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Androgen excess and metabolic disorders in women with PCOS: beyond the body mass index

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Abstract

Background

Insulin resistance is a common feature among women with polycystic ovary syndrome (PCOS), especially in those patients with hyperandrogenism and chronic anovulation. PCOS women are at risk for developing metabolic syndrome, impaired glucose tolerance and type II diabetes mellitus (DM II).

Objective

The aim of this review is to explore the existing knowledge of the interplay between androgen excess, pancreatic β-cell function, non-alcoholic fatty liver disease (NAFLD), intra-abdominal and subcutaneous (SC) abdominal adipocytes in PCOS, providing a better comprehension of the molecular mechanisms of diabetologic interest.

Methods

A comprehensive MEDLINE® search was performed using relevant key terms for PCOS and DM II.

Results

Insulin-induced hyperandrogenism could impair pancreatic β-cell function, the SC abdominal adipocytes’ lipid storage capacity, leading to intra-abdominal adipocyte hypertrophy and lipotoxicity, which in turn promotes insulin resistance, and could enhance NAFLD. Fetal hyperandrogenism exposure prompts to metabolic disorders. Treatment with flutamide showed to partially reverse insulin resistance.

Conclusions

Metabolic impairment seems not to be dependent only on the total fat mass content and body weight in women with PCOS and might be ascribed to the androgen excess.

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Abbreviations

A:

Androstenedione

AACE:

American Association of Clinical Endocrinology

ACE:

American College of Endocrinology

BMI:

Body mass index

DHEAS:

Dehydroepiandrosterone sulfate

DHT:

Di-hydro-testosterone

DM II:

Type II diabetes mellitus

DNMT3:

De novo methyl-transferase 3

FFA:

Free fatty acids

FPIR:

First phase insulin response

IGT:

Impaired glucose tolerance

LDL-R:

LDL receptor

MetS:

Metabolic syndrome

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatoepatitis

NIH:

National Institutes of Health

17αOH-P:

17α-Hydroxy-progesterone

OGTT:

Oral glucose tolerance test

PCOS:

Polycystic ovary syndrome

SC:

Subcutaneous

SHBG:

Sex hormone-binding globulin

SSPG:

Steady-state plasma glucose

T:

Testosterone

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, 95123, Catania, Italy

    R. A. Condorelli, A. E. Calogero, M. Di Mauro, L. M. Mongioi’, R. Cannarella, G. Rosta & S. La Vignera

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  1. R. A. Condorelli
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  2. A. E. Calogero
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  3. M. Di Mauro
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  4. L. M. Mongioi’
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Correspondence to S. La Vignera.

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Condorelli, R.A., Calogero, A.E., Di Mauro, M. et al. Androgen excess and metabolic disorders in women with PCOS: beyond the body mass index. J Endocrinol Invest 41, 383–388 (2018). https://doi.org/10.1007/s40618-017-0762-3

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  • DOI: https://doi.org/10.1007/s40618-017-0762-3

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