Diagnosis, Pathogenesis and Management of Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine diseases occurs among women of childbearing age, which is affected by many factors, but its precise pathophysiology has not yet been determined. The heterogeneous of PCOS is reflected in its complex endocrine dysfunction of the hypothalamic-pituitarygonadal axis (HPG axis) and its multiple clinical features, such as obesity, insulin resistance, hyperandrogenism and anovulation. Meanwhile, women with PCOS also have an increased risk of major cardiovascular events, most notably type 2 diabetes, cardiovascular disease and atherosclerosis. So far, many therapies are available for improving reproductive and metabolic abnormalities in PCOS patients, in which lifestyle modification and insulin-sensitizing agents are more effective management strategies.

Involvement of Transcription Factor FoxO1 in the Pathogenesis of Polycystic Ovary Syndrome

“…The origin of PCOS is multifactorial with individual differences, such as abnormal ovarian steroid secretion, hyperinsulinemia, increased luteinizing hormone, and other aspects, which lead to complementary or synergistic effects, and affect the development of the disease ( Wang and Wang, 2017 ) and, therefore, the exact cause of PCOS is still unclear. Given the polymorphism of PCOS phenotype, it is considered to be a multi-gene-mediated disease ( Li et al, 2013 ; Barthelmess and Naz, 2014 ; Nandi et al, 2014 ; Wang and Wang, 2017 ).…”

“…The origin of PCOS is multifactorial with individual differences, such as abnormal ovarian steroid secretion, hyperinsulinemia, increased luteinizing hormone, and other aspects, which lead to complementary or synergistic effects, and affect the development of the disease ( Wang and Wang, 2017 ) and, therefore, the exact cause of PCOS is still unclear. Given the polymorphism of PCOS phenotype, it is considered to be a multi-gene-mediated disease ( Li et al, 2013 ; Barthelmess and Naz, 2014 ; Nandi et al, 2014 ; Wang and Wang, 2017 ). For example, PCOS has previously been related to insulin receptor (INSR) gene with racial differences ( Stewart et al, 2006 ; Wang et al, 2017a ; Lin et al, 2019 ), and the family history might be a potential risk factor for the incidence of PCOS ( Azziz and Kashar-Miller, 2000 ; Wang and Wang, 2017 ).…”

“…Given the polymorphism of PCOS phenotype, it is considered to be a multi-gene-mediated disease ( Li et al, 2013 ; Barthelmess and Naz, 2014 ; Nandi et al, 2014 ; Wang and Wang, 2017 ). For example, PCOS has previously been related to insulin receptor (INSR) gene with racial differences ( Stewart et al, 2006 ; Wang et al, 2017a ; Lin et al, 2019 ), and the family history might be a potential risk factor for the incidence of PCOS ( Azziz and Kashar-Miller, 2000 ; Wang and Wang, 2017 ). It has been also reported that visceral obesity, proinflammatory factors, hyperinsulinemia, and IR are likely associated with the occurrence of PCOS ( Wang et al, 2015 , 2017b ; Hughan et al, 2016 ; Zhang et al, 2019 ).…”

“…Polycystic ovary syndrome patients with hyperinsulinemia or IR are not dependent on obesity, body fat distribution, and androgen levels, and the risk of impaired glucose tolerance and type 2 diabetes mellitus is higher in these patients than the normal individuals ( Nandi et al, 2014 ). The high androgen level and occurrence of IR in PCOS patients might be related to the continuous release of inflammatory factors from adipose tissue ( Barthelmess and Naz, 2014 ; Wang and Wang, 2017 ; Cirillo et al, 2019a ; Barber and Franks, 2021 ). A large number of studies have demonstrated a role of inflammation in the pathogenesis of PCOS ( Alikhani et al, 2007 ), and the association of increased inflammatory markers, such as C reactive protein (CRP), ferritin, tumor necrosis factor (TNF) alpha, interleukin-6 (IL-6), and interleukin-18 (IL-18) with the occurrence of PCOS ( González et al, 2006 , 2007 , 2012 ).…”

“…At present, the incidence rate of polycystic ovary syndrome (PCOS) is about 5.6% among women of reproductive age (19–45 years) in Chinese Han population based on a large community-based study ( Li et al, 2013 ), but the specific mechanism underlying the pathogenesis of PCOS is still unclear. Apart from polycystic ovaries, hyperandrogenism, and ovulatory disorders, PCOS is often accompanied by insulin resistance (IR), low-grade chronic inflammatory response, obesity, abnormal lipid metabolism, and long-term complications, such as hypertension, type 2 diabetes, and endometrial cancer ( Li et al, 2013 ; Barthelmess and Naz, 2014 ; Nandi et al, 2014 ; Wang et al, 2015 , 2017a , b ; Wang and Wang, 2017 ; Lin et al, 2019 ; Zhang et al, 2019 ).…”