“Avaliação da função gonadotrópica hipofisária na síndrome dos ovários policísticos, após a introdução dos critérios de Roterdã”

Abstract

Objectives: To evaluate the pituitary gonadotrophic function in patients with polycystic ovary syndrome, after the introduction of the Rotterdam criteria. Casuistic and Methods: Cohort study including 42 patients with polycystic ovary syndrome aged 27 ± 6.2 years and 15 normal controls aged 31 ± 5 years. Glucose, glycated hemoglobin, lipids, FSH, LH, estradiol, progesterone, 17-OHP4, DHEAS, androstenedione, total testosterone, SHBG, free androgen index, cortisol, TSH, PRL, FT4, insulin were estimated. Insulin resistance was admitted with HOMA-IR ≥ 2.8. The pituitary response was assessed by the increase of gonadotrofin hormones observed after 60 min and area under the curve. Results: The basal concentrations of LH, PRL, DHEAS, T, A, IAL and 17OHP4 were higher in the PCOS group (p < 0.05). SHBG levels were lower in the PCOS group (p < 0.05). In the PCOS group, HOMA-IR ≥ 2.8 was found in 13 patients (39.4%). In the control group showed no HOMA-IR ≥ 2.8. There was negative correlation between BMI and baseline LH in PCOS patients, that there was no correlation between BMI and FSH. In the control group there was no influence of BMI on baseline LH and FSH. There was negative correlation between basal levels of insulin and LH in the PCOS group. In control patients this correlation was positive. The maximum percentage increase in LH was 340% in PCOS patients and 220% in control patients (p= 0.01). The area under the curve of LH after injection of GnRH was higher in PCOS patients than in controls (p < 0.05). Positive correlation between basal levels of LH and P4, with ASC-LH were found only in the PCOS group. No associations were found between basal levels of E2, T, A, DHEAS and IAL with ASC-LH in both groups (p > 0.05). There was no correlation between basal levels of insulin with ASC-LH in PCOS patients, but this correlation was positive in the control group. There was negative correlation between BMI and ASC-LH in PCOS patients only. Conclusion: Data from this study show there is hypersecretion of LH in PCOS even after the Rotterdam criteria. The magnitude of the response of LH in women with PCOS is correlated with the basal concentration of LH, and multiple factors, including progesterone, insulin and BMI, modulate LH secretion in this disorder.