Keywords
Polycystic ovaries syndrome
functional ovarian hyperandrogenism
function adrenal hyperandrogenism
pituitary gonadotrophins
infertility
functional ovarian hyperandrogenism
function adrenal hyperandrogenism
pituitary gonadotrophins
infertility
How to Cite
Orrego, A. (2019). Updated Approach to the Pathophysiology, Classification and Genetics of Polycystic Ovarian Syndrome. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(2), 101–106. https://doi.org/10.53853/encr.6.2.484
Abstract
Polycystic ovary syndrome (PCOS) seems to arise as a complex trait that results from the interaction of diverse genetic and environmental factors. One of main hypothesis is that PCOS result from functional ovarian hyperandrogenism (FOH) due to dysregulation of androgen secretion. There is a contribution of adrenal androgens like DHEA, that are metabolized in the ovary to androstenedione and the testosterone. Heritable factors include PCOM, hyperandrogenemia, insulin resistance, and insulin secretory defects. Environmental factors include prenatal androgen exposure and poor fetal growth, whereas acquired obesity is a major postnatal factor. A metabolic syndrome of obesity-related and/or intrinsic insulin resistance occurs in about half of PCOS patients, and the compensatory hyperinsulinism has tissue-selective effects, which include aggravation off hyperandrogenism. The variety of pathways involved and lack of a common thread attests to the multifactorial nature and heterogeneity of the syndrome. Knowing the fundamental basis of the disorder is necessary to optimally correct androgen levels, ovulation, and metabolic homeostasis, and solve the Ob & Gyn problems as well.
References
1. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005; 352: 1223-1236.
2. Lauritsen MP, Bentzen JG,Pinborg A, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Millerian hormone. Hum Reprod. 2014:29:791-801.
3. Stein IF, Leventhal MI. Amcnorrhea associated with bilateral polycistic ovaries. Am J Obstet Gynecol. 1935;29:181-191.
4. Azziz R, Adashi E Y. Stein and Leventhal: 80 years on. Am J Obstet gynecol. 1935; 29: 181-191.
5. Goldzieher MW, Green JA, The Polycystic Ovary. I. Clinical and histologic features. J Clin Endocrinol Metab. 1962;22:325-338.
6. Mcarthur JW, Ingersoll FM, Worcester J. The urinary excretion of intersticial-cell and follicle-stimulating hormone activity by women with disease of the repoductive system. J Clin Endocrinol Metab. 1958;18:1202-1215.
7. Yen SS, Vela P, Rankin J. Inappropiate secretion of follicle-stimulating hormone in polycystic ovarian disease. J Clin Endocrinol Metab. 1970;30:435-442.
8. Rosenfield RL, Ehrlich EN,Cleary R.Adrenal and ovarian contribution to the elevated free plasma androgens levels in hirsute women. J Clin Endocrinol Metab. 1972;34:92-98.
9. Futterweit W, Deligdisch L, Histopathological of effects exogenously administered testoterone in 19 female to male transsexuals.J Clin Endocrinol Metab 1986;62:16-21.
10. Franks S. Polycystic ovary syndrome: a changing perspective. Clin Endocrinol. 1989;31:87-120.
11. Hernandez ER, Resnick CE, Holtzclaw WD, et al. Insulin as a regulator of androgens biosynthesis by cultured rat ovarian cells: celular mechanism (s) underlying physiological pharmacological hormonal actions Endocrinology. 1988;122:2034
12. Cara JF, Rosenfield RL, Insulinlike growth factor 1 and insulin potentiate luteinizing hormone-Induced androgen synthesis by rat ovarian theca-intersticial cells. Endocrinology. 1998;123:733-739.
13. Barnes RB, Rosenfield RI, Bursteins S, et al. Pituitary-ovarian responses to nafarelin testing in the polycystic ovary syndrome. N Engl Med 1989;320:559-565.
14. Ronsenfield RL, Ehrman AD. The pathogenesis of polycystic ovary syndromre (PCOS): the hypothesis of PCOS as funcional ovary hyperandrogenism revisited. Endocrine Review. 2016;37:467-520.
15. Zawadzki J,Dunaif A. Diagnostic criteria for polycystic ovary syndrome: toward a rational approach. In Dunaif A,Givens J, Haseltine F, et al. Polycystic ovary syndrome. Cambridge, MA; Blackwell Scientific Publications. 1992:377-384.
16. Balen AH, Laven JS, Tan SL, et al. Ultrasound assessment of the polycystic ovary. International Consensus Definitions. Hum Reprod uptodate. 2003:9;505-514.
17. Rotterdam. ESHRE/ASRM- Sponsored PCOS Consensus Workshop Group. Revised 2003 consesus on diagnostic criteria and long-term health risks related to polycystic ovary síndrome. Fertil Steril 2004,81:29-25
18. Azziz R, Carmina E, Dewaily D, et al. The androgen excess and PCOS Society criteria for the polycytic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456- 488.
19. Rosenfield RL. The polycystic ovary sundrome spectrum. J pediatr Adolesc Gynecol. 201;28:412-419.
20. Martin KA, Chang RJ, Ehrmann DA, et al.Evaluation and treatment of hirsutism in premenopausal women. An Endocrine Society Clinical Practice Guideline. J Clin Endocrin Metab. 2008;93:1105-1120.
21. Lauritsen MP, Pinborg A,Loft et al. Revised Criteria for PCOS in WHO Group II anovulatory infertility-a revival of hypothalamic amenorrea?. Clin Endocrinol.2015;82:584-591.
22. Burger HG, Hale GE, Robertson DM. et al. A review of hormonal changes during the menopausal transition: focus of finding from the Melbourne Women`s Midlife health project. Hum Reprod uptodate. 2007;13:59-565.
23. Fauser BC, Tarlatzis BC,RW, et al. Consersus on Women`s health aspect of polycysctic ovary syndrome (PCOS): the Amsterdam ESHRE/ARM. Sponsored 3rd PCOS consensus Workshop Group. Fertil Steril. 2012;87:28-38-e25.
24. Miller WL, Auchus RJ. The molecular biology, biochemistry and physiology of human steroidogenesis and its disorders. Endocr Rev. 2011;32:81-151.
25. Dorfman RI, Forchielli, Gut M. Androgens biosynthesis and related studies. Rec Prog Horm Res. 1963;19:251-273.
26. Axelrod LR, Goldzieher JW. The polycystic ovary III.Steroid bosynthesis in nomal and polycystic ovarian tissue. J Clin Endocrinol. 1962;22;431-440.
27. Nelson VL, Qin KN, Rosenfield RL, et al. The bochemical basis for increased testosterona production in theca cell propagated from patients with polycystic ovary syndrome. J Clin Endocrinol Metab.1988;67:379-383.
28. Prizant H,Glincher N, Sen A. Androgens actions in the ovary: Balance is key. J Endocrinol. 2014,222:R141-R151.
29. Hirschfeld-Cytron, Barnes RB, Ehrmann DA, et al. Characterization of funcionally typical and atypical types of polycystic ovary syndrome. J Clin Endocrinal Metab. 2009;94:1587- 1594.
30. McCartney CR, Bellows AB, Grindrich MK, et al. Exagerated 17-Hidroxyprogesterone response to intravenous infusión of recombinant human LH in women with polycystic ovary syndrome. Am J Physiol Endocrinol Metab. 2004;286:E902-E908.
31. Ronsenfield RL. Polycistic ovary syndrome and insulin-resistance hyperinsulinemia. J Am Acad Dermatol. 2001;45:S095-S104.
2. Lauritsen MP, Bentzen JG,Pinborg A, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Millerian hormone. Hum Reprod. 2014:29:791-801.
3. Stein IF, Leventhal MI. Amcnorrhea associated with bilateral polycistic ovaries. Am J Obstet Gynecol. 1935;29:181-191.
4. Azziz R, Adashi E Y. Stein and Leventhal: 80 years on. Am J Obstet gynecol. 1935; 29: 181-191.
5. Goldzieher MW, Green JA, The Polycystic Ovary. I. Clinical and histologic features. J Clin Endocrinol Metab. 1962;22:325-338.
6. Mcarthur JW, Ingersoll FM, Worcester J. The urinary excretion of intersticial-cell and follicle-stimulating hormone activity by women with disease of the repoductive system. J Clin Endocrinol Metab. 1958;18:1202-1215.
7. Yen SS, Vela P, Rankin J. Inappropiate secretion of follicle-stimulating hormone in polycystic ovarian disease. J Clin Endocrinol Metab. 1970;30:435-442.
8. Rosenfield RL, Ehrlich EN,Cleary R.Adrenal and ovarian contribution to the elevated free plasma androgens levels in hirsute women. J Clin Endocrinol Metab. 1972;34:92-98.
9. Futterweit W, Deligdisch L, Histopathological of effects exogenously administered testoterone in 19 female to male transsexuals.J Clin Endocrinol Metab 1986;62:16-21.
10. Franks S. Polycystic ovary syndrome: a changing perspective. Clin Endocrinol. 1989;31:87-120.
11. Hernandez ER, Resnick CE, Holtzclaw WD, et al. Insulin as a regulator of androgens biosynthesis by cultured rat ovarian cells: celular mechanism (s) underlying physiological pharmacological hormonal actions Endocrinology. 1988;122:2034
12. Cara JF, Rosenfield RL, Insulinlike growth factor 1 and insulin potentiate luteinizing hormone-Induced androgen synthesis by rat ovarian theca-intersticial cells. Endocrinology. 1998;123:733-739.
13. Barnes RB, Rosenfield RI, Bursteins S, et al. Pituitary-ovarian responses to nafarelin testing in the polycystic ovary syndrome. N Engl Med 1989;320:559-565.
14. Ronsenfield RL, Ehrman AD. The pathogenesis of polycystic ovary syndromre (PCOS): the hypothesis of PCOS as funcional ovary hyperandrogenism revisited. Endocrine Review. 2016;37:467-520.
15. Zawadzki J,Dunaif A. Diagnostic criteria for polycystic ovary syndrome: toward a rational approach. In Dunaif A,Givens J, Haseltine F, et al. Polycystic ovary syndrome. Cambridge, MA; Blackwell Scientific Publications. 1992:377-384.
16. Balen AH, Laven JS, Tan SL, et al. Ultrasound assessment of the polycystic ovary. International Consensus Definitions. Hum Reprod uptodate. 2003:9;505-514.
17. Rotterdam. ESHRE/ASRM- Sponsored PCOS Consensus Workshop Group. Revised 2003 consesus on diagnostic criteria and long-term health risks related to polycystic ovary síndrome. Fertil Steril 2004,81:29-25
18. Azziz R, Carmina E, Dewaily D, et al. The androgen excess and PCOS Society criteria for the polycytic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456- 488.
19. Rosenfield RL. The polycystic ovary sundrome spectrum. J pediatr Adolesc Gynecol. 201;28:412-419.
20. Martin KA, Chang RJ, Ehrmann DA, et al.Evaluation and treatment of hirsutism in premenopausal women. An Endocrine Society Clinical Practice Guideline. J Clin Endocrin Metab. 2008;93:1105-1120.
21. Lauritsen MP, Pinborg A,Loft et al. Revised Criteria for PCOS in WHO Group II anovulatory infertility-a revival of hypothalamic amenorrea?. Clin Endocrinol.2015;82:584-591.
22. Burger HG, Hale GE, Robertson DM. et al. A review of hormonal changes during the menopausal transition: focus of finding from the Melbourne Women`s Midlife health project. Hum Reprod uptodate. 2007;13:59-565.
23. Fauser BC, Tarlatzis BC,RW, et al. Consersus on Women`s health aspect of polycysctic ovary syndrome (PCOS): the Amsterdam ESHRE/ARM. Sponsored 3rd PCOS consensus Workshop Group. Fertil Steril. 2012;87:28-38-e25.
24. Miller WL, Auchus RJ. The molecular biology, biochemistry and physiology of human steroidogenesis and its disorders. Endocr Rev. 2011;32:81-151.
25. Dorfman RI, Forchielli, Gut M. Androgens biosynthesis and related studies. Rec Prog Horm Res. 1963;19:251-273.
26. Axelrod LR, Goldzieher JW. The polycystic ovary III.Steroid bosynthesis in nomal and polycystic ovarian tissue. J Clin Endocrinol. 1962;22;431-440.
27. Nelson VL, Qin KN, Rosenfield RL, et al. The bochemical basis for increased testosterona production in theca cell propagated from patients with polycystic ovary syndrome. J Clin Endocrinol Metab.1988;67:379-383.
28. Prizant H,Glincher N, Sen A. Androgens actions in the ovary: Balance is key. J Endocrinol. 2014,222:R141-R151.
29. Hirschfeld-Cytron, Barnes RB, Ehrmann DA, et al. Characterization of funcionally typical and atypical types of polycystic ovary syndrome. J Clin Endocrinal Metab. 2009;94:1587- 1594.
30. McCartney CR, Bellows AB, Grindrich MK, et al. Exagerated 17-Hidroxyprogesterone response to intravenous infusión of recombinant human LH in women with polycystic ovary syndrome. Am J Physiol Endocrinol Metab. 2004;286:E902-E908.
31. Ronsenfield RL. Polycistic ovary syndrome and insulin-resistance hyperinsulinemia. J Am Acad Dermatol. 2001;45:S095-S104.
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