Polycystic Ovary Syndrome as Metabolic Disease: New Insights on Insulin Resistance (original) (raw)
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Clinical medicine (London, England), 2015
Polycystic ovary syndrome (PCOS) is a common condition that typically develops in reproductive-age women. The cardinal clinical and biochemical characteristics of PCOS include reproductive dysfunction and hyperandrogenic features. PCOS is also strongly associated with obesity based on data from epidemiological and genetic studies. Accordingly, PCOS often becomes manifest in those women who carry a genetic predisposition to its development, and who also gain weight. The role of weight gain and obesity in the development of PCOS is mediated at least in part, through worsening of insulin resistance. Compensatory hyperinsulinaemia that develops in this context disrupts ovarian function, with enhanced androgen production and arrest of ovarian follicular development. Insulin resistance also contributes to the strong association of PCOS with adverse metabolic risk, including dysglycaemia, dyslipidaemia and fatty liver. Conversely, modest weight loss of just 5% body weight with improvement ...
The purpose of this paper is to present a review of the current research on polycystic ovary syndrome (PCOS). PCOS is one of the most common endocrine disorders in women of reproductive age, affecting 5-10% of the population. Despite its prevalence, PCOS remains largely under unknown. This review has been broken down into two separate chapters. The first is the pathogenesis and related health consequences of PCOS. This chapter focuses on the diagnosis of PCOS as well as the prevalence and incidence of the disease. It then delves into the pathogenesis with a focus on genetics, obesity, insulin resistance and birth weight. Lastly, the health consequences related to PCOS are discussed, with a focus on insulin resistance. The health outcomes reviewed include the metabolic syndrome, cardiovascular disease, and type II diabetes mellitus. The second chapter is a comparison of drug therapies and lifestyle modifications used to treat polycystic ovary syndrome. A short discussion on combination therapy is also included. By focusing on insulin resistance in treatment, it is possible to manage many of the symptoms of PCOS solely through lifestyle modifications. Although many questions remain surrounding polycystic ovary syndrome, this article provides a summary of the current research.
Insulin Resistance in Polycystic Ovary Syndrome
Paripex Indian Journal Of Research, 2016
Polycystic ovary syndrome (PCOS) is a common endocrine disease with metabolic, reproductive and psychological consequences effecting reproductive age women. In addition to the clinical features of oligo-anovulation, infertility and hyperandrogenism, PCOS is closely interrelated with insulin resistance (IR) and hyperinsulinemia, with a high prevalence. IR is also suggested to have a role in the pathogenesis of PCOS. Post-receptor defects, as well as genetic susceptibility has been held responsible for underlying mechanisms of IR. Assessment of IR includes tests of fasting insulin and blood glucose levels. In especially obese women with PCOS, oral glucose tolerance tests are recommended for screening. To overcome IR, reducing body fat and weight with a healthy diet is the initial step. Therapeutic approach includes insulin-sensitizing agents. The prevention of long-term consequences of IR in PCOS, like cardiovascular disease, type 2 diabetes and endometrium cancer, through appropriate...
Clinical Impact of Insulin Resistance in Women with Polycystic Ovary Syndrome
Polycystic Ovarian Syndrome [Working Title]
Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder characterized by multiple hormonal imbalances, reflecting on the clinical presentation. Among them, the insulin resistance (IR), defined as a metabolic state characterized by a decrease in cellular ability to respond to insulin signaling, is a key feature of PCOS independently of obesity. Thus, IR occurs in more than 70% of obese PCOS women and in 30-50% of lean ones. Compensatory high insulin levels are both a symptom and an underlying physiopathological driver of PCOS. Insulin appears to disrupt all components of the hypothalamic-pituitary-ovarian axis, and ovarian tissue IR results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia. The latter is the main culprit of the clinical picture in PCOS. Testing for IR can be helpful to rule out other conditions that are commonly misdiagnosed as PCOS and to recommend an appropriate treatment for the different PCOS phenotypes.
Divergences in Insulin Resistance Between the Different Phenotypes of the Polycystic Ovary Syndrome
The Journal of Clinical Endocrinology & Metabolism, 2013
Context/Objective: Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women.
Journal of Ovarian Research
Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic ovulation dysfunction and overabundance of androgens; it affects 6–20% of women of reproductive age. PCOS involves various pathophysiological factors, and affected women usually have significant insulin resistance (IR), which is a major cause of PCOS. IR and compensatory hyperinsulinaemia have differing pathogeneses in various tissues, and IR varies among different PCOS phenotypes. Genetic and epigenetic changes, hyperandrogenaemia, and obesity aggravate IR. Insulin sensitization drugs are a new treatment modality for PCOS. We searched PubMed, Google Scholar, Elsevier, and UpToDate databases in this review, and focused on the pathogenesis of IR in women with PCOS and the pathophysiology of IR in various tissues. In addition, the review provides a comprehensive overview of the current progress in the efficacy of insulin sensitization therapy in the management of PCOS, providing the latest evidenc...
Reproductive health, 2015
Polycystic ovary syndrome (PCOS) is associated with an increased risk of insulin resistance (IR), metabolic syndrome (MetS), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). Metabolic aspects of the four PCOS phenotypes remain to be fully defined. The aim of this study was to compare metabolic parameters and insulin resistance among the four PCOS phenotypes defined according to the Rotterdam criteria and to determine predictors of these complications. A total of 526 reproductive-aged women were included in this observational case-control study. Of these, 263 were diagnosed as a PCOS based on Rotterdam criteria and 263 infertile women with no evidence of PCOS were recruited as controls. Biochemical, metabolic and insulin resistance parameters were compared in the two groups and the frequency of MetS and IR were compared among the four phenotypes. Data were analyzed for statistical significance using Student's t-test and one way analysis of variance followed b...
New perspectives in polycystic ovary syndrome
Trends in Endocrinology & Metabolism, 1996
Polycystic ovary syndrome (PCOS) is, perhaps, the most common endocrinopathy affecting premenopausal women. Of such women, 5%10% have the classic endocrine syndrome of hyperandrogenism and chronic anovulation. The syndrome not ordy has these longappreciated reproductive morbidities, but it also has more recently recognized important metabolic consequences related to insulin resistance. This article reviews the current state of the field with respect to the pathogenesis of PCOS and the insulin resistance associated with it. @ 1996, Elsevier Science Inc. (Trends Endocrlnol Metab 1996;7:267-271).. Metabolic Features of Polycystic genie states in geneml (Dunaif et al. 1987; Ovary Syndrome Dunaif 1992). The association between masculinization and abnormal carbohydrate metabolism was first noted in 192 1 by Achard and Thiers, who called this "the diabetes of bearded women" (Achard and Thiers 192 1). In 1980, Burghen, Givens, and Kitahchi reported that women with polycystic ovary syndrome (PCOS) had significantly elevated basal and postglucose load insulin levels compared with weightmatched control women (Burghen et al. 1980). They also noted positive linear correlations between androgen and insulin levels and suggested that this might have pathophysiologic importance. Subsequent studies found that both lean and obese women with PCOS were hyperinsulinemic and that this finding was a unique feature of PCOS and not of hyperandro
Insulin Resistance and Polycystic ovary Syndrome: A Review
Journal of Drug Delivery and Therapeutics, 2019
Polycystic Ovary Syndrome (PCOS) is the most common, yet complex, endocrine disorder affecting women in their reproductive years and is a leading cause of infertility. This disease appears to be multifactorial and polygenic in nature involving multisystem dysfunction, namely reproduction, endocrine and metabolic. Hyperandrogenism and insulin resistance appear to be central cause to the pathophysiology of the disease. The glucose and insulin metabolism pathways have been studied and debated to understand whether Insulin Resistance is due to a defect in insulin action or a primary defect in β-cell function or decreased hepatic clearance of insulin, or a combination of all these factors. Numerous studies have demonstrated that obese, normal weight and thin women with PCOS have a form of insulin resistance that is unique and intrinsic to the disorder. Moreover obese women with PCOS possess an additional burden of insulin resistance resulting from their excess adiposity. Hyperinsulinemia leads to increase in androgen production directly by acting as a co-gonadotropin, augmenting Luteinizing Hormone activity within the ovary, and indirectly by increasing serum LH pulse amplitude. Whereas Androgens may in turn contribute at least partially to the insulin resistance state linked with PCOS. In this review, we will briefly study the role of insulin resistance in polycystic ovary syndrome.