scholarly journals Polycystic Ovary Syndrome, Insulin Resistance, and Obesity: Navigating the Pathophysiologic Labyrinth

2014 ◽  
Vol 2014 ◽  
pp. 1-17 ◽  
Author(s):  
Joselyn Rojas ◽  
Mervin Chávez ◽  
Luis Olivar ◽  
Milagros Rojas ◽  
Jessenia Morillo ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Ovarian Tissue ◽  
Ovary Syndrome ◽  
Main Culprit ◽  
Exact Etiology

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome.

scholarly journals Developmental origin of polycystic ovary syndrome - a hypothesis

2002 ◽  
Vol 174 (1) ◽  
pp. 1-5 ◽  
Author(s):  
DH Abbott ◽  
DA Dumesic ◽  
S Franks
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Regulatory Region ◽  
Later Life ◽  
Ovary Syndrome ◽  
Increased Risk ◽  
Genetically Determined ◽  
Lh Secretion

Polycystic ovary syndrome (PCOS) is a common but complex endocrine disorder and is a major cause of anovulation and consequent subfertility. It is also associated with a metabolic disturbance, characterized by hyperinsulinaemia and insulin resistance that carries an increased risk of type 2 diabetes in later life. Despite its prevalence little is known about its aetiology, but there is increasing evidence for an important genetic involvement. On the basis of experimental observations in the prenatally androgenized sheep and rhesus monkey, and supported by data from human studies, we propose that the clinical and biochemical features of PCOS can arise as a consequence of genetically determined hypersecretion of androgens by the ovary during, or very likely long before, puberty. The resulting hyperandrogenism results in 'programming' of the hypothalamic-pituitary unit to favour excess LH secretion, and encourages preferential abdominal adiposity that predisposes to insulin resistance. The severity of hyperinsulinaemia and insulin resistance (which has a profound influence on the phenotype of PCOS) is further influenced by both genetic factors (such as polymorphism in the insulin gene regulatory region) and environmental factors, notably obesity. This hypothesis therefore suggests a unifying, 'linear' model to explain the aetiology of the heterogeneous phenotype.

scholarly journals INFLUENCE OF LIFESTYLE ON THE PROGNOSIS OF POLYCYSTIC OVARY SYNDROME

2021 ◽  
Keyword(s):  
Quality Of Life ◽  
Insulin Resistance ◽  
Cardiovascular Risk ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Overweight And Obesity ◽  
Lifestyle Changes ◽  
Ovary Syndrome ◽  
Pubmed Database

Polycystic Ovary Syndrome (PCOS) is the most common endocrine-metabolic pathology among women at reproductive age. It has a multifactorial character, and its etiology has not yet been precisely explained. The pathogenesis of PCOS is related to metabolic issues such as hyperandrogenism and insulin resistance, and is also associated with obesity, type 2 diabetes and increased cardiovascular risk. Manifestations such as irregular menstruation, acne, hisurtism and androgenic alopecia are common in addition to the consequent psychological and quality of life impacts. Thus, knowing that the adoption of healthy habits have therapeutic impacts in the face of various signs and symptoms of PCOS, there is a need to analyze the influence of lifestyle on the prognosis of PCOS. The present study carried out its searches in the PUBMED database, using the descriptors "polycystic ovary syndrome", "life style" and "prognosis", using the Boolean operator "and". Inclusion criteria were used: articles written in Portuguese, English and Spanish, published in the last 5 years. 19 results were obtained, 5 of which were excluded, resulting in 14 articles chosen for theoretical reference. The influence of lifestyle on the prognosis of PCOS is notorious, especially in patients with overweight and obesity. Thus, healthy behaviors have the potential to improve pathological conditions and bad habits demonstrate that they can induce clinical manifestations of PCOS in predisposed people. Lifestyle changes, mainly associated with weight loss, show improvements in aspects such as insulin resistance, free testosterone, acne, hirsutism and reproductive function, reduced cardiovascular risk, in addition to positively influence to the psychic and quality of life in analyzed patients. Therapeutic strategies that combine lifestyle changes and drug interventions have been shown to be more effective, as well as strategies structered with the monitoring of professionals tend to increase adherence to treatment.

scholarly journals An adolescent with polycystic ovary syndrome

2006 ◽  
Vol 155 (suppl_1) ◽  
pp. S149-S152 ◽  
Author(s):  
Marja Ojaniemi ◽  
Michel Pugeat
Keyword(s):  
Physical Activity ◽  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Polycystic Ovaries ◽  
Ovary Syndrome ◽  
The Metabolic Syndrome ◽  
Menstrual Irregularities ◽  
Term Basis

Polycystic ovary syndrome (PCOS) is a common clinical condition that manifests during adolescence with menstrual irregularities, acne, and hirsutism. As these symptoms are frequently observed in healthy teenagers, it can be difficult to recognize PCOS. Establishment of hyperandrogenism, polycystic ovaries, and identifying a metabolic disorder are required for the management of PCOS in a teenager. The underlying defects in PCOS are still unclear; however, insulin resistance and the metabolic syndrome are common in both obese and non-obese PCOS patients, so that the evaluation of glucose tolerance is recommended. More than 50% of PCOS patients are overweight or obese, and will benefit from an increase in physical activity and weight loss. Metformin is a treatment option that requires further investigation before being recommended on a long-term basis.

The mean and the biological variation of insulin resistance does not differ between polycystic ovary syndrome and type 2 diabetes

2009 ◽  
Vol 46 (3) ◽  
pp. 218-221 ◽  
Author(s):  
Li Wei Cho ◽  
V Jayagopal ◽  
E S Kilpatrick ◽  
S L Atkin
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Polycystic Ovary Syndrome ◽  
Postmenopausal Women ◽  
Polycystic Ovary ◽  
Biological Variation ◽  
Biological Variability ◽  
Ovary Syndrome ◽  
The Mean

Background There is an assumption that the mean and biological variation of insulin resistance (IR) is less in polycystic ovary syndrome (PCOS), and intuitively higher in type 2 diabetes (T2DM). To test this hypothesis we compared the mean and biological variation in IR in PCOS to that of T2DM and to age- and weight-matched controls. Methods Twelve PCOS, 11 matched healthy women; 12 postmenopausal diet-controlled T2DM and 11 matched healthy postmenopausal women were recruited. Blood samples were collected at 4-d intervals on 10 consecutive occasions. The biological variability of IR was derived on duplicate samples. Results Mean and biological variability of HOMA-IR for PCOS did not differ from T2DM. Both measures were higher than the matched controls. There was no difference in insulin or IR measures between the body mass index matched pre- and postmenopausal women. Percentage β cell function were 208.8%, 62.3%, 106.5% and 111.9%, respectively, in PCOS, postmenopausal women with T2DM, healthy premenopausal and healthy postmenopausal women. Conclusions The progression from PCOS to the development of T2DM is unlikely to be due to a further increase in IR (or variability), but rather the progressive failure of pancreatic beta cells with a decrease in insulin production. The clinical trial registration number for this study is ISRCTN65353256.

No changes of peripheral insulin resistance in polycystic ovary syndrome after long-term reduction of endogenous androgens with leuprolide

1995 ◽  
Vol 133 (6) ◽  
pp. 718-722 ◽  
Author(s):  
Antonino Lasco ◽  
Domenico Cucinotta ◽  
Alfonso Gigante ◽  
Giulia Denuzzo ◽  
Marilena Pedulla ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Insulin Sensitivity ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Control Subjects ◽  
Peripheral Insulin Resistance ◽  
Androgen Levels

Lasco A, Cucinotta D, Gigante A, Denuzzo G, Pedulla M, Trifiletti A, Frisina N. No changes of peripheral insulin resistance in polycystic ovary syndrome after long-term reduction of endogenous androgens with leuprolide. Eur J Endocrinol 1995;133:718–22. ISSN 0804–4643 The aim of this study was to investigate the relationship between plasma insulin levels, peripheral insulin sensitivity and androgen secretion in ten patients with polycystic ovary syndrome and in six obese women as compared with six normal-weight control subjects. During a euglycemic–hyperinsulinemic clamp no significant change of testosterone, androstenedione or dehydroepiandrosterone sulfate plasma levels was observed in the two groups of patients or in the control subjects; insulin sensitivity was clearly reduced and was similar in polycystic ovary patients and in obese women, in spite of the different plasma androgen levels. A long-term (5 months) androgen suppression with the gonadotropin-releasing hormone agonist leuprolide was not able to improve significantly the insulin sensitivity. These results demonstrate that the short-term hyperinsulinemia achieved with the clamp technique does not affect androgen secretion and that insulin resistance, measured with the same technique, is not influenced by long-term suppression of plasma androgen levels in polycystic ovary syndrome. A Lasco, Via Faustina e Tertullo 19, 98100 Messina, Italy

scholarly journals Relationship of Insulin Receptor Substrate-1 and -2 Genotypes to Phenotypic Features of Polycystic Ovary Syndrome

2002 ◽  
Vol 87 (9) ◽  
pp. 4297-4300 ◽  
Author(s):  
David A. Ehrmann ◽  
Xu Tang ◽  
Issei Yoshiuchi ◽  
Nancy J. Cox ◽  
Graeme I. Bell
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
African American ◽  
African Americans ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Insulin Receptor Substrate ◽  
Ovary Syndrome ◽  
Glucose Levels

Insulin resistance is a key component in the pathogenesis of polycystic ovary syndrome (PCOS) and type 2 diabetes. Polymorphisms in the genes encoding the insulin receptor substrate (IRS) proteins, IRS-1 (Gly972Arg) and IRS-2 (Gly1057Asp), influence susceptibility to type 2 diabetes. This study was undertaken to assess the influence of these polymorphisms on insulin resistance, glucose tolerance, and androgen levels in nondiabetic PCOS women. We studied 227 PCOS subjects including 126 and 48 nondiabetic white and African-American subjects, respectively. The IRS-1 Gly972Arg allele frequencies were identical in whites and African-Americans [0.95 (Gly) and 0.05 (Arg)]. The IRS-2 Gly1057Asp allele frequencies were 0.85 (Gly) and 0.15 (Asp) in African-Americans and 0.59 (Gly) and 0.41 (Asp) in whites. There was no association of IRS-1 genotype with any clinical or hormonal measure in nondiabetic white or African-American PCOS subjects. However, nondiabetic subjects with the IRS-2 Gly/Gly genotype had significantly higher 2-h oral glucose tolerance test glucose levels compared with those with Gly/Asp and Asp/Asp genotypes in whites or Gly/Asp genotype in African-Americans (there were no Asp/Asp subjects in our modest size African-American sample). These results suggest that the IRS-2 Gly1057Asp polymorphism influences blood glucose levels in nondiabetic white and African-American women with PCOS. Thus, individuals with the common IRS-2 Gly/Gly genotype may be at increased risk of developing type 2 diabetes.

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