Kurzrock Razelle, Cohen Philip R
Phase I Program, Division of Cancer Medicine, University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States.
Med Hypotheses. 2007;68(3):480-3. doi: 10.1016/j.mehy.2006.03.057. Epub 2006 Nov 28.
Polycystic ovary syndrome (PCOS), also referred to as Stein-Leventhal syndrome, is one of the most common endocrinopathies. It is characterized by hyperandrogenism, hyperinsulinemia, central obesity, polycystic ovaries, and anovulation. However, some of these manifestations, including the polycystic ovaries, are neither specific for the disorder, nor found in all affected individuals. PCOS appears to be due to one or more primary defects in the upstream gonadotropin/androgen and/or insulin pathway, with the polycystic ovaries being one of many downstream manifestations. Yet, the pathophysiology of PCOS is not completely elucidated. Since the primary defect underlying PCOS may be an upstream endocrine and/or metabolic disturbance, rather than a defect in the ovaries themselves, we hypothesize that this aberration can also arise in men and that the absence of polycystic ovaries in men with other stigmata of the disorder should not eliminate the diagnosis. Our hypothesis is supported by the observation that a genetic susceptibility to PCOS exists, and that PCOS-type manifestations are not limited to women. Indeed, male relatives may suffer from insulin resistance, obesity, diabetes mellitus, and cardiovascular disease. Therefore, recognition of this syndrome in men is important, since pharmacologic treatments identified for women with PCOS may alleviate metabolic problems related to insulin resistance and its sequelae in men with a similar underlying defect. We suggest that first-degree relatives of patients with PCOS should be examined not only for phenotypic features characteristic of PCOS but also for biochemical evidence of hyperinsulinemia and hyperandrogenism. In addition to examining these individuals for obesity, the women should be evaluated for hirsutism and the men should be screened for early-onset male-pattern alopecia and excess hairiness. Serologic evaluation should included the ratio of fasting levels of glucose to insulin, a glucose tolerance test, the free testosterone level and the sex hormone-binding globulin level. Finally, both male and female first-degree relatives of patients with PCOS should be tested for the underlying molecular defect(s) of this condition, once it is identified. As new treatments for PCOS emerge, e.g. insulin-sensitizing drugs, it will be important to determine if these treatments have beneficial effects on the metabolic symptoms and complications in all afflicted patients, regardless of gender.
多囊卵巢综合征（PCOS），也被称为斯坦因-莱文塔尔综合征，是最常见的内分泌疾病之一。其特征为雄激素过多、高胰岛素血症、中心性肥胖、多囊卵巢以及无排卵。然而，这些表现中的一些，包括多囊卵巢，既不是该疾病所特有的，也并非在所有受影响个体中都能发现。PCOS似乎是由于上游促性腺激素/雄激素和/或胰岛素途径中的一个或多个原发性缺陷所致，多囊卵巢只是众多下游表现之一。然而，PCOS的病理生理学尚未完全阐明。由于PCOS潜在的原发性缺陷可能是上游内分泌和/或代谢紊乱，而非卵巢本身的缺陷，我们推测这种异常在男性中也可能出现，并且患有该疾病其他体征的男性若无多囊卵巢不应排除诊断。我们的假设得到了以下观察结果的支持：存在对PCOS的遗传易感性，且PCOS型表现并不局限于女性。事实上，男性亲属可能患有胰岛素抵抗、肥胖、糖尿病和心血管疾病。因此，在男性中识别该综合征很重要，因为针对PCOS女性确定的药物治疗可能会缓解具有类似潜在缺陷的男性与胰岛素抵抗及其后遗症相关的代谢问题。我们建议，PCOS患者的一级亲属不仅应检查是否具有PCOS的典型表型特征，还应检查高胰岛素血症和雄激素过多的生化证据。除了检查这些个体是否肥胖外，女性应评估多毛情况，男性应筛查早发性男性型脱发和多毛症。血清学评估应包括空腹血糖与胰岛素水平的比值、葡萄糖耐量试验、游离睾酮水平和性激素结合球蛋白水平。最后，一旦确定了PCOS患者的潜在分子缺陷，其男性和女性一级亲属都应进行检测。随着PCOS新治疗方法的出现，例如胰岛素增敏药物，确定这些治疗方法对所有患病患者（无论性别）的代谢症状和并发症是否具有有益作用将很重要。
