Obesity and the polycystic ovary syndrome

被引:530
作者
Gambineri, A [1 ]
Pelusi, C [1 ]
Vicennati, V [1 ]
Pagotto, U [1 ]
Pasquali, R [1 ]
机构
[1] Univ Alma Mater Studiorum, S Orsola Malpighi Hosp, Dept Internal Med, Endocrinol Unit, Bologna, Italy
关键词
obesity; polycystic ovary syndrome; hyperandrogenism; metabolic syndrome;
D O I
10.1038/sj.ijo.0801994
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The polycystic ovary syndrome (PCOS) is a condition characterized by hyperandrogenism and chronic oligo-anovulation. However, many features of the metabolic syndrome are inconsistently present in the majority of women with PCOS. Approximately 50% of PCOS women are overweight or obese and most of them have the abdominal phenotype. Obesity may play a pathogenetic role in the development of the syndrome in susceptible individuals. In fact, insulin possesses true gonadotrophic function and an increased insulin availability at the level of ovarian tissue may favour excess androgen synthesis. Obesity, particularly the abdominal phenotype, may be partly responsible for insulin resistance and associated hyperinsulinemia in women with PCOS. Therefore, obesity-related hyperinsulinemia may play a key role in favouring hyperandrogenism in these women. Other factors such as increased estrogen production rate, increased activity of the opioid system and of the hypothalamic-pituitary-ad renal axis, decreased sex hormone binding globulin synthesis and, possibly, high dietary lipid intake, may be additional mechanisms by which obesity favours the development of hyperandrogenism in PCOS. Irrespective of the pathogenetic mechanism involved, obese PCOS women have more severe hyperandrogenism and related clinical features (such as hirsutism, menstrual abnormalities and anovulation) than normal-weight PCOS women. This picture tends to be more pronounced in obese PCOS women with the abdominal phenotype. Body weight loss is associated with beneficial effects on hormones, metabolism and clinical features. A further clinical and endocrinological improvement can also be achieved by adding insulin-sensitizing agents and/or antiandrogens to weight reduction programmes. These obviously emphasize the role of obesity in the pathophysiology of PCOS.
引用
收藏
页码:883 / 896
页数:14
相关论文
共 111 条
[1]   Drug therapy - Metformin [J].
Bailey, CJ ;
Turner, RC .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (09) :574-579
[2]   The pathogenesis of polycystic ovary syndrome: Lessons from ovarian stimulation studies [J].
Barnes, RB .
JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 1998, 21 (09) :567-579
[3]   Insulin stimulates both leptin secretion and production by rat white adipose tissue [J].
Barr, VA ;
Malide, D ;
Zarnowski, MJ ;
Taylor, SI ;
Cushman, SW .
ENDOCRINOLOGY, 1997, 138 (10) :4463-4472
[4]  
Bjorntorp P, 1996, INT J OBESITY, V20, P291
[5]   METABOLIC IMPLICATIONS OF BODY-FAT DISTRIBUTION [J].
BJORNTORP, P .
DIABETES CARE, 1991, 14 (12) :1132-1143
[6]   EFFECT OF INSULIN ON THE HEPATIC PRODUCTION OF INSULIN-LIKE GROWTH FACTOR-BINDING PROTEIN-1 (IGFBP-1), IGFBP-3, AND IGF-I IN INSULIN-DEPENDENT DIABETES [J].
BRISMAR, K ;
FERNQVISTFORBES, E ;
WAHREN, J ;
HALL, K .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1994, 79 (03) :872-878
[7]   EVIDENCE FOR A DEFECT IN INSULIN METABOLISM IN HYPERANDROGENIC WOMEN WITH POLYCYSTIC OVARIAN SYNDROME [J].
BUFFINGTON, CK ;
KITABCHI, AE .
METABOLISM-CLINICAL AND EXPERIMENTAL, 1994, 43 (11) :1367-1372
[8]   CLINICAL REVIEW .26. INSULIN RESISTANCE IN OBESE AND NONOBESE MAN [J].
CARO, JF .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1991, 73 (04) :691-695
[9]   Cellular insulin resistance in adipocytes from obese polycystic ovary syndrome subjects involves adenosine modulation of insulin sensitivity [J].
Ciaraldi, TP ;
Morales, AJ ;
Hickman, MG ;
OdomFord, R ;
Olefsky, JM ;
Yen, SSC .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1997, 82 (05) :1421-1425
[10]   CELLULAR MECHANISMS OF INSULIN RESISTANCE IN POLYCYSTIC OVARIAN SYNDROME [J].
CIARALDI, TP ;
ELROEIY, A ;
MADAR, Z ;
REICHART, D ;
OLEFSKY, JM ;
YEN, SSC .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1992, 75 (02) :577-583