Book Overview

It is now widely accepted that polycystic ovary syndrome (PCOS) is the most frequent endocrinopathy among women of reproductive age (Legro, 2013), especially after the extension of the diagnostic categories following the publication of the Rotterdam diagnostic criteria, the prevalence reaching as much as 20% in certain populations (Conway, 2014). In addition, the current data demonstrate that PCOS is not a condition limited to the reproductive age, its consequences being responsible for a significant part of morbidity and mortality in postmenopausal women (Shaw, 2008). PCOS is a complex disorder whose pathogenesis is incompletely elucidated at present, although many studies have evaluated this aspect suggesting an interconnection between genetic, hormonal and environmental factors, with a potential percentage dependent on the ethnicity. The public impact of this disease is reflected by the large number of internet sites dedicated to PCOS (15 millions) and to the costs involved in the diagnosis and treatment efforts (4 millions dollars annually in the US) (Azziz, 2005; Conway, 2014). Besides, the progress made in understanding this disease continues to require regular meetings of the experts, two of these meetings took place recently, namely the working meeting of the National Institute of Health (NIH) in December 2012 (Final Report National Institute of Health 2012) and the statement of the European Society of Endocrinology published in 2014 (Conway, 2014). Although more than 75 years have passed since the first description of the disease in 1935 by Stein and Leventhal (Leventhal & Stein, 1935), many aspects of PCOS continue to be debated, representing an extremely dynamic area of research. Thus, although initially described as a predominantly reproductive condition, PCOS has also turned out to be a condition with cardiometabolic implications as the studies of the past 25 years have demonstrated (Scicchitano, 2012; Moran, 2010). But it seems that cardio–metabolic risk is not similar in all PCOS patients, currently being intensely debated which is the profile of the patient at high risk and which are the determining risk factors. Although insulin resistance has been for a long time considered the central element in the pathogenesis of PCOS, being an intrinsic characteristic of the syndrome, now more and more studies show that it can be secondary to excessive or dysfunctional adiposity. But which are the determinants of this anomaly it is still debated, last years studies showing complex connections between the metabolic and hormonal parameters.Thus both thyroid stimulating hormone (TSH), prolactine and anti–Müllerian hormone (AMH) have recently been demonstrated to be associated with metabolic parameters in patients with PCOS and other population categories. The clarification of these aspects could lead to the identification of new cardiometabolic risk factors among the hormonal parameters already included in the routine evaluation of PCOS patients, having therefore the advantages of no additional cost.