Abstract
Polycystic ovary syndrome is characterized by excess levels of circulating androgens
and by chronic anovulation. Although the fundamental pathophysiologic defect has not
been determined, women with polycystic ovary syndrome are known to be uniquely insulin
resistant. Obesity in polycystic ovary syndrome aggravates the underlying predisposition
towards insulin resistance. Diagnostic criteria that focus on menstrual irregularity
are more likely to discriminate insulin-resistant women than are such criteria as
abnormal gonadotropin secretion or ovarian morphologic characteristics. About 40%
of patients with polycystic ovary syndrome demonstrate glucose intolerance (either
impaired glucose tolerance or type 2 diabetes) in response to an oral glucose challenge.
The lack of a clear causal mechanism in the syndrome has led to a multitude of symptom-oriented
treatments, with few therapies improving all aspects of the endocrine abnormalities
associated with polycystic ovary syndrome. Many of these therapies—such as ovulation
induction with medical agents—hold increased risks for women with polycystic ovary
syndrome, including ovarian hyperstimulation syndrome and multiple gestation. Empirical
studies of interventions that improve insulin sensitivity in polycystic ovary syndrome
(either weight loss and diet programs or pharmaceutical agents) have been shown to
improve the endocrine abnormalities in the syndrome. Initial results with antidiabetic
agents (specifically insulin-sensitizing agents) are promising but need to be confirmed
with larger, randomized studies. (Am J Obstet Gynecol 1998;179:S101-8.)
Keywords
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Article info
Footnotes
☆Supported by Public Health Service grant K08 HDO118; The National Center for Infertility Research at University of Pennsylvania, Brigham and Women’s Hospital, University of California at San Francisco, Pennsylvania State University grant U54 HD 34449; General Clinical Research Center grant MO1 RR 10732 to Pennsylvania State University, and a grant from the Center for Research on Women and Newborn Health, Lancaster Pa.
☆☆Reprint requests: Richard S. Legro, MD, Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, M.S. Hershey Medical Center, 500 University Dr, Room C3608, Hershey, PA 17033.
★0002-9378/98 $5.00 + 06/0/94974
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Copyright
© 1998 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
