Pathogenesis of PCOS: From Metabolic and Neuroendocrine Implications to the Choice of the Therapeutic Strategy

Prati, Alessia; Genazzani, Andrea R.; Genazzani, Alessandro D.

doi:10.1007/978-3-030-63650-0_5

Cited by 3 publications

(12 citation statements)

References 63 publications

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“…While Estradiol levels are low or normal, plasma levels of Estrone, a weak estrogen, are increased because of peripheral conversion of Androstenedione by aromatase activity, mainly at the adipose tissue level, with the reversal of estrone/estradiol ratio. This hyperestrogenic state might predispose to endometrial proliferation and increased risk for endometrial cancer [ 17 ].…”

Section: Endocrine Profile Of Pcosmentioning

confidence: 99%

“…Obesity and insulin resistance (IR) negatively impact the fertility of PCOS women, since together, these factors decrease the number of spontaneous ovulatory cycles and raise the percentage of spontaneous abortions. For this reason, the first line of treatment for PCOS patients is a correct lifestyle through hypocaloric diet and physical exercise (20–60 min of physical activity a day, from 3 to 5 times a week), in particular in women with BMI > 25 kg/m 2 [ 17 ].…”

Section: Pharmacological Therapiesmentioning

confidence: 99%

“…Therapy should be initiated with a starting dose of 250 mg twice a day (15 min before lunch and dinner), which can be increased up to 500–1000 mg after 15 days with a gradual increase in dosage to avoid common gastrointestinal side effects [ 17 ].…”

Section: Pharmacological Therapiesmentioning

confidence: 99%

“…Letrozole, an aromatase inhibitor, is used as an alternative to Clomiphene, especially in Clomiphene-resistant women. It is even more effective than Clomiphene but it is burdened by important side effects, and in Italy it is used off-label [ 17 ].…”

Section: Pharmacological Therapiesmentioning

confidence: 99%

“…Considering the relevant role of inositols in promoting glucose uptake, glucose oxidative use, and glycogen storage, their concentrations and functions are essential for the maintenance of the glycemic homeostasis, acting like insulin sensitizers [ 17 ].…”

Section: Complementary/integrative Treatmentsmentioning

confidence: 99%

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Putative Complementary Compounds to Counteract Insulin-Resistance in PCOS Patients

et al. 2022

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Polycystic ovary syndrome (PCOS) is the most frequent endocrine-metabolic disorder among women at reproductive age. The diagnosis is based on the presence of at least two out of three criteria of the Rotterdam criteria (2003). In the last decades, the dysmetabolic aspect of insulin resistance and compensatory hyperinsulinemia have been taken into account as the additional key features in the etiopathology of PCOS, and they have been widely studied. Since PCOS is a complex and multifactorial syndrome with different clinical manifestations, it is difficult to find the gold standard treatment. Therefore, a great variety of integrative treatments have been reported to counteract insulin resistance. PCOS patients need a tailored therapeutic strategy, according to the patient’s BMI, the presence or absence of familiar predisposition to diabetes, and the patient’s desire to achieve pregnancy or not. The present review analyzes and discloses the main clinical insight of such complementary substances.

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Section: Endocrine Profile Of Pcosmentioning

confidence: 99%

Section: Pharmacological Therapiesmentioning

confidence: 99%

Section: Pharmacological Therapiesmentioning

confidence: 99%

Section: Pharmacological Therapiesmentioning

confidence: 99%

Section: Complementary/integrative Treatmentsmentioning

confidence: 99%

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Putative Complementary Compounds to Counteract Insulin-Resistance in PCOS Patients

et al. 2022

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Alpha lipoic acid administration improved both peripheral sensitivity to insulin and liver clearance of insulin reducing potential risk of diabetes and nonalcoholic fatty liver disease in overweight/obese PCOS patients

Genazzani,

Battipaglia,

Rusce

et al. 2024

Gynecological Endocrinology

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Familial Diabetes in Obese PCOS Predisposes Individuals to Compensatory Hyperinsulinemia and Insulin Resistance (IR) Also for Reduced Hepatic Insulin Extraction (HIE)

et al. 2022

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Background: Polycystic ovary syndrome (PCOS) is a frequent reproductive disease characterized by hyperandrogenism, oligo /anovulation, and polycystic aspects at ultrasound. In these last years, a body of evidence disclosed the frequent occurrence in PCOS patients of insulin resistance (IR) and compensatory hyperinsulinemia. Aim: To evaluate whether any relationship exists between IR, compensatory hyperinsulinemia and familial predisposition to diabetes. Methods: A group of overweight/obese PCOS patients (n = 84) was selected from our Clinic database according to the Rotterdam criteria and the following parameters were extracted from the database: insulin, C Peptide, aspartate amino transferase (AST), alanine amino transferase (ALT), HOMA (Homeostasis Model Assessment) index, total cholesterol, LDL (Low Density Lypoprotein), HDL (High Density Lypoprotein), and body mass index (BMI). The presence and absence of diabetes among first grade relatives (parents and/or grandparents) were also considered. The Hepatic Insulin Extraction (HIE) index was computed as a ratio between insulin and C-Peptide plasma levels. Results: PCOS patients with familial diabetes showed higher levels of ALT, AST, HOMA index, and HIE. Baseline insulin levels above 12 μU/mL were more frequently observed in PCOS with familial diabetes. HIE index, ALT, and AST were higher in these latter PCOS patients than in PCOS without diabetic first grade relatives, sustaining the hypothesis of an impaired liver clearance of insulin in the case of familial diabetes. Conclusions: According to our study, the presence of anamnestic evidence of familial diabetes together with baseline levels of insulin higher that 12 µIU/mL and elevated transaminase levels should be considered as a consistent clinical suspect of liver impairment that might trigger compensatory hyperinsulinemia and lead to NAFLD and liver steatosis.

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Pathogenesis of PCOS: From Metabolic and Neuroendocrine Implications to the Choice of the Therapeutic Strategy

Cited by 3 publications

References 63 publications

Putative Complementary Compounds to Counteract Insulin-Resistance in PCOS Patients

Putative Complementary Compounds to Counteract Insulin-Resistance in PCOS Patients

Alpha lipoic acid administration improved both peripheral sensitivity to insulin and liver clearance of insulin reducing potential risk of diabetes and nonalcoholic fatty liver disease in overweight/obese PCOS patients

Familial Diabetes in Obese PCOS Predisposes Individuals to Compensatory Hyperinsulinemia and Insulin Resistance (IR) Also for Reduced Hepatic Insulin Extraction (HIE)

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