Debates regarding lean patients with polycystic ovary syndrome: A narrative review

Abstract

Polycystic ovary syndrome (PCOS) is a complex syndrome showing the clinical features of an endocrine/metabolic disorder, including hyperinsulinemia and hyperandrogenism. Two phenotypes are present, either lean or obese, with different biochemical, hormonal, and metabolic profiles. Evidence suggests many treatment modalities that can be applied. However, many of these modalities were found to be not suitable for the lean phenotype of PCOS. Much contradictory research was found regarding lean patients with PCOS. The aim of this narrative review is to shed light on the debate prevailing regarding characteristics, as well as metabolic, hematological, and potential management modalities. Literature review was performed from January 1, 2000 to March 31, 2017 with specific word search such as lean PCOS, hormonal abnormalities in lean PCOS, and the management of lean PCOS. All retrieved articles were carefully assessed, and data were obtained. We could conclude that the debate is still prevailing regarding this specific lean population with PCOS, especially with regard to their characteristics and management modalities. Further studies are still required to resolve this debate on the presence of PCOS in lean women.

Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis

“…This spectrum, however, aligns with the known pathophysiology of PCOS and is bolstered by our genetic association findings. Our approach, therefore, appears to be a more reliable way of identifying subgroups of PCOS cases who have been noted in the literature [91] but have previously been defined using only a single trait like BMI [92][93][94][95] or by diagnostic criteria that do not reflect the genetic heterogeneity of the disorder [22]. Perhaps future studies that use clustering to identify reproductive and metabolic subtypes in PCOS can omit nondistinguishing traits such as DHEAS and T in an effort to reduce noise and improve subtype delineation and reproducibility.…”

Meta-analysis of gene expression profiles of lean and obese PCOS to identify differentially regulated pathways and risk of comorbidities

“…Metabolic syndrome, which is a constellation of conditions such as hypertension, abdominal obesity, insulin resistance and hypercholesterolemia, is commonly seen in women with obesity and PCOS [8] , [9] . Dyslipidemia and insulin resistance are more pronounced in obese PCOS as compared to lean PCOS; suggestive of dissimilar metabolic profiles in these phenotypes [4] , [10] , [11] , [12] . For the same reason, the incidence of acanthosis nigricans and impaired lipid profiles and glucose tolerance, which are indicators of insulin resistance, are more widespread in obese PCOS [13] .…”

Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non- Obese Women

“…PCOS is associated with obesity and insulin resistance. On the other hand, there is a growing population of thin slim women having PCOS as well ( 14 ).…”