Polycystic Ovary Syndrome PDF

Preface

More than a decade has passed since the first NIH conference on polycystic ovary syndrome was held in Washington, D.C., to discuss and codify this perplexing reproductive endocrinopathy. As anticipated, a variety of opinions were elicited from the participants, which reflected the broad clinical perspective underlying this disorder. Importantly, the meeting established some common understanding of the similarities and differences of opinion among those in attendance and underscored the need for further investigation. Since that time, substantial progress has been made in both basic and clinical investigation, which has widened the spectrum of the syndrome while, at the same time, raising more questions. In addition, it appears that direct and indirect consequences of this disorder extend to all phases of a woman's life.

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrinopathy of women in their childbearing years and is responsible for an estimated 70% of cases of anovulatory infertility. In addition to the clinical features of hyperandrogenism and chronic anovulation, many women are insulin resistant and at increased risk for type 2 diabetes. They may also be at increased risk for cardiovascular disease. The relationship between these metabolic effects and the etiology of PCOS has not been defined. Familial clustering of cases suggests a genetic component, but a clear mode of inheritance has not been delineated. It is also probable that an environmental component to the initiation and/or progression of PCOS exists. With the encouragement and support of the National Institutes of Environmental Health and Safety, a meeting of a multidisciplinary group of scientists—cellular and molecular biologists, endocrinologists, toxicologists, epidemiologists, and clinicians—was convened at Research Triangle Park, North Carolina, to disseminate the most up-to-date research on the etiology, mechanisms, and treatment of PCOS. The primary goal of this gathering was to identify data gaps and needs, future research directions, and new approaches and technologies that might possibly lead to a better understanding of this syndrome, as well as to improved intervention and prevention strategies. This book summarizes the proceedings of that meeting.

The book is divided into eight parts, which correspond to sessions of the meeting. Part I presents a historical perspective on PCOS. Part II, ‘‘Epidemiology of Polycystic Ovary Syndrome,'' covers cardiovascular epidemiology, puberty and adolescent PCOS, and long-term health consequences. Part III, ‘‘Reproductive Abnormalities,'' addresses ovarian structure/function correlates, ovarian imaging, altered steroidogenesis, adrenal abnormalities, and neuroendocrine dysfunction in PCOS. In Part IV, ‘‘Animal Models of Polycystic Ovary Syndrome,'' studies from various animal models and their relevance to PCOS are presented. Part V, ‘‘Metabolic Abnormalities and Their Relationship to Polycystic Ovary Syndrome,'' focuses on the relevance of obesity and the metabolic syndrome, abnormal insulin secretion and action, lipids and cardiovascular risk, and endothelial dysfunction in PCOS. Part VI, ‘‘Genetics and Environmental Influences,'' discusses the potential genetic/environmental influences on PCOS (such as genetic approaches and gene susceptibility, obesity, and environmental toxins). Part VII, ‘‘Intervention/Prevention Strategies,'' outlines therapeutic strategies, including manipulation of diet and lifestyle, metabolic phenotyping, treatment of hyperandrogenism, and treatment of insulin resistance. Finally, Part VIII summarizes the group discussion of diagnostic criteria.

Clearly, PCOS has become an important consideration for the health and well-being of women during all phases of life, and, as we advance our knowledge, the enormous complexity of this problem becomes increasingly apparent. Nevertheless, improved treatment alternatives continue to emerge with the hope of resolving and, for some, eliminating clinical symptomatology.

We are deeply appreciative of the generous educational grants from Organon, Ferring, Parke-Davis, and Bristol-Myers Squibb, without which the success of this conference would not have been possible.