Ayuda
 

Comprar este artículo
Extensión: 6.43 páginas impresas en papel A4

file05.gif (1491 bytes)
Artículos seleccionados para su compra


SINDROME PLURIMETABOLICA: UMA CONSEQUÊNCIA ENDOCRINO-METABOLICA EM MENINAS COM PUBARCA PRECOCE
(especial para SIIC © Derechos reservados)
Nosso objetivo foi descrever os fatores relacionados à síndrome plurimetabólica (SPM) na pubarca precoce (PP).
rosime9.jpg Autor:
De Jesus Teixeira, Rosimere
Columnista Experto de SIIC

Institución:
Hospital Universitario Pedro Ernesto UERJ RJ, Brasil


Artículos publicados por De Jesus Teixeira, Rosimere
Coautores
Valéria Cataldo Gomes da Silva*  Denise Ginzbarg**  Josele Rodrigues de Freitas*** 
Professora Assistente de Radiologia da UERJ*
Mestre em Endocrinologia pela UERJ**
Mestre em Endocrinologia pela UERJ / Professora Assistente de Ginecologia da UERJ***
Recepción del artículo
2 de Junio, 2004
Aprobación
12 de Octubre, 2004
Primera edición
24 de Enero, 2005

Resumen
Nosso objetivo foi descrever os fatores relacionados à síndrome plurimetabólica (SPM) na pubarca precoce (PP). Selecionamos 45 meninas com 7.2 ± 1.4 ano de idade. Avaliamos os parâmetros clínicos (história familiar de SPM, IMC, pressão arterial sistólica e diastólica [PAS e PAD] e acantose), hormonais (SHBG, IGFBP-1, SDHEA, testosterona e androstenediona), metabólicos (glicose [G], insulina [I] e perfil lipídico) e a presença de ovários microcísticos. Consideramos como resistência à I (RI) a taxa de jejum da G/I < 7. Analisamos os dados após divisão em 2 grupos: RI (n = 16, 36%) e ñRI (n = 29, 64%). Observamos história familiar de SPM em 47%, excesso de peso em 60%, acantose em 36%, pressão arterial anormal em 16%, perfil lipídico alterado em 77% e ovários microcísticos em 55% dos casos. Os níveis de I e de triglicerídeo (TG) foram maiores, enquanto a G/I e os níveis de IGFBP-1 e HDL foram menores no grupo RI do que ñRI. A I mostrou correlação positiva com triglicerídeo (TG), G, PAS e PAD, mas negativa com SHBG. O IMC mostrou correlação negativa com SHBG e positiva com PAS e PAD. Na análise multivariada, o TG (r2 = 0.52) mostrou ser dependente da I e a SHBG (r2 = 0.42) do IMC. Não houve diferença entre os grupos em relação ao IMC e androgênios. Na PP, a hiperinsulinemia parece ocorrer de forma independente da obesidade e do hiperandrogenismo. O grupo RI apresentou hipertrigliceridemia e HDL baixo, alterações típicas da SPM. Como obesidade, dislipidemia e acantose estão associados à RI e são comuns na PP, então a PP pode ser considerada uma população de risco para o desenvolvimento da SPM na vida adulta.

Palabras clave
Hiperinsulinemia, hiperandrogenismo, obesidade, pubarca precoce e síndrome plurimetabólica


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página  www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Endocrinología y MetabolismoPediatría
  Relacionadas: Medicina InternaObstetricia y Ginecología

Enviar correspondencia a:
de Jesus Teixeira, Rosimere

Artículo completo

(castellano)
Extensión:  +/-6.43 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

PLURIMETABOLIC SYNDROME: AN ENDOCRINE AND METABOLIC CONSEQUENCE OF PREMATURE PUBARCHE

Abstract
The aim of this study was to describe the factors associated with the plurimetabolic syndrome (PMS) in premature pubarche (PP). We selected 45 girls of 7.2 ± 1.4 years of age. The clinical parameters (familiar history of PMS, BMI, systolic and diastolic blood pressures [SBP and DBP] and acanthosis), hormonal (SHBG, IGFBP-1, SDHEA, testosterone and androstenedione), metabolic (glucose [G], insulin [I] and lipid profile) and the presence of microcysctic ovaries were evaluated. The fasting G to I rate < 7 was considered as insulin resistance (IR). The data were analysed after the division into two groups: IR (n = 16, 36%) and n-IR (n = 29, 64%). We observed a familiar history of PMS in 47%, the overweight in 60%, acanthosis in 36%, abnormal blood pressure in 16%, changed lipid profile in 77% and microcysctic ovaries in 55% of the cases. Serum levels of I and triglyceride (TG) were higher, while the G/I and serum levels of IGFBP-1 and HDL were lower in IR group than nIR. The insulin disclosed a positive correlation with TG, G, SBP and DBP, but correlated negatively with SHBG. BMI was negatively correlated with SHBG and positively with SBP and DBP. In the multivariated regression analysis, TG (r2 = 0.52) showed to be dependent of the I and SHBG (r2 = 0.42) of the BMI. There were not differences in the BMI and androgens between the groups. In the PP, the hyperinsulinemia appears to exist independently of the obesity and hyperandrogenism. The IR group showed hipertriglyceridemia and low HDL levels - typical changes of the PMS. Since obesity, dyslipidemia and acanthosis are associated with IR and are usual in the PP, than PP could be considered as population at risk for the development of PMS in adult life.

Key words
Hyperinsulinemia, hiperandrogenism, obesity, premature pubarche and plurimetabolic syndrom

Bibliografía del artículo
  1. Ginzbarg D, Teixeira RJ, Bordallo MAN et al. Pubarca precoce: variante normal do desenvolvimento puberal. Arq Bras Pediat 1995; 2:95-98.
  2. Borges MF, Paula F, Nomeline MB et al. Pubarca precoce: estudo retrospectivo clínico e laboratorial. Arq Bras Endocrinol Metab 2000; 44:405-412.
  3. Saenger P, Reiter EO. Editorial: Premature adrenarche: a normal variant of puberty J Clin Endocrinol Metab 1992; 74:236-238.
  4. Auchus RJ, Rainey WE. Adrenarche: Physiology, biochemistry and human disease. Clin Endocrinol 2004; 60:288-296.
  5. Rosenfield RL. Puberty and its disorders in girls. Endocrinol Metab Clin North Am 1991; 20:115-142.
  6. Ibañez L, Virdis R, Potau N et al. Natural history of premature pubarche: an auxological study. J Clin Endocrinol Metab 1992; 74:254-257.
  7. Rosenfield RL. Normal and almost normal precocious variations in pubertal development premature pubarche and premature thelarche revisited. Horm Res 1994; 41:7-13.
  8. Ibañez L, Potau N, Chacon P et al. Hyperinsulinemia, dyslipaemia and cardiovascular risk in girls with a history of premature pubarche. Diabetologia 1998; 41:1057-1063.
  9. Di Martino-Nardi J. Premature adrenarche: findings in prepubertal African-American and Caribbean-Hispanic girls. Acta Paediatr 1999; Suppl 433:67-72.
  10. Ibañez L, Di Martino-Nardi J, Potau N et al. Premature adrenarche –normal variant or forerunner of adult disease Endocr Rev 2000; 21:671-696.
  11. Teixeira RJ, Ginzbarg D, Bordallo MAN. Tipos de resposta ao teste de estimulação com ACTH em meninas com Pubarca Precoce. In: VIII Reunión Anual Sociedad Latinoamericana de Endocrinología Pediátrica, Pucón /Chile, 1994. p.57.
  12. Pang S. Congenital adrenal hyperplasia. Baillieres Clin Obstet Gynaecol 1997; 11:281-306.
  13. Kuczmarski RJ, Ogden CL, Guo SS et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 2002; 246:1-190.
  14. Update on the 1987 Task force report on high blood pressure in children and adolescents: a working group report from the national high blood pressure education program. Pediatrics 1996; 98:649-658.
  15. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. National Cholesterol Education Program. Pediatrics 2000; 105:637-638.
  16. Teixeira Rj, Silva VCG, Freitas JR et al. Ultra-sonografia Pélvica em 140 meninas normais pré e pós-puberais. Arq Bras Endocrinol Metab 1999; 43:210-216.
  17. Rittmaster RS, Deshwal N and Lehman L. The role of adrenal hyperandrogenism, insulin resistance, and obesity in the pathogenis of polycistic ovarian syndrome. J Clin Endocrinol Metab 1993; 76:1295-1299.
  18. Silfen ME, Manibo AM, McMahon DJ et al. Comparison of Simple Measures of Insulin Sensitivity in Young Girls with Premature Adrenarche: The Fasting Glucose to Insulin Ratio may be a simple and useful measure. J Clin Endocrinol Metab 2001; 86:2863-2868.
  19. Monteiro CA. Epidemiologia da Obesidade. In: Obesidade. Lemos Editorial, São Paulo, 1998, p. 15-30.
  20. Parizzi MR. Obesidade na infância. In: Fonseca JGM, editor convidado. Obesidade e outros Distúrbios Alimentares. Clínica Médica. Rio de Janeiro: MEDSI; 2001. p. 279-289.
  21. Teixeira RJ, Coelho RA, Perecmanis T et al. Prevalência de Obesidade e Baixo Peso ao Nascer na Pubarca Precoce. Arq Bras Endocrinol Metab 2003; 47:166-170.
  22. Ilyés I, Pósán E, Sári S. Insulin resistance in obese boys with acanthosis nigricans. Acta Paed Hung 1992; 32:325-332.
  23. Teixeira RJ, Gazolla HM, Cunha SB et al. Resistência à Insulina na Pubarca Precoce –Relação com os androgênios. Arq Bras Endocrinol Metab 2001;45:278-84.
  24. Oppennheimer E, Linder B, Di Martino-Nardi J. Decreased insulin sensitivity in prepubertal girls with premature adrenarche and acanthosis nigricans. J Clin Endocrinol Metab 1995; 80:614-618.
  25. Miller D, Emans SJ, Kohane I. Follow-up study of adolescent girls with a history of premature pubarche. J Adolesc Health 1996; 18:301-305.
  26. Charney E, Goodman HC, McBride M et al. Childhood antecedents of adult obesity. Do chubby infants become obese adults N Engl J Med 1976; 295:6-9.
  27. Freedman DS. Clustering of coronary heart disease risk factors among obese children. JPEM 2002; 15:1099-1108.
  28. Kiess W, Reich A, Muller G et al. Clinical aspects of obesity in childhood and adolescence. Intern J Obesity 2001; 25:75-79.
  29. Orchard TJ, Becker DJ, Bates M et al. Plasma insulin and lipoprotein concentrations: an atherogenic association Am J Epidemiol 1983; 118:326-337.
  30. Ibáñez L, Potau N, Zampoli M et al. Girls diagnosed with premature pubarche show an exaggerated ovarian androgen synthesis from the early stages of puberty: evidence from gonadotropin-releasing hormone agonist testing. Fertil Steril 1997; 67:849-855.
  31. Dunaif A, Sorbara L, Delson R et al. Ethnicity and polycystic ovary syndrome are associated with independent and additive decreased in insulin action in Caribbean Hispanic women. Diabetes 1993; 42:1462-1468.
  32. Banerjee S, Raaghavan S, Wasserman EJ et al. Hormonal findings in African-American and Caribbean Hispanic girls with premature adrenarche: implications for polycystic ovarian syndrome. Pediatrics 1998; 102:1-4.
  33. Ibañez L, Potau N, Virdis R et al. Postpubertal outcome in girls diagnosed of premature pubarche during childhood: Increased frequency of functional ovarian hyperandrogenism. J Clin Endocrinol Metab 1993; 76:1599-1603.
  34. Teixeira RJ, Silva VCG, Freitas JR et al. The relationship between ovarian structure and hyperandrogenism in premature pubarche. JPEM 2001; 14:257-265.
  35. Teixeira RJ, Silva VCG, Gazolla HM et al. The relationship between ovarian structure and serum insulin, Insulin-like growth factor-I (IGF-I) and its binding protein (IGFBP-1 and IGFBP-3) levels in premature pubarche. JPEM 2002; 15:69-75.
  36. Dunaif A. Insulin resistance and the polycistic ovary syndrome: mecanism and implications for pathogenesis. Endcr Rev 1997; 18:774-800.
  37. Cara JF, Rosenfield RL. Insulin-like growth factor-I and insulin potentiate luteinizing hormone induced androgen synthesis by rat ovarian thecal-interstitial cells. Endocrinology 1988; 123:733-739.
  38. Lálleman D, Penhoat A, Lebrethon MC et al. Insulin-like growth factor enhance steroidogenic enzyme and corticotropin receptor messenger ribonucleic acid levels and corticotropin steroidogenic responsiveness in cultured human adrenocortical cells. J Clin Endocrinol Metab 1996; 81:3892-3897.
  39. Dunaif A, Scott D, Finegood D et al. The insulin sensitising agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endocrinol Metab 1996; 81:3299-3306.
  40. Ibáñez L, Potau N, Ferrer A et al. Anovulation in eumenorrheic, nonobese adolescent girls born small for gestational age: Insulin sensitization induces ovulation, increases lean body mass, and reduces abdominal fat excess, dyslipidemia, and subclinical hyperandrogenism. J Clin Endocrinol Metab 2002; 87:5702–5705.
  41. Nestler JE, Powers LP, Matt DW. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycistic ovary syndrome. J Clin Endocrinol Metab 1991; 72:83-89.
  42. Peiris AN, Stagner JI, Plymate SR et al. Relationship of insulin secretory pulses to sex hormone-binding globulin levels in normal men. J Clin Endocrinol Metab 1993; 76:279-282.
  43. Ibáñez L, Potau N, Zampolli M et al. Hyperinsulinemia and decreased insulin-like growth factor-binding protein-1 are common features in prepubertal and pubertal girls with a history of premature pubarche. J Clin Endocrinol Metab 1997; 82:2283-2288.
  44. Nobels F and Dewailly D. Puberty and polycistic ovarian syndrome: the insulin/insulin-like growth factor I hypothesis. Fertil Steril 1992; 58:655-666.
  45. Vuguin P, Wasserman E, Linder B et al. The role of insulin sensitivity, IGF-I, IGFBP-1 and IGFBP-3 in the hyperandrogenism in Black and Hispanic girls with premature adrenarche. Horm Res 1997; 48 (suppl 2):104.
  46. Teixeira RJ, Ginzbarg D, Freitas JR et al. Globulina ligadora dos hormônios sexuais e proteína ligadora 1 do IGF-1: marcadores para resistência à insulina na pubarca precoce Arq Bras Endocrinol Metab 2003; 47:261-265.
  47. Ibáñez L, Potau N, Georgopoulos N et al. Growth hormone, insulin-like growth factor-1 axis and insulin secretion in hyperandrogenic adolescents. Fertil Steril 1995; 64:1113-1119.
  48. Balducci R, Finocchi G, Mangiantini A et al. Lack of correlation between sex hormone-binding globulin, adrenal and peripheral androgens in precocious adrenarche. J Endocrinol Invest 1992; 15:501-505.
  49. Gascon F, Valle M, Martos R et al. Sex hormone-binding globulin as a marker for hyperinsulinemia and/or insulin resistance in obese children. Eur J Endocrinol 2000; 143:85-89.
  50. Hautanen A. Synthesis and regulation of sex hormone-binding globulin in obesity. Int J Obes Relat Metab Disord 2000; 24:64-70.
  51. Teixeira RJ, Dimetz T, Bordallo MAN et al. Papel dos androgênios adrenais e periféricos na modulação dos níveis da globulina ligadora dos hormônios sexuais na pubarca precoce. Arq Bras Endocrinol Metab 2002; 46:520-525.
  52. Ibáñez L, Potau N and Zegher F. Precocious pubarche in girls may be a marker of a polyendocrinopathy. In: Bourguignon JP and Plant TM, Elsevier editora. The onset of Puberty in Perspective. Amsterdan: Elsevier ed; 2000. p. 289-297.
  53. Barker DJP, Hales CHD, Osmond C et al. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993; 36:62-67.
  54. Ibañez L, Potau N, Francois I et al. Precocious pubarche, hyperinsulinism and ovarian hyperandrogenism in girls: relation to reduce fetal growth. J Clin Endocrinol Metab 1998; 83:3558-3562.

 
Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
(exclusivo a suscriptores)
  Autoevaluación
  Tema principal en SIIC Data Bases
 Especialidades

 English title
 Abstract
 Key words
Full text
(exclusivo a suscriptores)


Autor 
Artículos
Correspondencia
Patrocinio y reconocimiento
Imprimir esta página
Clasificado en
Artículos originales>
Expertos de Iberoamérica

Especialidad principal:
Endocrinología y MetabolismoPediatría

Relacionadas:
 Medicina Interna
 Obstetricia y Ginecología
Suscripción a siicsalud

Comprar este artículo
Extensión: ± 6.43 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra

Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.

anterior.gif (1015 bytes)


Suscripción a siicsalud


Bienvenidos a siicsalud

Acerca de SIIC     Estructura de SIIC

Sociedad Iberoamericana de Información Científica (SIIC)
Av. Belgrano 430, (C1092AAR), Buenos Aires, Argentina
Tel: +54 11 4342 4901; Fax: +54 11 4331 3305
Casilla de Correo 2568, (C1000WAZ) Correo Central, Buenos Aires
Copyright siicsalud© 1997-2014, Sociedad  Iberoamericana de Información Científica (SIIC)
ISSN siicsalud: 1667-9008
ua4711
Mensajes a SIIC