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CC BY 4.0 · Rev Bras Ginecol Obstet 2016; 38(02): 071-076
DOI: 10.1055/s-0036-1571423
Original Article

Association between Lipid Accumulation Product and Hirsutism in Patients with Polycystic Ovary Syndrome

Associação entre lipid accumulation product (LAP) e hirsutismo na síndrome do ovário policístico
Flávia Ribeiro de Oliveira
1   Faculdade de Saúde e Ecologia Humana – FASEH, Vespasiano, Brazil; Laboratory of Human Reproduction, Hospital das Clínicas, Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, MG, Brazil
,
Mariana Bicalho Rezende
2   Undergraduate Medical Course, FASEH, Vespasiano, MG, Brazil
,
Nícolas Figueiredo Faria
2   Undergraduate Medical Course, FASEH, Vespasiano, MG, Brazil
,
Tomás Ribeiro Gonçalves Dias
2   Undergraduate Medical Course, FASEH, Vespasiano, MG, Brazil
,
Walter Carlos Santos de Oliveira
2   Undergraduate Medical Course, FASEH, Vespasiano, MG, Brazil
,
Ana Luiza Lunardi Rocha
3   Department of Gynecology and Obstetrics, School of Medicine; Laboratory of Human Reproduction and Hyperandrogenism Outpatient Clinic, Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil
,
Ana Lúcia Cândido
4   Department of Clinical Medicine, School of Medicine; Hyperandrogenism Outpatient Clinic, Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil
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Abstract

Objective Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause. Clinical hyperandrogenism is the most important diagnostic criterion of the syndrome, which manifests as hirsutism in 70% of cases. Hirsute carriers of PCOS have high cardiovascular risk. Lipid accumulation product (LAP) is an index for the evaluation of lipid accumulation in adults and the prediction of cardiovascular risk. The aim of this study was to evaluate the association between LAP and hirsutism in women with PCOS.

Methods This was a cross-sectional observational study of a secondary database, which included 263 patients who had visited the Hyperandrogenism Outpatient Clinic from November 2009 to July 2014. The exclusion criteria were patients without Ferriman-Gallwey index (FGI) and/or LAP data. We used the Rotterdam criteria for the diagnosis of PCOS. All patients underwent medical assessment followed by measurement and recording of anthropometric data and the laboratory tests for measurement of the following: thyroid-stimulating hormone, follicle-stimulating hormone, prolactin, total testosterone, sex hormone binding globulin, 17-α-hydroxyprogesterone (follicular phase), glycohemoglobin A1c, and basal insulin. In addition, the subjects underwent lipid profiling and oral glucose tolerance tests. Other laboratory measurements were determined according to clinical criteria. LAP and the homeostatic model assessment index (HOMA-IR) were calculated using the data obtained. We divided patients into two groups: the PCOS group with normal LAP (< 34.5) and the PCOS group with altered LAP (> 34.5) to compare the occurrence of hirsutism. For statistical analysis, we used SPSS Statistics for Windows® and Microsoft Excel programs, with descriptive (frequencies, percentages, means, and standard deviations) and comparative analyses (Student's t-test and Chi-square test). We considered relations significant when the p-value was ≤ 0.05.

Results LAP was high in most patients (n = 177; 67.3%) and the FGI indicated that 58.5% of the patients (n = 154) had hirsutism. The analysis by LAP quartiles showed a positive correlation (p = 0.04) among patients with a high FGI and an upper quartile LAP (> 79.5) when compared with those with LAP < 29.0 (lower quartile).

Conclusion This study demonstrated an association between high LAP and hirsutism. The FGI could represent a simple and low-cost tool to infer an increased cardiovascular risk in women with PCOS.

Resumo

Objetivo A síndrome dos ovários policísticos (SOP) é o distúrbio endócrino mais comum em mulheres entre a menarca e a menopausa. O hiperandrogenismo clínico é o critério diagnóstico mais importante da síndrome, que se manifesta como hirsutismo em 70% dos casos. Portadores de SOP hirsutas têm elevado risco cardiovascular. O Lipid accumulation product (LAP) é um índice para a avaliação da acumulação de lípidos nos adultos e é um preditor de risco cardiovascular. O objetivo deste estudo é avaliar a associação entre LAP e hirsutismo em portadoras da SOP.

Métodos Estudo observacional transversal de banco de dados secundário, que incluiu 263 pacientes do Ambulatório de Hiperandrogenismo no período de novembro de 2009 a julho de 2014. Foram excluídas pacientes sem o índice de Ferriman-Gallwey e/ou LAP. Foram utilizados como critérios diagnósticos da SOP os critérios de Rotterdam. Todas as pacientes foram submetidas à avaliação médica seguida da aferição e registro dos dados antropométricos e a realização dos seguintes exames laboratoriais: hormônio estimulante da tireoide (TSH), hormônio folículo estimulante (FSH), prolactina (PRL), Testosterona total, globulina ligadora dos hormônios sexuais (SHBG), 17-α-hidroxiprogesterona, (fase folicular), perfil lipídico, teste oral de tolerância à glicose, glico-hemoglobina a1C, insulina basal. Outras dosagens laboratoriais foram determinadas à critério clínico. O LAP e o HOMA-IR (homeostatic model assessment) foram calculados com os dados obtidos. As pacientes foram divididas em dois grupos: grupo das portadoras de SOP com LAP normal (LAp < 34,5) e grupo das portadoras de SOP com LAP alterado (LAP >34,5) para as comparações do hirsutismo. Para a análise estatística, foram utilizados os programas SPSS Statistics for Windows® e Microsoft Excel®, sendo feitas análises descritivas (frequências, percentuais, médias, desvios-padrão) e comparativas (t-Student e qui-quadrado). Foram consideradas relações significativas quando p-valor foi menor ou igual a 0,05.

Resultados O LAP foi elevado na maioria das pacientes (n = 177; 67,3%) e o índice de Ferriman-Gallwey (IF) demonstrou que 58,5% das pacientes (n = 154) eram hirsutas. A análise por quartis de LAP, demonstrou correlação positiva (p = 0,04) entre pacientes com IF elevado e LAP no quartil superior (> 79,5) quando comparadas àquelas com LAP menor que 29,0 (quartil inferior).

Conclusão O estudo demonstrou associação do LAP elevado e hirsutismo. O escore de Ferriman-Gallwey poderia representar uma ferramenta simples e de baixo custo para inferir risco cardiovascular aumentado em portadoras da síndrome.

Keywords

polycystic ovary syndrome - hirsutism - cardiovascular disease - insulin resistance

Palavras-chave

síndrome dos ovários policísticos - hirsutismo - doença cardiovascular - resistência à insulina


Publication History

Received: 30 June 2015

Accepted: 25 November 2015

Publication Date:
24 February 2016 (online)

© 2016. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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