Further investigation of the adrenal participation in determining the hyperandrogenic state in PCOS should be performed. Whether this is due to a specific alteration of enzymes involved in adrenal steroidogenesis or in some alteration of the HPA axis activity should be clearly defined. Furthermore, while available data support the concept that insulin excess may play a role in the dysregulation of both adrenal and ovarian enzymes directly responsible for androgen production and/or their metabolism in both the adrenals and extradrenal compartments, much more remains to be investigated, since not all women with PCOS have 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. This appears to be particularly interesting in the presence of obesity and its different phenotypes.
Expert Rev Endocrinol Metab. 2012;7(5):555-566. © 2012 Expert Reviews Ltd.