PCOS Forum

Research in Polycystic Ovary Syndrome Today and Tomorrow

Renato Pasquali; Elisabet Stener-Victorin; Bulent O. Yildiz; Antoni J. Duleba; Kathleen Hoeger; Helen Mason; Roy Homburg; Theresa Hickey; Steve Franks; Juha S. Tapanainen; Adam Balen; David H. Abbott; Evanthia Diamanti-Kandarakis; Richard S. Legro

Disclosures

Clin Endocrinol. 2011;74(4):424-433. 

In This Article

Summary

Potential areas of further research activity include the analysis of predisposing conditions that increase the risk of PCOS, particularly genetic background and environmental factors, such as endocrine disruptors and diet.[78] In addition, defining alterations of steroidogenesis in PCOS needs to be re-examined to quantify ovarian, adrenal and extraglandular contribution, as well as a change in the blood androgen reference values because of the expanding use of mass spectrometry. Clearly identifying premenarchal and postmenopausal phenotypes of androgen excess and PCOS would significantly enhance our epidemiologic studies of natural history and intervention studies. Intraovarian regulation of follicle development and mechanisms of follicle arrest and the impact of metabolic abnormalities on these processes, as well as molecular mechanisms by which insulin excess regulates androgen secretion and metabolism and disrupts follicle development,[79] are other potential issues for investigation. Current information would suggest androgens alone may be necessary but not sufficient to cause follicular arrest, and it is likely that other inhibitors and nonsteroid-directed pathways are implicated in follicular arrest. Future studies should utilize both existing cell culture and animal models discussed earlier, but also utilize ovarian follicles grown and matured in 3-D matrices or created out of stem cells.

The concept that androgen excess may be responsible for the development of insulin resistance also needs to be re-examined, because studies performed in the last decade in experimental animals have supported the hypothesis that early exposure to modest androgen excess may favour the development of insulin resistance and enlarged visceral adiposity, although available data in humans are still sparse and controversial[80] and preliminary prospective data in humans seem to not support this hypothesis.[81] There have been a number of recent well-designed, adequately powered trials examining infertility treatment in women with PCOS. While this is a positive development, it is only a start. PCOS status is expected to lead to many long-term consequences in women, specifically the development of type 2 diabetes, CVDs and hormone-dependent cancers. Identifying susceptible individuals would help to individualize therapeutic and, possibly, preventive strategies.

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