Criterios de Clasificación del Síndrome de Ovario Poliquístico Profesor Titular: Dr. Héctor Godoy Morales Profesor Adjunto: Dr. Alfredo Ulloa Aguirre Presenta: Dr. Horacio Alvarado Delgado R1BR Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Síndrome de Ovario Poliquístico 1935 Stein yLeventhal Incremento riesgo Infertilidad DMt2 Dislipidemia Hipertensión Enfermedad Cardiovascular Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

Clasificación NIH (Abril 1990) Hiperandrogenismo o Hiperandrogenemia 2 Oligoovulación Exclusión de otras patologías 3 Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

Criterios de Rooterdam, Mayo 2003 1 Oligo o anovulación 2 Signos clínicos y/o bioquímicos de hiperandrogenismo Diagnóstico 2 ó 3 Ovarios poliquísticos y exclusión de otras patologías (hiperplasia adrenal congénita, tumores secretores de andrógenos, Síndrome de Cushing) 3 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Criterios de Rooterdam 1 Oligo o anovulación 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Oligo o anovulación 75% con alteraciones menstruales 20% eumenorrea Paciente anovulatoria y eumenorreica Progesterona 20 – 24 del ciclo Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

2 CRITERIOS DE ROOTERDAM (2003) Signos clínicos y/o bioquímicos de hiperandrogenismo 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Hiperandrogenismo Hiperandrogenismo Clínico Hirsurtismo Ácne Aloplecia andrógenica 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Hiperandrogenismo Hirsurtismo Presente en 60% Escala modificada de Ferriman-Gallwey  Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

Hiperandrogenismo Hiperandrogenismo bioquímico (60 – 80%) Medición de testosterona total 6.86 ng/ml Testosterona libre 20 a 40 años: 0.6 – 3.1 pg/mL 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Hiperandrogenismo Hiperandrogenismo bioquímico Androstenediona y DHEAS Solo en 10% Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

Hiperandrogenismo Hiperandrogenismo bioquímico Usar solo como auxiliar diagnóstico, NO COMO CRITERIO DIAGNOSTICO AISLADO Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

CRITERIOS DE ROOTERDAM (2003) Ovarios poliquísticos y exclusión de otras patologías (hiperplasia adrenal congénita, tumores secretores de andrógenos, Síndrome de Cushing) 3 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Ovarios Poliquísticos 12 o más folículos en cada ovario de 2 a 9 mm Aumento del volumen de ovario (>10 mL) 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

Ovarios Poliquísticos Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

Diagnóstico de SOP Excluir diagnóstico Hiperplasia adrenal congénita Síndrome de Cushing Tumores secretores de andrógenos Deficiencia de 21 – hidroxilasa Enfermedades tiroideas Hiperprolactinemia Hipogonadismo hipogonadotrofico Excluir diagnóstico 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. Fertility and Sterility 81(1) 19 – 25, Jan 2004

1 2 3 Clasificación AES 2006 Disfunción ovárica Oligoovulación Hiperandrogenismo Hirsurtismo y/o Hiperandrogenemia 1 Disfunción ovárica Oligoovulación Ovario Poliquístico 2 Exclusión de otros trastornos relacionados con el exceso de andrógenos 3 Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006

Fenotipos Azziz R., Carmina E., Dewally D., et al., POSITION STATEMENT: Criteria for defining Polycystic Ovary Syndrome as a predominantly hyperandrogenyc syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism 91 (11): 4237 – 4245. 2006