Women with PCOS may be characterized by an increased production rate of adrenal androgens, particularly DHEA, while cortisol production rates seem to be normal, unless obesity is present. The activity of the HPA axis as well as peripheral cortisol metabolism may also be affected in women with PCOS, although the presence of obesity appears to play a key role in explaining these associations. The role of insulin in the regulation of enzymes involved in adrenal steroidogenesis has been postulated, although much remains to be investigated, since not all women with PCOS show evidence of altered adrenal steroidogenesis. Finally, given the high prevalence of psychopathological traits in obesity, much more information should be obtained on the role of chronic stress exposure and hyperfunction of the HPA axis in women with PCOS.
Expert Rev Endocrinol Metab. 2012;7(5):555-566. © 2012 Expert Reviews Ltd.