The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. The disorder is characterized by clinical features of hyperandrogenism, menstrual irregularities and often central obesity and hyperinsulinaemia. PCOS may increase the risk for infertility, type 2 diabetes mellitus, dyslipidaemia, cardiovascular disease and endometrial cancer, emphasizing the need for early diagnosis of the syndrome.The genetic basis of PCOS is unknown. There is a strong familial component but the mode of inheritance is uncertain and several candidate genes have been proposed to contribute to susceptibility. Not only genes involved in steroid hormone biosynthesis have been studied but also genes associated with the regulation of insulin secretion and action since hyperinsulinaemia is a characteristic of PCOS. So far there is evidence that INS VNTR (insulin variable number of tandem repeats) or CYP11a (cholesterol side chain cleavage) genes are associated with this syndrome. PCOS appears, however, to be an oligogenic disorder and more studies are necessary to define the genetic basis.

Section: The Insulin Genesupporting

confidence: 80%

The genetic basis of polycystic ovary syndrome

Xita

Georgiou

Tsatsoulis

2002

“…secondary amenorrhea or with regular menstrual cycles did not differ in markers of IR from Group D. Two previous smaller studies (nZ72 and nZ418 respectively) reported that patients with PCOS and oligomenorrhea or amenorrhea had more severe IR than patients with PCOS and regular cycles (10,11). However, the latter studies did not differentiate between patients with oligomenorrhea and amenorrhea (10,11).…”

Section: Tablementioning

confidence: 48%

“…Therefore, menstrual cycle pattern might serve as a marker of IR in patients with PCOS, as IR can induce oligo-or anovulation and thus menstrual cycle irregularity by exacerbating hyperandrogenemia and by disrupting follicular growth (2). Nevertheless, very few small studies evaluated the association between menstruation abnormalities and the endocrine and metabolic characteristics in PCOS (10,11,12,13).…”

Section: Introductionmentioning

confidence: 99%

Association between menstrual cycle irregularities and endocrine and metabolic characteristics of the polycystic ovary syndrome

Panidis

Τζιόμαλος

Chatzis

et al. 2013

Objective: Insulin resistance (IR) is frequent in polycystic ovary syndrome (PCOS) and contributes to the increased risk for type 2 diabetes mellitus and cardiovascular disease of this population. Several markers of IR are used but most are expensive or have limited sensitivity and specificity. Preliminary data suggest that the menstrual cycle pattern correlates with IR in PCOS but existing studies are small. We aimed to assess the relationship between the type of menstrual cycle irregularities and IR in PCOS. Design: Prospective study. Methods: We studied 1285 women with PCOS, divided according to the menstrual cycle pattern. Results: Patients with isolated secondary amenorrhea and those with secondary amenorrhea alternating with regular menstrual cycles were more insulin resistant than patients with regular cycles (Group D). Patients with isolated oligomenorrhea were also more insulin resistant than Group D. However, patients with oligomenorrhea alternating with regular cycles, secondary amenorrhea, or polymenorrhea had comparable levels of markers of IR with Group D. Moreover, patients with oligomenorrhea alternating with regular cycles were less insulin resistant than patients with secondary amenorrhea alternating with regular cycles. Finally, patients with isolated polymenorrhea and those with polymenorrhea alternating with regular cycles had comparable levels of markers of IR with Group D. Conclusions: Amenorrhea is associated with more pronounced IR in PCOS, and oligomenorrhea portends a less excessive risk for IR than amenorrhea whereas polymenorrhea appears to be even more benign metabolically. Therefore, the type of menstrual cycle abnormality appears to represent a useful tool for identifying a more adverse metabolic profile in PCOS.

“…In any case, it seems that insulin resistance in PCOS is disproportionate to the degree of obesity; it should, however, be considered that it is invariably present in all obese women (39). Interestingly, it has been reported that ovulatory women with PCOS are less insulin-resistant than anovulatory PCOS ones (40). Obesity is known to increase androgen and insulin levels and, consequently, it is suggested that it may increase PCOS prevalence and exacerbate the clinical features of PCOS (41).…”

Section: Arguments In Favor Of the Definition Of Secondary Pcosmentioning

confidence: 99%

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

Pasquali

Diamanti-Kandarakis

Gambineri

2016

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).