stener Victorin E, Marshall JC, Laven JS, Legro RS. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocr Rev. 2015;36(5):487-525. DOI: https://doi.org/10.1210/er.2015-1018

Pena AS, Doherty DA, Atkinson HC, Hickey M, Norman RJ, Hart R. The majority of irregular menstrual cycles in adolescence are ovulatory: results of a prospective study. Arch Dis Childhood. 2018;103(3):235-9. DOI: https://doi.org/10.1136/archdischild-2017-312968

Villarroel C, López P, Merino PM, Iniguez G, Petermann T, Codner E. Hirsutism and oligomenorrhea are appropriate screening criteria for polycystic ovary syndrome in adolescents. Gynecol Endocrinol. 2015;31(8):625-9. DOI: https://doi.org/10.3109/09513590.2015.1025380

Legro RS, Lin HM, Demers LM, Lloyd T. Rapid maturation of the reproductive axis during perimenarche independent of body composition. J Clin Endocrinol Metab. 2000;85(3):1021-5. DOI: https://doi.org/10.1210/jcem.85.3.6423

Adams Hillard PJ. Menstruation in young girls: a clinical perspective. Obstet Gynecol. 2002;99(4):655-62. DOI: https://doi.org/10.1016/s0029-7844(02)01660-5

Slap GB. Menstrual disorders in adolescence. Best Pract Res Clin Obstet Gynaecol. 2003;17(1):75-92. DOI: https://doi.org/10.1053/ybeog.2002.0342

van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J. Predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligoamenorrhoea at age 18 years. Hum Reprod. 2004;19(2):383-92. DOI: https://doi.org/10.1093/humrep/deh079

Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118(5):2245-50. DOI: https://doi.org/10.1542/peds.2006-2481

Peña AS, Witchel SF, Hoeger KM, Oberfield SF, Vogiatzi MG, Misso M, et al. Adolescent polycystic ovary syndrome according to the international evidence based guideline. BMC Medicine. 2020;18:72. DOI: https://doi.org/10.1186/s12916-020-01516-x

Witchel SF, Levy M, Lucky A, Mancini AJ, Orlow SJ. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131(Suppl. 3):S163-86. DOI: https://doi.org/10.1542/peds.2013-0490B

Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study. J Pediatr. 1997;130(1):30-9. DOI: https://doi.org/10.1016/s0022-3476(97)70307-x

Slayden SM, Moran C, Sams WM Jr, Boots LR, Azziz R. Hyperandrogenemia in patients presenting with acne. Fertil Steril. 2001;75(5):889-2. DOI: https://doi.org/10.1016/s0015-0282(01)01701-0

Olutunmbi Y, Paley K, English JC III. Adolescent female acne: etiology and management. J Pediatr Adolesc Gynecol. 2008;21:171-6. DOI: https://doi.org/10.1016/j.jpag.2007.07.004

Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21:1440-7. DOI: https://doi.org/10.1210/jcem-21-11-1440

DeUgarte CM, Woods KS, Bartolucci AA, Azziz R. Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab. 2006;91(4):1345-50. DOI: https://doi.org/10.1210/jc.2004-2301

Zhao X, Ni R, Li L, Mo Y, Huang J, Huang M, et al. Defining hirsutism in Chinese women: a cross-sectional study. Fertil Steril. 2011;96(3):792-6. DOI: https://doi.org/10.1016/j.fertnstert.2011.06.040

Kelsey TW, Dodwell SK, Wilkinson AG, Greve T, Andersen CY, Anderson RA, et al. Ovarian volume throughout life: a validated normative model. PLoS One. 2013;8(9):e71465. DOI: https://doi.org/10.1371/journal.pone.0071465

Razzaghy Azar M, Ghasemi F, Hallaji F, Ghasemi A, Ghasemi M. Sonographic measurement of uterus and ovaries in premenarcheal healthy girls between 6 and 13 years old: correlation with age and pubertal status. J Clin Ultrasound. 2011;39(2):64- 73. DOI: https://doi.org/10.1002/jcu.20723

Tokmak A, Timur H, Aksoy RT, Cinar M, Yilmaz N. Is anti-Mullerian hormone a good diagnostic marker for adolescent and young adult patients with polycystic ovary syndrome? Turk J Obstet Gynecol. 2015;12(4):199-204. DOI: https://doi.org/10.4274/tjod.21549

Yetim A, Yetim C, Bas F, Erol OB, Cig G, Ucar A, et al. Anti-Mullerian hormone and inhibin-a, but not inhibin-B or insulin-like peptide-3, may be used as surrogates in the diagnosis of polycystic ovary syndrome in adolescents: preliminary results. J Clin Res Pediatr Endocrinol. 2016;8(3):288-97. DOI: https://doi.org/10.4274/jcrpe.3253

Kim JY, Tfayli H, Michaliszyn SF, Lee S, Nasr A, Arslanian S. Anti-Mullerian hormone in obese adolescent girls with polycystic ovary syndrome. J Adolesc Health. 2017;60(3):333-9. DOI: https://doi.org/10.1016/j.jadohealth.2016.10.015

Peláez MJ. Métodos anticonceptivos y adolescencia. Consideraciones para su selección e indicación en su controversias y aspectos novedosos sobre anticoncepción. La Habana: Editorial Científico Técnica, 2009.

Rodríguez Jiménez MJ. Anticoncepción. ¿Qué necesitan los adolescentes? ADOLESCERE. 2015 [acceso: 31/10/2021];3(2):69-79. Disponible en: https://www.adolescenciasema.org/wp-content/uploads/2015/06/adolescere-2015-vol3-n2_69-79_Anticoncepcion.pdf

Serrano Fuster I. Anticoncepción en la adolescencia. Guía de Atención Ginecológica en la Infancia y Adolescencia. Grupo de Trabajo de Ginecología en la Infancia y Adolescencia. Soc. Españ. Ginecolog Obstetric. 2013 [acceso: 31/10/2021]:143-51. Disponible en: http://www.sepexpal.org/wp-content/uploads/2021/10/Gu%C3%ADa-Ginecolog%C3%ADa.pdf

Álvarez Vázquez L, Salomón Avich N. El aborto en adolescentes en un contexto legal. Rev Cubana Salud Pública. 2012 [acceso: 31/10/2021];38(1):45-53. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662012000100005&lng=es

Al Khalifah RA, Florez ID, Dennis B, Thabane L, Bassilious E. Metformin or oral contraceptives for adolescents with polycystic ovarian syndrome: a meta-analysis. Pediatrics. 2016;137(5):e20154089. DOI: https://doi.org/10.1542/peds.2015-4089

Teede H, Tassone EC, Piltonen T, Malhotra J, Mol BW, Pena A, et al. Effect of the combined oral contraceptive pill and/or metformin in the management of polycystic ovary syndrome: a systematic review with meta-analyses. Clin Endocrinol. 2019;91(4):479-89. DOI: https://doi.org/10.1111/cen.14013

Al Khalifah RA, Florez ID, Zoratti MJ, Dennis B, Thabane L, Bassilious E. Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents. J Endocr Soc. 2020;5(1):bvaa155. DOI: https://doi.org/10.1210/jendso/bvaa155

Ganie MA, Khurana ML, Eunice M, Gupta N, Gulati M, Dwivedi SN, et al. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab. 2004;89(6):2756-62. DOI: https://doi.org/10.1210/jc.2003-031780

Gambineri A, Patton L, Vaccina A, Cacciari M, Morselli Labate AM, Cavazza C, et al. Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study. J Clin Endocrinol Metab. 2006;91(10):3970-80. DOI: https://doi.org/10.1210/jc.2005-2250

Tartagni M, Schonauer MM, Cicinelli E, Petruzzelli F, De Pergola G, De Salvia MA, et al. Intermittent low-dose finasteride is as effective as daily administration for the treatment of hirsute women. Fertil Steril. 2004;82(3):752-5. DOI: https://doi.org/10.1016/j.fertnstert.2004.02.118

Bajares de LM, Pizzi R, Velázquez ME. Tratamiento del síndrome de ovario poliquístico. Manejo dermatológico. Caracas: Editorial Ateproca; 2007.

Ibáñez TL, Rodríguez HF. Tratamiento del hirsutismo. Anales españoles de pediatría. 2002 [acceso: 31/10/2021];56(Supl. 4):34-7. Disponible en: https://analesdepediatria.org/es-tratamiento-del-hirsutismo-articulo-13031046

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