One of the reasons that progress has been slow and controversy abundant in this field has been the lack of recognition of the heterogeneity of the syndrome. The phenotypic variety of PCOS relates to genetic and biochemical differences, compounded by environmental and even developmental factors. The clinical expression of the disease represents the final common pathway of these derangements. This more encompassing view of PCOS, as well as its origin, was recently explored and described. It is likely that this heterogeneity will be addressed more effectively and seriously in the next few years. For example, clinical trials will target specific populations and more efforts will be made to understand the genetic, biochemical, environmental and developmental determinants of the disease in a given patient. In light of the epidemic of adolescent and childhood obesity, management of PCOS in this age group will assume greater importance. More efforts will be made to delineate cardiovascular risk individually. Clinically useful markers of this risk will be further developed and tested in this patient population, as will changes in risk markers with treatment. As we approach the 75th anniversary of the early observations of Stein and Leventhal, these efforts will probably be well underway and progress is inevitable.
Shahla Nader, Professor, Departments of Obstetrics and Gynecology and Internal Medicine (Endocrinology), University of Texas Medical School-Houston, 6431 Fannin Street, Suite 3604, Houston, TX 77030, USA, Tel.: +1 713 500 6387 Fax.: +1 713 500 0508; E-mail: firstname.lastname@example.org
Expert Rev Endocrinol Metab. 2008;3(3):349-359. © 2008 Future Drugs Ltd.
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