Palabras clave
Síndrome del ovario poliquístico
Sobrediagnóstico
Hiperandrogenismo
Anovulación
Sobrediagnóstico
Hiperandrogenismo
Anovulación
Cómo citar
Guzmán López, J. A., Robles Lara, P. D., Rivera Contreras, O. E., Ramírez Velandia, F., Sepúlveda Sanguino, A. J., & Sepúlveda Agudelo, J. (2020). Revisión de los criterios diagnósticos para el síndrome de ovario poliquístico. Médicas UIS, 33(3), 21–28. https://doi.org/10.18273/revmed.v33n3-2020002
Resumen
El síndrome de ovario poliquístico, es la alteración endocrina metabólica más frecuente en mujeres en edad fértil, teniendo implicaciones a nivel reproductivo, metabólico, cardiovascular y psicosocial. Actualmente, su sobrediagnóstico corresponde a una problemática común derivada de la heterogeneidad en la aplicación de los criterios actualmente avalados para su hallazgo, lo que ha contribuido en el incremento de tratamientos innecesarios, así como los efectos negativos en la calidad de vida y el bienestar de las pacientes falsamente calificadas con este trastorno. Se realizó una búsqueda en PubMed-MENDELEY y Ovid entre los meses de Febrero a Abril del 2020, obteniendo 43 artículos relacionados con el tema, publicados en los últimos 10 años. El conocimiento por parte del personal médico capacitado sobre los consensos actuales para la correcta evaluación del síndrome y el estudio individualizado de cada caso, corresponden las medidas más apropiadas para la reducción del sobrediagnóstico. ÉD.UIS.2020;33(3):21-28.
Referencias
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2. Stein IF, Leventhal ML. (1935). Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol.1935; 29(2):181–191. doi:10.1016/s0002-9378(15)30642-6
3. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010 Feb;25(2):544-51. doi:10.1093/ humrep/dep399
4. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO.The Prevalence and Features of the Polycystic Ovary Syndrome in an Unselected Population. J Clin Endocrinol Metab. 2004 Jun;89(6):2745-9. doi:10.1210/jc.2003-032046
5. Muñoz C. Síndrome de ovario poliquístico (SOP). ADOLESCERE. Revista de Formación Continuada de la Sociedad Española de Medicina de la Adolescencia. 2016; 4(2)
6. Nandi A, Chen Z, Patel R, Poretsky L. Polycystic Ovary Syndrome. Endocrinol Metab Clin North Am. 2014 Mar;43(1):123-47. doi: 10.1016/j.ecl.2013.10.003.
7. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstet Gynecol. 2018; 131(6):e157-e171. doi: 10.1097/ AOG.0000000000002656
8. Sir T, Preisler J, Magendzo A. Síndrome de ovario poliquístico. diagnóstico y manejo. Rev. med. clin. las Condes 2013;24(5), 818–826.
9. Copp T, Jansen J, Doust J, Mol BW, Dokras A, McCaffery K. Areexpanding disease definitions unnecessarily labelling women with polycystic
vary syndrome?. BMJ. 2017;358:j3694. doi: 10.1136/bmj.j3694.
10. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome; towards a rational approach. In: Dunaif A, Givens
JR, Haseltine F, Merriam G,editors. Polycystic ovary syndrome. Boston: Blackwell Scientific; 1992; 377-384
11. Capella D, Aeda S, Irribarra C. Consensos existentes para el diagnóstico de síndrome de ovario Poliquístico. Rev Per Ginecol Obstet 2004;50(1):45-60. Disponible en https://www. sciencedirect.com/science/article/pii/S0015028208013927
12. Consenso sobre síndrome de ovario poliquístico. Federacion Argentina De Sociedades De Obstetricia Y Ginecologia. 2011;
10, 69–76. Disponible en: http://www.fasgo.org.ar/archivos/ consensos/ovario_poliq.pdf
13. National Institutes of Health. Evidence-based methodology workshop on polycystic ovary syndrome, December 3-5, 2012. Executive summary. Disponible en: https://prevention.nih.gov/ sites/default/files/2018-06/FinalReport.pdf
14. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/jc.2013-2350.
15. Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol 2010;203:e201– e205. doi: 10.1016/j.ajog.2010.03.008
16. Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics 2015; 136(6):1154–1165. doi:10.1542/
peds.2015-1430
17. Zhang HY, Zhu FF, Xiong J, Shi XB, Fu SX. Characteristics of different phenotypes of polycystic ovary syndrome based on the
Rotterdam criteria in a large-scale Chinese population. BJOG 2009;116:1633–9.doi: 10.1111/j.1471-0528.2009.02347.x
18. Zhao Y, Ruan X, Mueck AO. Clinical and laboratory indicators of polycystic ovary syndrome in Chinese Han nationality with different Rotterdam criteria-based phenotypes. Gynecol Endocrinol. 2016;32(2):151-6. doi: 10.3109/09513590.2015.1107895.
19. Guastella E, Longo RA, Carmina E.Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril. 2010 Nov;94(6):2197-201. doi: 10.1016/j.fertnstert.2010.02.014
20. Diamanti-Kandarakis E, Panidis, D. Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS. Clin Endocrinol (Oxf). 2007 Nov;67(5):735-42 doi:10.1111/j.1365-2265.2007.02954.x
21. Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, et al. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013 Sep;28(9):2562-9. doi: 10.1093/humrep/det262.
22. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod. 2012 Oct;27(10):3067-73. doi:10.1093/humrep/des232
23. Tehrani FR, Rashidi H, Khomami MB, Tohidi M, Azizi F. The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran. Reprod Biol Endocrinol. 2014 Sep 16;12:89. doi: 10.1186/1477-7827-12-89
24. Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample
of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol. 2011 Mar 25;9:39. doi: 10.1186/1477-7827-9-39
25. Espinós J, Ramos A. Estudio y tratamiento de la anovulacinen el síndrome de ovarios poliquísticos. Sociedad Española de Infertilidad. Guías de práctica clínica [Internet].2020 [citado 15 Abril 2020]. Disponible en: https://www.sefertilidad.net/docs/ biblioteca/guiasPracticaClinicas/guia7.pdf
26. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010 Jun 30;8:41. doi: 10.1186/1741-7015-8-41.
27. Balen AH, Conway GS, Kaltsas G, Techatraisak K, Manning, PJ, et al. Andrology: Polycystic ovary syndrome: the spectrum of
the disorder in 1741 patients. Hum Reprod, 1995 10(8), 2107– 2111. doi:10.1093/oxfordjournals.humrep.a136243
28. Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome.
Best Practice & research. Clinical Obstetrics & Gynaecology. 2004 Oct;18(5):671-683. DOI: 10.1016/j.bpobgyn.2004.05.001.
29. Azziz R, Sanchez LA, Knochenhauer ES., Moran C, Lazenby J, Stephens KC, et al. Androgen Excess in Women: Experience with Over 1000 Consecutive Patients. J Clin Endocrinol Metab 2004, 89(2), 453–462. doi:10.1210/jc.2003-031122
30. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary
syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012 Jan;97(1):28-38.e25. doi: 10.1016/j.fertnstert.2011.09.024.
31. Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol 2018; 132(2), 321–336. doi:10.1097/aog.0000000000002698
32. Landay M, Huang A, Azziz R. Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS. Fertil Steril 2009; 92(2):643– 647. doi:10.1016/j.fertnstert.2008.06.021
33. Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibáñez L, et al. The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Horm Res Paediatr. 2015, 83(6), 376– 389. doi:10.1159/000375530
34. Sigall DA, Arenas R. Hipertricosis : sus causas , formas clínicas y manejo 2011; 9(1): 33–42.
35. Sirmans S, Pate K. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013 Dec 18;6:1- 13. doi:10.2147/clep.s37559
36. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and longterm
health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19–25.
37. Hsu MI, Liou TH, Chou SY, Chang CY, et al. Diagnostic criteria for polycystic ovary syndrome in Taiwanese Chinese women: comparison between Rotterdam 2003 and NIH 1990. Fertility and Sterility 2007; 88(3): 727–729. https://doi.org/10.1016/j. fertnstert.2006.11.149
38. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. 2018;(July):1–17. doi: 10.1093/humrep/dey256
39. Williams T, Mortada R, Poter S. Diagnosis and Treatment of Polycystic Ovary Syndrome.American Family Physician 2016;94(2):116-113
40. Nereud B, Dewailly D. Drug-Induced Hyperandrogenism. Contemporary Endocrinology: Androgen Excess Disorders in Women: Polycystic Ovary Syndrome and Other Disorders, Second Edition Cap 10. 121-127
41. Capella D, Aedo Sócrates, Irribarra C. Consensos existentes para el diagnóstico del Sindrome de Ovario Poliquístico. Rev. Obstet.
Ginecol 2014; 9 (1): 39-44
42. Mustaniemi S, Vääräsmäki M, Eriksson JG, Gissler M, Laivuori H,et al. Polycystic ovary syndrome and risk factors for gestational diabetes. Endocrine connections 2018; 7(7):859–869. https://doi. org/10.1530/EC-18-0076
43. De Vries MJ, Dekker GA, Schoemaker J. Higher risk of preeclampsia in the polycystic ovary syndrome. European Journal of Obstet Gynecol Reprod Biol 1998; 76(1), 91–95. doi:10.1016/ s0301-2115(97)00164-4
44. Copp T, Hersch J, Doust J, et al 95 Challenges and uncertainties regarding polycystic ovary syndrome (PCOS) and the potentialfor overdiagnosis: clinicians’ views and experiences BMJ Evidence-Based Medicine 2018;23:A45.
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2. Stein IF, Leventhal ML. (1935). Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol.1935; 29(2):181–191. doi:10.1016/s0002-9378(15)30642-6
3. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010 Feb;25(2):544-51. doi:10.1093/ humrep/dep399
4. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO.The Prevalence and Features of the Polycystic Ovary Syndrome in an Unselected Population. J Clin Endocrinol Metab. 2004 Jun;89(6):2745-9. doi:10.1210/jc.2003-032046
5. Muñoz C. Síndrome de ovario poliquístico (SOP). ADOLESCERE. Revista de Formación Continuada de la Sociedad Española de Medicina de la Adolescencia. 2016; 4(2)
6. Nandi A, Chen Z, Patel R, Poretsky L. Polycystic Ovary Syndrome. Endocrinol Metab Clin North Am. 2014 Mar;43(1):123-47. doi: 10.1016/j.ecl.2013.10.003.
7. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstet Gynecol. 2018; 131(6):e157-e171. doi: 10.1097/ AOG.0000000000002656
8. Sir T, Preisler J, Magendzo A. Síndrome de ovario poliquístico. diagnóstico y manejo. Rev. med. clin. las Condes 2013;24(5), 818–826.
9. Copp T, Jansen J, Doust J, Mol BW, Dokras A, McCaffery K. Areexpanding disease definitions unnecessarily labelling women with polycystic
vary syndrome?. BMJ. 2017;358:j3694. doi: 10.1136/bmj.j3694.
10. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome; towards a rational approach. In: Dunaif A, Givens
JR, Haseltine F, Merriam G,editors. Polycystic ovary syndrome. Boston: Blackwell Scientific; 1992; 377-384
11. Capella D, Aeda S, Irribarra C. Consensos existentes para el diagnóstico de síndrome de ovario Poliquístico. Rev Per Ginecol Obstet 2004;50(1):45-60. Disponible en https://www. sciencedirect.com/science/article/pii/S0015028208013927
12. Consenso sobre síndrome de ovario poliquístico. Federacion Argentina De Sociedades De Obstetricia Y Ginecologia. 2011;
10, 69–76. Disponible en: http://www.fasgo.org.ar/archivos/ consensos/ovario_poliq.pdf
13. National Institutes of Health. Evidence-based methodology workshop on polycystic ovary syndrome, December 3-5, 2012. Executive summary. Disponible en: https://prevention.nih.gov/ sites/default/files/2018-06/FinalReport.pdf
14. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/jc.2013-2350.
15. Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol 2010;203:e201– e205. doi: 10.1016/j.ajog.2010.03.008
16. Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics 2015; 136(6):1154–1165. doi:10.1542/
peds.2015-1430
17. Zhang HY, Zhu FF, Xiong J, Shi XB, Fu SX. Characteristics of different phenotypes of polycystic ovary syndrome based on the
Rotterdam criteria in a large-scale Chinese population. BJOG 2009;116:1633–9.doi: 10.1111/j.1471-0528.2009.02347.x
18. Zhao Y, Ruan X, Mueck AO. Clinical and laboratory indicators of polycystic ovary syndrome in Chinese Han nationality with different Rotterdam criteria-based phenotypes. Gynecol Endocrinol. 2016;32(2):151-6. doi: 10.3109/09513590.2015.1107895.
19. Guastella E, Longo RA, Carmina E.Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril. 2010 Nov;94(6):2197-201. doi: 10.1016/j.fertnstert.2010.02.014
20. Diamanti-Kandarakis E, Panidis, D. Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS. Clin Endocrinol (Oxf). 2007 Nov;67(5):735-42 doi:10.1111/j.1365-2265.2007.02954.x
21. Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, et al. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013 Sep;28(9):2562-9. doi: 10.1093/humrep/det262.
22. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod. 2012 Oct;27(10):3067-73. doi:10.1093/humrep/des232
23. Tehrani FR, Rashidi H, Khomami MB, Tohidi M, Azizi F. The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran. Reprod Biol Endocrinol. 2014 Sep 16;12:89. doi: 10.1186/1477-7827-12-89
24. Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample
of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol. 2011 Mar 25;9:39. doi: 10.1186/1477-7827-9-39
25. Espinós J, Ramos A. Estudio y tratamiento de la anovulacinen el síndrome de ovarios poliquísticos. Sociedad Española de Infertilidad. Guías de práctica clínica [Internet].2020 [citado 15 Abril 2020]. Disponible en: https://www.sefertilidad.net/docs/ biblioteca/guiasPracticaClinicas/guia7.pdf
26. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010 Jun 30;8:41. doi: 10.1186/1741-7015-8-41.
27. Balen AH, Conway GS, Kaltsas G, Techatraisak K, Manning, PJ, et al. Andrology: Polycystic ovary syndrome: the spectrum of
the disorder in 1741 patients. Hum Reprod, 1995 10(8), 2107– 2111. doi:10.1093/oxfordjournals.humrep.a136243
28. Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome.
Best Practice & research. Clinical Obstetrics & Gynaecology. 2004 Oct;18(5):671-683. DOI: 10.1016/j.bpobgyn.2004.05.001.
29. Azziz R, Sanchez LA, Knochenhauer ES., Moran C, Lazenby J, Stephens KC, et al. Androgen Excess in Women: Experience with Over 1000 Consecutive Patients. J Clin Endocrinol Metab 2004, 89(2), 453–462. doi:10.1210/jc.2003-031122
30. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary
syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012 Jan;97(1):28-38.e25. doi: 10.1016/j.fertnstert.2011.09.024.
31. Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol 2018; 132(2), 321–336. doi:10.1097/aog.0000000000002698
32. Landay M, Huang A, Azziz R. Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS. Fertil Steril 2009; 92(2):643– 647. doi:10.1016/j.fertnstert.2008.06.021
33. Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibáñez L, et al. The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Horm Res Paediatr. 2015, 83(6), 376– 389. doi:10.1159/000375530
34. Sigall DA, Arenas R. Hipertricosis : sus causas , formas clínicas y manejo 2011; 9(1): 33–42.
35. Sirmans S, Pate K. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013 Dec 18;6:1- 13. doi:10.2147/clep.s37559
36. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and longterm
health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19–25.
37. Hsu MI, Liou TH, Chou SY, Chang CY, et al. Diagnostic criteria for polycystic ovary syndrome in Taiwanese Chinese women: comparison between Rotterdam 2003 and NIH 1990. Fertility and Sterility 2007; 88(3): 727–729. https://doi.org/10.1016/j. fertnstert.2006.11.149
38. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. 2018;(July):1–17. doi: 10.1093/humrep/dey256
39. Williams T, Mortada R, Poter S. Diagnosis and Treatment of Polycystic Ovary Syndrome.American Family Physician 2016;94(2):116-113
40. Nereud B, Dewailly D. Drug-Induced Hyperandrogenism. Contemporary Endocrinology: Androgen Excess Disorders in Women: Polycystic Ovary Syndrome and Other Disorders, Second Edition Cap 10. 121-127
41. Capella D, Aedo Sócrates, Irribarra C. Consensos existentes para el diagnóstico del Sindrome de Ovario Poliquístico. Rev. Obstet.
Ginecol 2014; 9 (1): 39-44
42. Mustaniemi S, Vääräsmäki M, Eriksson JG, Gissler M, Laivuori H,et al. Polycystic ovary syndrome and risk factors for gestational diabetes. Endocrine connections 2018; 7(7):859–869. https://doi. org/10.1530/EC-18-0076
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