Reconsidering PCOS Etiology, Diagnosis, Clinical Subgroups, and Subgroup-Specific Treatments

January 2024 in “ Endocrine and metabolic science ”

Vittorio Unfer, Eleni Kandaraki, Lali Pkhaladze, Scott Roseff, Mónica H. Vazquez‐Levin, Antonio Simone Laganà, C. Shiao-Yng, Maria Isidora Margarita Yap‐Garcia, Nicholas D. E. Greene, Christophe O. Soulage, Arturo Bevilacqua, Salvatore Benvenga, Lorenzo Di Bari, Basilio Pintaudi, Artur Wdowiak, Cesare Aragona, Zdravko Kamenov, Marialuisa Appetecchia, Giuseppina Porcaro, Imelda Hernández Marín, Fabio Facchinetti, Tony Tak Yu Chiu, O.A. Pustotina Pustotina, Olga Papalou, Maurizio Nordio, Tonino Cantelmi, Pietro Cavalli, Ivana Vučenik, Rosario D’Anna, Vittorio Unfer, Simona Dinicola, Saghar Salehpour, Annarita Stringaro, M Oliva, М. Т. Тугушев, Nikos Prapas, Mariano Bizzarri, Maria Salomè Bezerra Espinola, Cherubino Di Lorenzo, Ali Cenk Özay, John E. Nestler

PCOS Polycystic Ovary Syndrome hyperandrogenism insulin resistance endometrial thickness ovarian pathogenesis metabolic irregularities

Studysummary This review explores the applicability of the current PCOS diagnostic criteria, highlighting the need to reassess these criteria in light of new evidence on the disorder's heterogeneity and potential subtypes. Our plain-language summary of this paper — not a Tressless recommendation.

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting 10-13% of women of reproductive age, with four clinical subgroups (A, B, C, and D) identified. Subgroups A, B, and C are characterized by hyperandrogenism and metabolic irregularities such as insulin resistance, which affects around 75% of PCOS patients. Subgroup D lacks hyperandrogenic features and has a lower incidence of metabolic and endocrine issues, suggesting a solely ovarian pathogenesis. The document suggests that the current diagnostic criteria for PCOS should consider additional parameters such as insulin resistance and endometrial thickness. It also highlights the need for a more tailored therapeutic approach, especially for subgroup D, and calls for further research to refine diagnostic criteria and develop targeted treatments.

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Recommendations From The 2023 International Evidence-Based Guideline For The Assessment And Management Of Polycystic Ovary Syndrome

research Recommendations From The 2023 International Evidence-Based Guideline For The Assessment And Management Of Polycystic Ovary Syndrome

6 citations , August 2023 in “European journal of endocrinology”

This review discusses the 2023 International Guideline for PCOS assessment and management, highlighting updated evidence-based recommendations and practice points aimed at improving care and health outcomes, but notes that research quality remains generally low to moderate.

research Reconsidering the Polycystic Ovary Syndrome (PCOS)

41 citations , June 2022 in “Biomedicines”

This study proposes reclassifying PCOS into two distinct phenotypes based on androgen levels and suggests androgen supplementation may overcome IVF resistance in one group with advancing age.

research Acne Syndromes and Mosaicism

1 citations , November 2021 in “Biomedicines”

This review elaborates on the concept of cutaneous mosaicism and its link to acneiform conditions, but it reports no new clinical results.

research Cutaneous Manifestations of Polycystic Ovary Syndrome

5 citations , March 2020 in “Current Opinion in Endocrine and Metabolic Research”

This review discusses the contribution of non-androgen causes to acne and female pattern hair loss in PCOS and emphasizes the need for targeted treatment approaches without relying on hyperandrogenism as a diagnostic marker.

research Androgen Action in the Ovary

62 citations , August 2018 in “Frontiers in Endocrinology”

This review discusses the physiological roles of ovarian androgens in follicle development and atresia, emphasizing their contributions to polycystic ovary syndrome and normal follicle maturation but provides no new clinical results.

American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome - Part 1

research American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome - Part 1

343 citations , October 2015 in “Endocrine Practice”

This review discusses the diagnostic criteria and management strategies for Polycystic Ovary Syndrome (PCOS) and highlights the need for comprehensive clinical assessment, but does not report new clinical findings.

Prevalence of Androgenic Alopecia in Patients with Polycystic Ovary Syndrome and Characterization of Associated Clinical and Biochemical Features

research Prevalence of Androgenic Alopecia in Patients with Polycystic Ovary Syndrome and Characterization of Associated Clinical and Biochemical Features

48 citations , February 2014 in “Fertility and Sterility”

This study found that androgenic alopecia is present in 22% of women with polycystic ovary syndrome and is associated with acne and hirsutism, but not with increased biochemical hyperandrogenemia or metabolic dysfunction beyond PCOS.

research Nonclassic Congenital Adrenal Hyperplasia

59 citations , January 2010 in “International Journal of Pediatric Endocrinology”

This review discusses the pathophysiology, diagnosis, and treatment of nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency and provides no new clinical results.

research The Androgen Excess and PCOS Society Criteria for the Polycystic Ovary Syndrome: The Complete Task Force Report

1540 citations , October 2008 in “Fertility and Sterility”

This review discusses the definition of polycystic ovary syndrome proposed by the AE-PCOS Society Task Force, emphasizing hyperandrogenism, ovarian dysfunction, and excluding related disorders, while noting potential variations needing more research.

Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline

research Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline

1744 citations , August 2006 in “The Journal of Clinical Endocrinology and Metabolism”

This review discusses definitions of polycystic ovary syndrome and reports no new clinical results; the authors support using modified 1990 NIH criteria and acknowledge ongoing evolution as research advances.

research Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS)

4025 citations , December 2003 in “Human Reproduction”

This review discusses the evolution of diagnostic criteria for polycystic ovary syndrome and emphasizes its association with various metabolic and cardiovascular risks, but it provides no new research findings.