MANAGEMENT OF ENDOCRINE DISEASE: Secondary polycystic ovary syndrome: theoretical and practical aspects

Abstract

PCOS is a clinical heterogeneous entity of female androgen excess diagnosed by exclusion of other disorders responsible for androgen excess. The concept of secondary PCOS implies that there is a primary well-defined cause leading to the PCOS phenotype with underlying androgen overproduction, regardless of the origin. In these cases, we presume the term of 'secondary PCOS' could be used. In all these conditions, the potential complete recovery of the hyperandrogenemic state as well as the remission of the PCOS phenotype should follow the removal of the cause. If accepted, these concepts could help clinicians to perform in-depth investigations of the potential factors or disorders responsible for the development of these specific forms of secondary PCOS. Additionally, this could contribute to develop further research on factors and mechanisms involved in the development of the classic and the nonclassic PCOS phenotypes. Invited author's profileRenato Pasquali is full professor of Endocrinology & Metabolism and Director of the division of Endocrinology of the S.Orsola-Malpighi Hospital, Bologna, Italy. He also heads the School of Specialization in Endocrinology and Metabolism, University Alma Mater Studiorum of Bologna, Italy. He is a member of numerous national and international scientific societies and serves on the editorial boards of international journals. His scientific interests relate to (i) the pathophysiology and treatment of the polycystic ovary syndrome; (ii) the endocrinology of obesity (sex hormones, the hypothalamic-pituitary-adrenal axis, and the endocannabinoid system).

Definitive diagnosis of mandibular hypoplasia, deafness, progeroid features and lipodystrophy (MDPL) syndrome caused by a recurrent <i>de novo</i> mutation in the <i>POLD1</i> gene

“…Insulin is thought to stimulate ovarian thecal cells or stromal cells to produce androgen and decrease the production of SHBG by the liver, resulting in a hyperandrogenism [35][36][37]. Therefore, the characteristics of our patient support the view that the primary role of sustained hyperinsulinemia may be as a cause of secondary PCOS, acanthosis nigricans, and hirsutism [35,38,39]. In contrast, undescended testes and hypogonadism have been reported in males [14,16,26].…”

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

“…Nevertheless, it should be noticed that polycystic ovary syndrome (PCOS) occurs in 29% of female patients with obesity (144) reaching up to 36% of women with severe obesity (145). Obesity in females can be associated with relative functional hyperandrogenism (146,147); women should undergo further evaluation when suggestive symptoms or signs such as acne, hirsutism, or androgenic alopecia are present. In fact, obesity plays a major role in determining female hyperandrogenaemia, especially in adolescence in what has been defined as obesity-related hyperandrogenaemia (146,148).…”

Can Polycystic Ovarian Syndrome be cured? Unfolding the Concept of Secondary Polycystic Ovarian Syndrome!

“…PCOS secondary to SSIR states is not very uncommon. The prevalence of 1.5% of all PCOS phenotypes has been reported [22].…”