The polycystic ovary syndrome. A position statement from the European Society of Endocrinology

Gerard Conway, Didier Dewailly, Evanthia Diamanti-Kandarakis

Abstract


Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject.

The NIH Experts Panel recommended the maintenance of the broad diagnostic criteria of Rotterdam, but focused on the need for specific identification of the phenotype of each patient. Four different phenotypes of PCOS are now identified: 1) hyperandrogenism (clinical or biochemical) and CA (H-CA); 2) hyperandrogenism and polycystic ovaries on ultrasound (PCOm) but with ovulatory cycles (H-PCOm); 3) CA and polycystic ovaries without hyperandrogenism (CA-PCOm); and, finally, 4) hyperandrogenism, CA and polycystic ovaries (H-CA-PCOm). This paper offers a critical endocrine on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient’s needs.


Keywords


polycystic ovary syndrome; hyperandrogenism; insulin resistance; obesity; European Society of Endocrinology

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DOI: http://dx.doi.org/10.18370/2309-4117.2015.25.32-52

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