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Chapter 8 - Adrenal and Polycystic Ovary Syndrome

Published online by Cambridge University Press:  13 May 2022

By
Ozlem Celik  and
Bülent Okan Yildiz
Edited by
Gabor T. Kovacs ,
Bart Fauser  and
Richard S. Legro
Gabor T. Kovacs
Affiliation:
Monash University, Melbourne, Australia
Bart Fauser
Affiliation:
University Medical Center, Utrecht, Netherlands
Richard S. Legro
Affiliation:
Penn State Medical Center, Hershey, PA, USA
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Summary

Polycystic ovary syndrome (PCOS) is characterized by clinical or biochemical hyperandrogenism, oligo-anovulation and polycystic ovarian morphology on ultrasound. Although the ovaries are the primary source of hyperandrogenism in PCOS, between 20% and 30% of patients with PCOS demonstrate adrenal androgen (AA) excess, as reflected by the circulating dehydroepiandrosterone sulfate (DHEAS) levels. The contribution of AA excess to the development or phenotypic expression of PCOS is not fully understood. Women with PCOS, particularly those with hyperandrogenic subphenotypes, show generalized hypersecretion of adrenocortical products, basally and in response to adrenocorticotropic hormone (ACTH). Alterations in adrenocortical biosynthesis, an exaggeration in the responsivity to ACTH, defects in cortisol metabolism and extra-adrenal factors, including obesity, insulin and glucose levels, and ovarian secretions play a limited role in increased AA production observed in PCOS. Adrenal androgen (AA) levels and their response to ACTH stimulation are highly individualized and relatively constant over time, suggesting that AA hypersecretion may be an inherited trait. Familial aggregation of AA excess in both brothers and sisters of patients with PCOS also supports heritability. However, studies to date have failed to identify specific genetic defects in adrenocortical dysfunction of PCOS due to the genetic and phenotypic heterogeneity of the syndrome and the lack of insufficiently large cohorts.

Keywords

polycystic ovary syndrome (PCOS)hyperandrogenismadrenaladrenal androgendehydroepiandrosterone (DHEA)dehydroepiandrosterone sulfate (DHEAS)
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Chapter
Information
Polycystic Ovary Syndrome , pp. 67 - 79
Publisher: Cambridge University Press
Print publication year: 2022

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