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Avaliação antropométrica, metabólica e da função gonadal em adolescentes e mulheres adultas jovens acompanhadas desde a infância devido à adrenarca precoceAnthropometric, metabolic evaluation and gonadal function in adolescents and young adult women followed since childhood due to precocious adrenarcheAdrenarca.Síndrome dos ovários policísticos.Hirsutismo.Transtornos do metabolismo de glucose.Dislipidemias.Ciências da SaúdeAdrenarca precoce (AP) idiopática é definida como o aparecimento de sinais androgênicos antes dos 8 anos de idade em meninas e 9 anos em meninos na ausência de puberdade verdadeira, defeitos enzimáticos esteroidogênicos e tumores virilizantes. Até finais dos anos 90, a AP era considerada uma variante benigna do desenvolvimento puberal sem necessidade de acompanhamento especial ou tratamento. Posteriormente, vários estudos têm correlacionado a AP com componentes da síndrome metabólica (SM) e alguns com vários outros distúrbios, incluindo hiperandrogenismo funcional. O objetivo desta pesquisa é investigar anormalidades hormonais e metabólicas na evolução de pacientes que foram assistidas devido à AP, considerando que essa condição predispõe a anormalidades hormonais, aumentando a probabilidade de desenvolvimento da síndrome dos ovários policísticos (SOP), SM, diabetes mellitus tipo 2, hipertensão arterial sistêmica (HAS) e condições relacionadas a maior risco cardiometabólico. Foram incluídas no estudo adolescentes e mulheres adultas jovens que tiveram diagnóstico prévio de adrenarca precoce e foram excluídas as pacientes com hiperplasia adrenal congênita, puberdade precoce verdadeira e outras condições endocrinológicas que pudessem interferir no diagnóstico em questão e também aquelas pacientes que não haviam completado seu desenvolvimento e maturação sexual e que ainda não atingiram sua estatura final, totalizando 34 pacientes para análise. Para avaliação clínica, foi realizado exame físico completo, que constou de avaliação de peso, estatura, cálculo do índice de massa corporal (IMC), medida de circunferência abdominal, aferição de pressão arterial, avaliação de estadiamento puberal, avaliação da presença de acne e acantose nigricans, e avaliação do escore de Ferriman e Gallwey. Foram coletados os seguintes exames para avaliação metabólica: glicemia de jejum (GJ), insulina basal (IB), hemoglobina glicada (HbA1c), colesterol total (CT), triglicérides (TG), HDLcolesterol (HDL-c), LDL- colesterol (LDL-c), NÃO-HDL colesterol (NÃO-HDL-c), VLDLcolesterol (VLDL-c), e a partir desses exames, também foram calculados a relação insulina/ Glicemia (INS/GJ), o índice HOMA-IR, e a relação triglicérides/ HDL (TG/HDL). Também foram colhidos os seguintes exames para avaliação hormonal: hormônio luteinizate (LH), hormônio folículo estimulante (FSH), estradiol, hormônio tireoestimulante (TSH), hormônio tiroxina livre (T4L), testosterona total, 17 α hidroxiprogesterona (17 α OHP), androstenediona(Δ4), sulfato de dehidroepiandrosterona (DHEAS). A presença de SOP foi definida tanto pelos critérios do Consenso de Rotterdam, quanto pelos critérios da Androgen Excess Society. A presença de SM foi definida pelos critérios da Federação Internacional de Diabetes. Por se tratar de um estudo de caráter descritivo, as variáveis de interesse foram inicialmente submetidas à análise descritiva, sendo as variáveis numéricas expressas a partir de medidas de centralidade e dispersão. Foi utilizado o teste de Shapiro-Wilk para verificação da normalidade das variáveis, enquanto a homogeneidade das variáveis dos dados de interesse foi verificada pelo teste de Levene. As correlações entre duas variáveis numéricas foram analisadas a partir de coeficientes de correlação linear de Pearson ou Spearman. O nível de significância para a realização de todos os procedimentos inferenciais foi de 5%. Os programas computadorizados Statistica, IBM SPSS STATISTIC 20, bem como Primer of Statistic foram utilizados. O banco de dados foi digitado no programa Excel. A mediana da idade das pacientes foi de 20 anos e 3 meses, 2,94% das pacientes apresentavam baixo peso, 61,77% apresentavam-se eutróficas, 23,53% apresentavam sobrepeso e 11,76% apresentavam obesidade. A cintura abdominal apresentava-se alterada em 29,42% das pacientes e 8,82% das pacientes foram categorizadas como hipertensas. Nos casos em que escore de Ferriman e Gallwey foi avaliado (n=20), 55% das pacientes mostraram-se com hirsutismo (escore≥ 8). A acne ocorreu em 38,23% das pacientes e acantose em 14,70%. Com relação às medidas de glicose, nenhuma paciente apresentou alterações, entretanto, 5,88% apresentavam hemoglobina glicada alterada, compatível com intolerância à glicose. A hiperinsulinemia de jejum foi constatada em 29,41% das pacientes e alteração da relação insulina/ glicemia em 5,88% dos casos. O marcador de resistência insulínica HOMA-IR esteve aumentado em 38,23 % dos casos e a relação TG/HDL em 8,82% das pacientes. Com relação ao metabolismo lipídico, 14, 70% das pacientes apresentavam concentrações séricas do colesterol total elevado, 5,88% das pacientes apresentavam triglicerídeos elevados e 14,70% das pacientes apresentavam HDL-c baixo. A relação LH/FSH foi sugestiva de SOP em 26,47% das pacientes, a testosterona estava aumentada em 11,76% das pacientes, a concentração de SDHEA estava aumentada em 8,82% das pacientes e 23,52% das pacientes apresentavam concentrações de 17 α hidroxiprogesterona aumentada. Usando as classificações propostas, a presença de SOP, foi constatada em 41,17% das pacientes. Utilizando-se a classificação do IDF, encontramos que 2,94% das pacientes apresentavam síndrome metabólica. Perante os resultados, questiona-se o comportamento benigno da AP. No presente estudo, a presença de SOP foi de 41,17%, sendo mais elevada do que na população geral. Portanto, a intervenção precoce em meninas adolescentes com AP, visando diagnosticar SOP, fatores de riscometabólicos e SM, poderia reduzir o risco de desenvolvimento de diabetes e doenças cardiovasculares, no futuro.Idiopathic precocious adrenarche (PA) is defined as the appearance of androgenic signs before 8 years of age in girls or 9 years in boys in the absence of true puberty, steroidogenic enzymatic defects or virilizing tumors. Until the late 1990s, PA was considered a benign variant of pubertal development without the need for special monitoring or treatment. Several studies have correlated PA with components of the metabolic syndrome (MS) and some with several other disorders including functional hyperandrogenism. The objective of this research is to investigate hormonal and metabolic abnormalities in the evolution of patients who were assisted due to PA, considering that this condition predisposes to hormonal abnormalities, increasing the probability of developing polycystic ovarian syndrome (PCOS), MS, type 2 diabetes mellitus, systemic arterial hypertension (SAH), and conditions related to increased cardiometabolic risk. Included in the study were adolescents and young adult women who had previous diagnosis of PA and excluded patients with congenital adrenal hyperplasia, true precocious puberty and other endocrinological conditions that could interfere in the diagnosis in question and also those patients who had not completed their development and sexual maturation and have not yet reached their final height, resulting in a total of 34 patients for analysis. For the clinical evaluation, a complete physical examination was performed, which included weight, height, BMI calculation, abdominal circumference measurement, blood pressure measurement, pubertal staging evaluation, assessment of the presence of acne and acanthose nigricans, and evaluation of the Score of Ferriman and Galwey. The following exams were collected for metabolic evaluation; (TG), HDL-cholesterol (HDL-c), LDLcholesterol (LDL-c), non-HDL-cholesterol (non-HDL-c), fasting glycemia (GJ), basal Insulin (IB), glycated hemoglobin (HbA1c) VLDL-cholesterol (VLDL-c), and from these exams the insulin / glucose ratio (INS / GJ), the HOMA-IR, and the triglyceride / HDL ratio (TG / HDL) were also calculated and the following tests for hormonal evaluation: hormone luteinizate (LH), follicle stimulating hormone (FSH), estradiol, thyroid stimulating hormone (TSH), free thyroxine hormone (T4L), testosterone, 17α-hydroxyprogesterone (17 α OHP), androstenedione (Δ4), dehidoepiandrosterone sulfate (DHEAS). The presence of PCOS was defined by both the Rotterdam consensus criteria and the Androgen Excess Society criteria. The presence of MS was defined by the criteria of the International Diabetes Federation.Because it is a descriptive study, the variables of interest were initially subjected to descriptive analysis, being expressed through measures of centrality and dispersion of the numerical variables. The Shapiro-Wilk test was used to verify the normality of the variables, while the homogeneity of the interest data variables was verified by the Levene test. Correlations between two numerical variables were analyzed using Pearson or Spearman linear correlation coefficients. The level of significance for performing all inferential procedures was 5%. The Statistica computer programs, IBM SPSS STATISTIC 20, as well as Primer of Statistic were used. The database was typed in the Excel program. The median age of the patients was 20 years and 3 months, 2.94% of the patients were underweight, 61.77% were eutrophic, and 23.53% were overweight and 11.76% presented obesity. The abdominal waist was altered in 29.42% of the patients and 8.82% were categorized as hypertensive. In cases in which Ferriman and Gallwey scores were assessed (n=20), 55% of the patients presented with hirsutism (score ≥ 8). Acne occurred in 38.23% of patients and acanthose in 14.70%. In the present study, no patient presented any changes in glucose measurements. However, 5.88% of the patients had altered glycated hemoglobin, compatible with glucose intolerance, fasting hyperinsulinemia was observed in 29.41% of the patients and insulin / glucose ratio in 5,88% of the cases. The HOMA-IR insulin resistance marker was increased in 38.23% of the cases, the TG / HDL ratio in 8.82% of the patients. With regard to lipid metabolism, in the present study, 14, 70% of the patients had high Total Cholesterol, 5.88% of the patients presented high Triglycerides, and 14, 70% of the patients had low HDL cholesterol. The LH / FSH ratio was suggestive of PCOS in 26.47% of the patients, testosterone was increased in 11.76% of the patients, the concentration of SDHEA was increased in 8.82% of the patients, 23.52% of the patients presented increased concentrations of 17OH progesterone. Using the proposed classifications, the presence of PCOS was found in 41.17% of the patients. Using the IDF classification, the presence of MS was found in 2,94% of the patients. After the above discussions, we questioned the benign behavior of PA. In the present study, the presence of PCOS was 41.17%, higher than in the general population. Thus, early intervention in adolescent girls with PA, aimed at diagnosing PCOS, metabolic risk factors and MS, could reduce the risk of developing diabetes and cardiovascular diseases in the futureUniversidade Federal do Triângulo MineiroInstituto de Ciências da Saúde - ICS::Programa de Pós-Graduação em Ciências da SaúdeBrasilUFTMPrograma de Pós-Graduação em Ciências da SaúdeBORGES, Maria de Fátima25537032600http://lattes.cnpq.br/3192369967083138PALHARES, Heloísa Marcelina da Cunha69680051668http://lattes.cnpq.br/1270962349979369RIBEIRO, Flávia Alves2023-12-14T13:54:58Z2023-12-14T13:54:58Z2018-01-18info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfapplication/pdfRIBEIRO, Flávia Alves. Avaliação antropométrica, metabólica e da função gonadal em adolescentes e mulheres adultas jovens acompanhadas desde a infância devido à adrenarca precoce. 2018. 100f. 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Onset of breast and pubic hair development in 1231 preadolescent Lithuanian school girls. Archives of Disease in Childhood, v.90, n. 9, p. 932- 936, Sep. 2005.http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFTMinstname:Universidade Federal do Triangulo Mineiro (UFTM)instacron:UFTM2023-12-15T02:02:55Zoai:bdtd.uftm.edu.br:123456789/1608Biblioteca Digital de Teses e Dissertaçõeshttp://bdtd.uftm.edu.br/PUBhttp://bdtd.uftm.edu.br/oai/requestbdtd@uftm.edu.br||bdtd@uftm.edu.bropendoar:2024-04-24T09:59:04.935138Biblioteca Digital de Teses e Dissertações da UFTM - Universidade Federal do Triangulo Mineiro (UFTM)false
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