Pasquali Renato, Gambineri Alessandra
Department of Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Ann N Y Acad Sci. 2006 Dec;1092:158-74. doi: 10.1196/annals.1365.014.
Polycystic ovary syndrome (PCOS), one of the most common causes of ovulatory infertility, affects 4-7% of women. Although it was considered that PCOS may have some genetic component and that clinical features of this disorder may change throughout a life span, starting from adolescence to postmenopausal age, no effort has been made to define differences in the phenotype and clinical presentation according to age. Indeed, it has been widely recognized in the last decade that several features of metabolic syndrome (MS), particularly insulin resistance and hyperinsulinemia, are inconsistently present in the majority of women with PCOS. This represents an important factor in the evaluation of PCOS throughout life, which implies that PCOS by itself may not be a hyperandrogenic disorder exclusively related to young and fertile-aged women, but may also have some health implications later in life. In young women with PCOS, hyperandrogenism, menses irregularities, and insulin resistance may occur together, emphasizing the pathophysiological role of excess androgen and insulin on PCOS. Hyperandrogenism and infertility represent the major complaints of PCOS in adult fertile age. In addition, obesity and MS may affect more than half these women. Later in life, it becomes clear that the association of obesity (particularly the abdominal phenotype) and PCOS renders affected women more susceptible to develop type 2 diabetes mellitus (T2DM), with some difference in the prevalence rates among countries, suggesting that environmental factors are important in determining individual susceptibility. Little is known about ovarian morphology and androgen production in women with PCOS after menopause. Some studies found that morphological ultrasonographic features consistent with polycystic ovaries are very common in postmenopausal women, and that these features are associated with higher than normal testosterone levels and metabolic alterations. There is an obvious need for further research in this area. Identification of major complaints and features of PCOS during the different ages of an affected woman may help, in fact, to plan individual therapeutic strategies, and, possibly, prevent long-term chronic metabolic diseases.
多囊卵巢综合征（PCOS）是排卵性不孕症最常见的病因之一，影响4%至7%的女性。尽管人们认为PCOS可能有一定的遗传因素，且这种疾病的临床特征可能在整个生命周期中发生变化，从青春期到绝经后年龄，但尚未有人根据年龄来界定其表型和临床表现的差异。事实上，在过去十年中人们已广泛认识到，代谢综合征（MS）的几个特征，尤其是胰岛素抵抗和高胰岛素血症，在大多数PCOS女性中并不一致地存在。这是评估PCOS整个生命周期的一个重要因素，这意味着PCOS本身可能并非仅与年轻和育龄期女性相关的高雄激素血症疾病，而是在生命后期也可能有一些健康影响。在患有PCOS的年轻女性中，高雄激素血症、月经不规律和胰岛素抵抗可能同时出现，这突出了过量雄激素和胰岛素在PCOS中的病理生理作用。高雄激素血症和不孕症是成年育龄期PCOS的主要症状。此外，肥胖和MS可能影响超过一半的这些女性。在生命后期，很明显肥胖（尤其是腹部型肥胖）与PCOS的关联使受影响的女性更容易患2型糖尿病（T2DM），不同国家的患病率存在一些差异，这表明环境因素在决定个体易感性方面很重要。关于绝经后PCOS女性的卵巢形态和雄激素产生情况知之甚少。一些研究发现，与多囊卵巢一致的形态学超声特征在绝经后女性中非常常见，且这些特征与高于正常水平的睾酮和代谢改变有关。该领域显然需要进一步研究。事实上，识别受影响女性不同年龄段PCOS的主要症状和特征可能有助于制定个体化治疗策略，并可能预防长期慢性代谢疾病。
