Polycystic ovary syndrome (PCOS) trilogy: a translational and clinical review

Abstract

Summary Although PCOS is the focus of intense research, the importance ofthe translation and application of this research to the clinical settingcannot be underestimated. The PCOS SIG’s annual meetingshowcased three different aspects of the disease, with the overall aimof encouraging interdisciplinary collaboration and networking inthis important area.PCOS is one of the most common conditions in women ofchildbearing age, and is the most common cause of hyperandrogenismin this cohort. Dr Mason detailed the factors implicated in the causeof the ovulatory dysfunction in PCOS. It is clear that there are dif-ferences in the production of many of the paracrine signallinghormones between normal and polycystic ovaries. Although subtlechanges can be observed in the inhibin/activin family it is difficultto assess the in vivo impact of such changes on follicle growth.Likewise, there are clearly alterations in the IGF/IGFBP system andin the production of various androgenic and other steroids andwhereas these are not without interest, it is impossible to determinewhether they reflect defective follicle function or cause it. It canhowever, be seen that the changes in testosterone and andro-stenedione are considerable and intrinsic and are likely candidatesfor disrupting folliculogenesis in the early stages. It is the sheermagnitude of the increase in AMH production that differentiates itfrom other factors and underlines the likelihood that this will proveto be an important factor in the pathogenesis of PCOS.Professor Colao detailed the CVR factors present in PCOS.However, it was noted that there is a paucity both of long-term datafor well-characterized women with PCOS, and for large-scaleprospective clinical trials to determine the outcome morbidity andmortality of CVD in PCOS subjects. Furthermore, the link betweenPCOS and primary cardiovascular events has not yet been demonstrated.Professor Blume-Peytavi urged that the impact of the dermato-logical manifestations of this disorder should not be underestimated,describing how many women find these symptoms extremelydebilitating, affecting many aspects of their lives. For patientssuffering from PCOS, treatment options include reduction of androgenproduction and action, lifestyle modification, oral contraceptives,antiandrogens, and insulin-sensitizing agents as well as topicaltreatment of acne, seborrhoea and AGA. Local management ofhirsutism should also include photoepilation combined witheflornithine cream.