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Published in: The Journal of Obstetrics and Gynecology of India 4/2019

01-08-2019 | Obesity | Editorial

Can Polycystic Ovarian Syndrome be cured? Unfolding the Concept of Secondary Polycystic Ovarian Syndrome!

Author: Prof. Suvarna Satish Khadilkar

Published in: The Journal of Obstetrics and Gynecology of India | Issue 4/2019

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Abstract

Classic polycystic ovarian syndrome (PCOS) is one of the commonest endocrine metabolic disorders in women of reproductive years. It is very disappointing that we have still not been able to know the exact cause, and hence, we cannot completely cure this syndrome. With availability of effective drugs and lifestyle modification, it can only be controlled and symptoms can be reduced. There are some well-defined factors which lead to PCOS phenotype. A concept of secondary PCOS is being described recently. This condition, even though rare, is completely curable, as majority of these factors are treatable. Hence, it is advisable to actively look for these conditions and offer treatment in time. This editorial gives an account of various causes of secondary PCOS, gives broader view of PCOS phenotypes and aims for an insight into pathophysiological aspects of PCOS. The clinical categorization by HA-PODS nomenclature of both primary and secondary PCOS can minimize diagnostic and therapeutic pitfalls and will serve as a checklist to ensure the appropriate investigation is ordered and specific treatment is initiated as per diagnostic code. This will achieve uniformity in therapies offered and also enable better comparison of data and a smooth conduct of research which is much needed in this field.
Literature
1.
go back to reference Stein I, Leventhal M. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181–5.CrossRef Stein I, Leventhal M. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181–5.CrossRef
3.
go back to reference Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.CrossRef Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.CrossRef
4.
go back to reference Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome—the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91:781–5.CrossRefPubMed Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome—the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91:781–5.CrossRefPubMed
5.
go back to reference Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456–88.CrossRefPubMed Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456–88.CrossRefPubMed
6.
go back to reference Khadilkar SS. Polycystic ovarian syndrome: is it time to rename pcos to HA-PODS? J Obstet Gynecol India. 2016;66(2):81–7.CrossRef Khadilkar SS. Polycystic ovarian syndrome: is it time to rename pcos to HA-PODS? J Obstet Gynecol India. 2016;66(2):81–7.CrossRef
7.
go back to reference Pasquali R, Gambineri A, Cavazza C, et al. Heterogeneity in the responsiveness to long-term lifestyle intervention and predictability in obese women with polycystic ovary syndrome. Eur J Endocrinol. 2011;164:53–60.CrossRefPubMed Pasquali R, Gambineri A, Cavazza C, et al. Heterogeneity in the responsiveness to long-term lifestyle intervention and predictability in obese women with polycystic ovary syndrome. Eur J Endocrinol. 2011;164:53–60.CrossRefPubMed
8.
go back to reference Moghetti P, Castello R, Negri C, et al. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo controlled 6 month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab. 2000;85:139–46.PubMed Moghetti P, Castello R, Negri C, et al. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo controlled 6 month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab. 2000;85:139–46.PubMed
9.
go back to reference Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, et al. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005;90:6364–9.CrossRefPubMed Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, et al. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005;90:6364–9.CrossRefPubMed
10.
go back to reference Skubleny D, Switzer NJ, Gill RS, et al. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Surg. 2016;26:169–76.CrossRefPubMed Skubleny D, Switzer NJ, Gill RS, et al. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Surg. 2016;26:169–76.CrossRefPubMed
11.
go back to reference Kosova G, Urbanek M. Genetics of the polycystic ovary syndrome. Mol Cell Endocrinol. 2013;373:29–38.CrossRefPubMed Kosova G, Urbanek M. Genetics of the polycystic ovary syndrome. Mol Cell Endocrinol. 2013;373:29–38.CrossRefPubMed
12.
go back to reference Choi YM, Kim WG, Kim TY, et al. Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid. 2014;24:655–61.CrossRefPubMedPubMedCentral Choi YM, Kim WG, Kim TY, et al. Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid. 2014;24:655–61.CrossRefPubMedPubMedCentral
14.
go back to reference Hagag P, Hertzianu I, Ben-Shlomo A, et al. Androgen suppression and clinical improvement with dopamine agonists in hyperandrogenic-hyperprolactinemic women. J Reprod Med. 2001;46(7):678–84.PubMed Hagag P, Hertzianu I, Ben-Shlomo A, et al. Androgen suppression and clinical improvement with dopamine agonists in hyperandrogenic-hyperprolactinemic women. J Reprod Med. 2001;46(7):678–84.PubMed
15.
go back to reference Azziz R, Sanchez LA, Knochenhauer ES, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004;89:453–62.CrossRefPubMed Azziz R, Sanchez LA, Knochenhauer ES, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004;89:453–62.CrossRefPubMed
16.
go back to reference Cussons AJ, Stuckey BG, Walsh JP, et al. Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management. Clin Endocrinol. 2005;62(3):289–95.CrossRef Cussons AJ, Stuckey BG, Walsh JP, et al. Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management. Clin Endocrinol. 2005;62(3):289–95.CrossRef
17.
go back to reference Semple RK, Savage DB, Cochran EK, et al. Genetic syndromes of severe insulin resistance. Endocr Rev. 2011;32:498–514.CrossRefPubMed Semple RK, Savage DB, Cochran EK, et al. Genetic syndromes of severe insulin resistance. Endocr Rev. 2011;32:498–514.CrossRefPubMed
18.
go back to reference Chan JL, Oral EA. Clinical classification and treatment of congenital and acquired lipodystrophy. Endocr Pract. 2010;16:310–23.CrossRefPubMed Chan JL, Oral EA. Clinical classification and treatment of congenital and acquired lipodystrophy. Endocr Pract. 2010;16:310–23.CrossRefPubMed
19.
go back to reference Garg A. Lipodystrophies: genetic and acquired body fat disorders. J Clin Endocrinol Metab. 2011;96:3313–25.CrossRefPubMed Garg A. Lipodystrophies: genetic and acquired body fat disorders. J Clin Endocrinol Metab. 2011;96:3313–25.CrossRefPubMed
20.
go back to reference Handelsman Y, Oral EA, Bloomgarden ZT, et al. American Association of Clinical Endocrinologists. The clinical approach to the detection of lipodystrophy - an AACE consensus statement. Endocr Pract. 2013;19:107–16.CrossRefPubMedPubMedCentral Handelsman Y, Oral EA, Bloomgarden ZT, et al. American Association of Clinical Endocrinologists. The clinical approach to the detection of lipodystrophy - an AACE consensus statement. Endocr Pract. 2013;19:107–16.CrossRefPubMedPubMedCentral
21.
go back to reference Semple RK. EJE PRIZE 2015: How does insulin resistance arise, and how does it cause disease? Human genetic lessons. Eur J Endocrinol. 2016;174:R209–23.CrossRefPubMed Semple RK. EJE PRIZE 2015: How does insulin resistance arise, and how does it cause disease? Human genetic lessons. Eur J Endocrinol. 2016;174:R209–23.CrossRefPubMed
22.
go back to reference Pasquali R, Diamanti-Kandarakis E, Gambineri A. Management of endocrine disease: secondary polycystic ovary syndrome: theoretical and practical aspects. Eur J Endocrinol. 2016;175(4):R157–69.CrossRefPubMed Pasquali R, Diamanti-Kandarakis E, Gambineri A. Management of endocrine disease: secondary polycystic ovary syndrome: theoretical and practical aspects. Eur J Endocrinol. 2016;175(4):R157–69.CrossRefPubMed
23.
go back to reference Weedon MN, Ellard S, Prindle MJ, Caswell R, Allen HL, Oram R, Godbole K, Yajnik CS, Sbraccia P, Novelli G, Turnpenny P. An in-frame deletion at the polymerase active site of POLD1 causes a multisystem disorder with lipodystrophy. Nat Genet 2013;45(8):947–50CrossRefPubMedPubMedCentral Weedon MN, Ellard S, Prindle MJ, Caswell R, Allen HL, Oram R, Godbole K, Yajnik CS, Sbraccia P, Novelli G, Turnpenny P. An in-frame deletion at the polymerase active site of POLD1 causes a multisystem disorder with lipodystrophy. Nat Genet 2013;45(8):947–50CrossRefPubMedPubMedCentral
24.
go back to reference Semple RK, Savage DB, Cochran EK, et al. Genetic syndromes of severe insulin resistance. Endocr Rev. 2011;32:498–514.CrossRefPubMed Semple RK, Savage DB, Cochran EK, et al. Genetic syndromes of severe insulin resistance. Endocr Rev. 2011;32:498–514.CrossRefPubMed
25.
go back to reference Gambineri A, Semple RK, Forlani G, et al. Monogenic polycystic ovary syndrome due to a mutation in the lamin A/C gene is sensitive to thiazolidinediones but not to metformin. Eur J Endocrinol. 2008;159:347–53.CrossRefPubMed Gambineri A, Semple RK, Forlani G, et al. Monogenic polycystic ovary syndrome due to a mutation in the lamin A/C gene is sensitive to thiazolidinediones but not to metformin. Eur J Endocrinol. 2008;159:347–53.CrossRefPubMed
26.
go back to reference Nelson-DeGrave VL, Wickenheisser JK, Cockrell JE, et al. Valproate potentiates androgen biosynthesis in human ovarian theca cells. Endocrinology. 2004;145:799–808.CrossRefPubMed Nelson-DeGrave VL, Wickenheisser JK, Cockrell JE, et al. Valproate potentiates androgen biosynthesis in human ovarian theca cells. Endocrinology. 2004;145:799–808.CrossRefPubMed
28.
go back to reference Hu X, Wang J, Dong W, et al. A meta-analysis of polycystic ovary syndrome in women taking valproate for epilepsy. Epilepsy Res. 2011;97(1–2):73–82.CrossRefPubMed Hu X, Wang J, Dong W, et al. A meta-analysis of polycystic ovary syndrome in women taking valproate for epilepsy. Epilepsy Res. 2011;97(1–2):73–82.CrossRefPubMed
29.
go back to reference Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev. 2016;37(5):467–520.CrossRefPubMedPubMedCentral Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev. 2016;37(5):467–520.CrossRefPubMedPubMedCentral
Metadata
Title
Can Polycystic Ovarian Syndrome be cured? Unfolding the Concept of Secondary Polycystic Ovarian Syndrome!
Author
Prof. Suvarna Satish Khadilkar
Publication date
01-08-2019

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