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Obesity and the polycystic ovary syndrome

International Journal of Obesity volume 26, pages 883–896 (2002)Cite this article

Abstract

The polycystic ovary syndrome (PCOS) is a condition characterized by hyperandrogenism and chronic oligo-anovulation. However, many features of the metabolic syndrome are inconsistently present in the majority of women with PCOS. Approximately 50% of PCOS women are overweight or obese and most of them have the abdominal phenotype. Obesity may play a pathogenetic role in the development of the syndrome in susceptible individuals. In fact, insulin possesses true gonadotrophic function and an increased insulin availability at the level of ovarian tissue may favour excess androgen synthesis. Obesity, particularly the abdominal phenotype, may be partly responsible for insulin resistance and associated hyperinsulinemia in women with PCOS. Therefore, obesity-related hyperinsulinemia may play a key role in favouring hyperandrogenism in these women. Other factors such as increased estrogen production rate, increased activity of the opioid system and of the hypothalamic-pituitary-adrenal axis, decreased sex hormone binding globulin synthesis and, possibly, high dietary lipid intake, may be additional mechanisms by which obesity favours the development of hyperandrogenism in PCOS. Irrespective of the pathogenetic mechanism involved, obese PCOS women have more severe hyperandrogenism and related clinical features (such as hirsutism, menstrual abnormalities and anovulation) than normal-weight PCOS women. This picture tends to be more pronounced in obese PCOS women with the abdominal phenotype.

Body weight loss is associated with beneficial effects on hormones, metabolism and clinical features. A further clinical and endocrinological improvement can also be achieved by adding insulin-sensitizing agents and/or antiandrogens to weight reduction programmes. These obviously emphasize the role of obesity in the pathophysiology of PCOS.

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References

  1. Stein IF, Leventhal ML . Amenorrhea associated with bilateral polycystic ovaries Am J Obstet Gynecol 1935 29: 181.

    Google Scholar 

  2. Goudas VT, Dumesic DA . Polycystic ovary syndrome Endocrinol Metab Clin N Am 1997 26: 893–912.

    CAS  Google Scholar 

  3. Legro RS . The genetics of polycystic ovary syndrome Am J Med 1995 98 (S1A): 9.

    Google Scholar 

  4. Dahlgren E, Johansson S, Lindstedt G, Kautsson F, Oden A, Jonson PO, Mattson LA, Crona N, Lundberg PA . Women with polycystic ovary syndrome wedge resected in 1956 to 1965: a long term follow-up focusing on natural history and circulating hormones Fertil Steril 1992 57: 505–513.

    CAS  Google Scholar 

  5. Pasquali R, Casimirri F . The impact of obesity on hyperandrogenism and polycystic ovary syndrome in premenopausal women Clin Endocrinol 1993 39: 1–16.

    CAS  Google Scholar 

  6. Cresswell II, Barker DJP, Osmond C, Egger P, Phillips DIW, Fraser RB . Fetal growth, length of gestation, and polycystic ovaries in adult life Lancet 1997 350: 1131–1135.

    CAS  Google Scholar 

  7. Poretsky L, Cataldo NA, Rosenwaks Z, Giudice LC . The insulin-related ovarian regulatory system in health and disease Endocr Rev 1999 20: 535–582.

    CAS  Google Scholar 

  8. Nestler JE, Jakubowicz DJ . Decreases in ovarian cytochrome P450c17α activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome New Engl J Med 1996 335: 617–623.

    CAS  Google Scholar 

  9. McGee E, Sawetawan C, Bird I, Rainey WE, Carr BR . The effects of insulin on 3β-hydroxysteroid dehydrogenase expression in human luteinized granulosa cells J Soc Gynecol Invest 1995 2: 535–541.

    CAS  Google Scholar 

  10. Garzo VG, Dorrington JH . Aromatase activity in human granulosa cells during follicular development and the modulation by follicle-stimulating hormone and insulin Am J Obstet Gynecol 1984 148: 657–662.

    CAS  Google Scholar 

  11. Plymate SR, Matej LA, Jones RE, Friedl KE . Inhibition of sex hormone-binding globulin production in the human hepatoma (HepG2) cell line by insulin and prolactin J Clin Endocrinol Metab 1988 67: 460–464.

    CAS  Google Scholar 

  12. Poretsky L, Chandrasekher YA, Bai C, Liu HC, Rosenwaks Z, Giudice L . Insulin receptor mediates inhibitory effect of insulin, but not of insulin-like growth factor (IGF)-I, on IGF binding protein 1 (IGFBP-1) production in human granulosa cells J Clin Endocrinol Metab 1996 81: 493–496.

    CAS  Google Scholar 

  13. L'Allemand D, Penhoat A, Lebrethon M-C, Ardevol R, Beehr V, Delkers W, Saez JM . Insulin-like growth factors enhance steroidogenic enzyme and corticotropin receptor messenger ribonucleic acid levels cells J Clin Endocrinol Metab 1996 81: 3892.

    CAS  Google Scholar 

  14. Moghetti P, Castello R, Negri C, Tosi F, Spiazzi GG, Brun E, Balducci R, Toscano V, Muggeo M . Insulin infusion amplifies 17α-hydroxycorticosteroid intermediates response to ACTH in hyperandrogenic women: apparent relative impairment of 17, 20-lyase activity J Clin Endocrinol Metab 1996 81: 881.

    CAS  Google Scholar 

  15. Dunaif A . Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis Endocr Rev 1997 18: 774–800.

    CAS  PubMed  Google Scholar 

  16. Ciaraldi TP, El-Roeiy A, Madar Z, Reichart D, Olefsky JM, Yen SS . Cellular mechanisms of insulin resistance in polycystic ovarian syndrome J Clin Endocrinol Metab 1992 65: 577–583.

    Google Scholar 

  17. Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T . Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome Diabetes 1992 41: 1257–1266.

    CAS  Google Scholar 

  18. Ciaraldi TP, Morales AJ, Hickman MG, Odom-Ford R, Olefsky JM, Yen SSC . Cellular insulin resistance in adipocytes from obese polycystic ovary syndrome subjects involves adenosine modulation of insulin sensitivity J Clin Endocrinol Metab 1997 82: 1421–1425.

    CAS  Google Scholar 

  19. Ehrmann DA, Schneider DJ, Sobel BE, Cavaghan MK, Imperial J, Rosenfield RL, Polonsky KS . Troglitazone improves defects in insulin action, insulin secretion, ovarian steroidogenesis, and fibrinolysis in woman with polycystic ovary syndrome J Clin Endocrinol Metab 1997 82: 2108–2116.

    CAS  Google Scholar 

  20. Holte J, Bergh T, Berne C, Berglund L, Lithell H . Enhanced early insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance J Clin Endocrinol Metab 1994 78: 1052–1058.

    CAS  Google Scholar 

  21. Holte J . Disturbances in insulin secretion and sensitivity in women with the polycystic ovary syndrome Baillieres Clin Endocrinol Metab 1996 10: 221–247.

    CAS  Google Scholar 

  22. Buffington CK, Kitabchi AE . Evidence for a defect in insulin metabolism in hyperandrogenic women with polycystic ovarian syndrome Metabolism 1994 43: 1367–1372.

    CAS  Google Scholar 

  23. Poretsky L, Bhargava G, Kalin MF, Wolf SA . Regulation of insulin receptors in the human ovary: in vitro studies J Clin Endocrinol Metab 1988 67: 774–778.

    CAS  Google Scholar 

  24. Nestler JE, Jakubowicz DJ, De Vergas AF, Brik C, Quintero N, Medina F . Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system J Clin Endocrinol Metab 1998 83: 2001–2005.

    CAS  Google Scholar 

  25. Caro JF . Clinical review 26: insulin resistance in obese and non obese man J Clin Endocrinol Metab 1991 73: 691–695.

    CAS  Google Scholar 

  26. Vettor R, Lombardi AM, Fabris R, Serra R, Pagano C, Macor C, Federspil G . Substrate competition and insulin action in animal models Int J Obes Relat Metab Disord 2000 24: S22–S24.

    CAS  Google Scholar 

  27. Hotamisligil GS, Peraldi P, Budavari A, Ellis R, White MF, Spiegelman BM . IRS-1 mediated ihibition of insulin receptor tyrosine kinase activity in TNF-α- and obesity-induced insulin resistance Science 1996 271: 665–668.

    CAS  Google Scholar 

  28. Voutilainen R, Franks S, Mason HD, Martikainen H . Expression of insulin-like growth factor (IGF), IGF-binding protein, and IGF receptor massenger ribonucleic acids in normal and polycystic ovaries J Clin Endocrinol Metab 1996 81: 1003–1008.

    CAS  Google Scholar 

  29. Nahum R, Thong KJ, Hillier SG . Metabolic regulation of androgen production by human thecal cells in vitro Hum Reprod 1995 10: 75–81.

    CAS  Google Scholar 

  30. Brismar K, Fernqvist-Forbes E, Wahren J, Hall K . Effect of insulin on the hepatic production of insulin-like growth factor binding protein-1 (IGFBP-1), IGFBP-3 and IGF-1 in insulin-dependent diabetes J Clin Endocrinol Metab 1994 79: 872–878.

    CAS  Google Scholar 

  31. Morales AJ, Laughlin GA, Bützow T, Maheshwari H, Baumann G, Yen SSC . Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features J Clin Endocrinol Metab 1996 81: 2854–2864.

    CAS  Google Scholar 

  32. Slowinska-Srzednicka J, Zgliczynski W, Makowska A, Jeske W, Brezinska A, Saszynski P, Zgliczynski S . An abnormality of the growth hormone/insulin-like growth factor-1 axis in women with polycystic ovary syndrome due to coexistent obesity J Clin Endocrinol Metab 1992 74: 1432–1435.

    CAS  Google Scholar 

  33. Veldhuis JD, Iranmanesh A, Ho KKY, Waters MJ, Johnson ML, Lizarralde G . Dual defects in pulsatile growth hormone secretion and clearance subserve the hyposomatotropinism of obesity in man J Clin Endocrinol Metab 1991 72: 51–59.

    CAS  Google Scholar 

  34. Hautanen A . Synthesis and regulation of sex hormone-binding globulin in obesity Int J Obes Relat Metab Disord 2000 24: S64–S70.

    CAS  Google Scholar 

  35. Von Shoultz B, Carlstrom K . On the regulation of sex-hormone-binding globulin. A challenge of old dogma and outlines of an alternative mechanism J Steroid Biochem Mol Biol 1989 32: 327–334.

    Google Scholar 

  36. Nestler JE, Baralascini CO, Matt DW, Steingold KA, Plymate SR, Clore JN, Blackard WG . Suppression of serum insulin diaxosside reduces serum testosterone levels in obese women with polycystic ovary syndrome J Clin Endocrinol Metab 1989 68: 1027–1032.

    CAS  Google Scholar 

  37. Preziosi P, Barret-Connor E, Papoz L, Roger M, Saint-Paul M, Nahoul K, Simon D . Interrelationship between plasma sex hormone-binding globulin and plasma insulin in healthy adult women: the Telecom study J Clin Endocrinol Metab 1993 76: 283–287.

    CAS  Google Scholar 

  38. Rosenfield RL . Ovarian and adrenal function in polycystic ovary syndrome Endocrinol Metab Clin N Am 1999 28: 265–293.

    CAS  Google Scholar 

  39. Barner RB . The pathogenesis of polycystic ovary syndrome: lessons from ovarian stimulation studies J Endocrinol Invest 1998 21: 567–579.

    Google Scholar 

  40. Zhang L, Rodriquez H, Ohno S, Miller WL . Serine phosphorylation of human P450c17 increases 17, 20 lyase activity: implications for adrenarche and the polycystic ovary syndrome Proc Natl Acad Sci USA 1995 92: 10619–10623.

    CAS  Google Scholar 

  41. Lanzone A, Petraglia F, Fulghesu AM, Ciampelli M, Caruso A, Mancuso S . Corticotropin-releasing hormone induces an exaggerated response of adrenocorticotropic hormone and cortisol in polycystic ovary syndrome Fertil Steril 1995 63: 1195–1199.

    CAS  Google Scholar 

  42. Rodin A, Thakkar H, Taylor N, Clayton R . Hyperandrogenism in polycystic ovary syndrome. Evidence of dysregulation of 11 beta-hydroxysteroid dehydrogenase New Engl J Med 1994 330: 460–465.

    CAS  Google Scholar 

  43. Pasquali R, Vicennati V . The abdominal obesity phenotype and insulin resistance are associated with abnormalities of the hypothalamic-pituitary-adrenal axis in humans Horm Metab Res 2000 32: 521–525.

    CAS  Google Scholar 

  44. Holte J, Bergh T, Gennarelli G, Wide L . The independent effects of polycystic ovary syndrome and obesity on serum concentrations of gonadotrophins and sex steroids in premenopausal women Clin Endocrinol 1994 41: 473–481.

    CAS  Google Scholar 

  45. Kiddy DS, Sharp PS, White DM, Scanlon MF, Mason HD, Bray CS, Polson DW, Reed MJ, Franks S . Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases Clin Endocrinol 1990 32: 213–220.

    CAS  Google Scholar 

  46. Pasquali R, Casimirri F, Cantobelli S, Labate Morselli AM, Venturoli S, Paradisi R, Zannarini L . Insulin and androgen relationships with abdominal body fat distribution in women with and without hyperandrogenism Horm Res 1993 39: 179–187.

    CAS  Google Scholar 

  47. Pasquali R, Casimirri F, Venturoli S, Labate M, orselli AM, Reho S, Pezzoli A, Paradisi R . Body fat distribution has weight-independent effects on clinical, hormonal and metabolic features of women with polycystic ovary syndrome Metabolism 1994 43: 706–713.

    CAS  Google Scholar 

  48. Pasquali R . The endocrine impact of obesity in eumenorrheic women In: Azziz R, Nestler JE, Dewailly D (eds) Androgen excess disorders in women Lippincott-Raven: Philadelphia, PA 1997 pp 455–461.

    Google Scholar 

  49. Barr VA, Malide D, Zarnowski MJ, Taylor S, Cushman SW . Insulin stimulates both leptin secretion and production by rat white adipose tissue Endocrinology 1997 138: 4463–4472.

    CAS  Google Scholar 

  50. Björntorp P . The regulation of adipose tissue distribution in humans Int J Obes Relat Metab Disord 1996 20: 291–302.

    Google Scholar 

  51. Holmäng A, Larsson BM, Brzezcinska Z, Björntorp P . Effects of short-term testosterone exposure on insulin sensitivity of muscles in female rats Am J Physiol 1992 262: E851–855.

    Google Scholar 

  52. Björntorp P . Metabolic implications of body fat distribution Diabetes Care 1991 14: 1132–1143.

    Google Scholar 

  53. Evans DJ, Hoffman RG, Kalkhoff RK, Kissebah AH . Relationship of androgenic activity to body fat topography, fat cell morphology, and metabolic aberrations in premenopausal women J Clin Endocrinol Metab 1993 57: 304–310.

    Google Scholar 

  54. Diamanti-Kandarakis E, Mitrakou A, Hennes MMI, Platanissiotis D, Kablas N, Spina J, Georgiadou E, Hoffman RG, Kissebach AH, Raptis S . Insulin sensitivity and antiandrogenic therapy in women with polycystic ovary syndrome Metabolism 1995 44: 525–531.

    CAS  Google Scholar 

  55. Moghetti P, Tosi F, Castello R, Magnani CM, Negri C, Brun E, Furlani L, Caputo M, Muggeo M . The insulin resistance in women with hyperandrogenism is partially reversed by anti-androgen treatment: evidence that androgens impair nsulin action in women J Clin Endocrinol Metab 1996 81: 952–960.

    CAS  Google Scholar 

  56. Zamorano PL, Mahesh VB, De Sevilla LM, Chorich LP, Bhat GK, Brann DW . Expression and localization of the leptin receptor in endocrine and neuroendocrine tissues of the rat Neuroendocrinology 1997 65: 223–228.

    CAS  Google Scholar 

  57. Yen SSC . The polycystic ovary syndrome Clin Endocrinol (Oxf) 1980 12: 177–208.

    CAS  Google Scholar 

  58. Taylor AE, McCourt B, Martin KA, Anderson EJ, Adams JM, Schoenfeld D, Hall JE . Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome J Clin Endocrinol Metab 1997 82: 2248–2256.

    CAS  Google Scholar 

  59. Soule AG . Neuroendocrinology of the polycystic ovary syndrome Baillières Clin Endocrinol Metab 1996 10: 205–219.

    CAS  Google Scholar 

  60. Fauser BC, Pache TD, Hop WC, De J, ong FH, Dahl KD . The significance of a single LH measurement in women with cycle disturbances: discrepancies between immunoreactive and bioactive hormone estimates Clin Endocrinol 1992 37: 445–452.

    CAS  Google Scholar 

  61. Pasquali R, Casimirri F, Venturoli S, Paradisi R, Matrioli L, Capelli M, Melchionda N, Labò G . Insulin resistance in patients with polycystic ovaries: its relationship to body weight and androgen levels Acta Endocrinol (Copenh) 1983 104: 110–116.

    CAS  Google Scholar 

  62. Morales AJ, Laughlin GA, Butzow T, Maheshwari H, Baumann G, Yen SSC . Insulin, somatotropic, and luteinizing hormone axes in non-obese and obese women with polycystic ovary syndrome: common and distinct features J Clin Endocrinol Metab 1996 81: 2854–2864.

    CAS  Google Scholar 

  63. Feldman M, Kiser RS, Unger RH, Li CH . β endorphin and the endocrine pancreas. Studies in healthy and diabetic human beings New Engl J Med 1983 308: 349–353.

    CAS  Google Scholar 

  64. Fulghesu AM, Lanzone A, Cucinelli F, Caruso A, Mancuso S . Long-term naltrexone treatment reduces the exaggerated insulin secretion in patients with polycystic ovary disease Obstet Gynecol 1993 82: 191–197.

    CAS  Google Scholar 

  65. Giugliano D, Cozzolino D, Torella R . Arguments for a role of opioid peptides in some pathogenetic events of obesity In: Lardy H, Stratman F (eds) Hormones, thermogenesis, and obesity Elsevier Science: New York 1989 pp 209–218.

    Google Scholar 

  66. Pasquali R, Cantobelli S, Casimirri F, Bortoluzzi L, Boschi S, Capelli M, Melchionda N, Barbara L . The role of the opioid peptides in the development of hyperinsulinemia in obese women with abdominal body fat distribution Metabolism 1992 41: 763–767.

    CAS  Google Scholar 

  67. Pasquali R, Vicennati V . Activity of the hypothalamic-pituitary-adrenal axis in different obesity phenotypes Int J Obes Relat Metab Disord 2000 24: S47–S49.

    CAS  Google Scholar 

  68. Kondoh Y, Uemura T, Ishikawa M, Yokoi N, Hirahara F . Classification of polycystic ovary syndrome into three types according to response to human corticotropin-releasing hormone Fertil Steril 1999 72: 15–20.

    CAS  Google Scholar 

  69. Lanzone A, Fulghesu A, Guido M, Cucinelli F, Caruso A, Mancuso S . Somatostatin treatment reduces the exaggerated response of adrenocorticotropin hormone and cortisol to corticotropin-releasing hormone in polycystic ovary syndrome Fertil Steril 1997 67: 34–39.

    CAS  Google Scholar 

  70. Pasquali R, Antenucci D, Melchionda N, Fabbri R, Venturoli S, Patrono D, Capelli M . Sex hormones in obese premenopausal women and their relationship to body fat mass and distribution, β cell function and diet composition J Endocrinol Invest 1987 10: 345–350.

    CAS  Google Scholar 

  71. Wild RA, Painter PC, Coulson RB, Carruth KB, Ranney GB . Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome J Clin Endocrinol Metab 1985 61: 946–951.

    CAS  Google Scholar 

  72. Trowell H, Burkitt D, Heaton K . Dietary fibre, fibre-depleted foods and disease Academic Press: London 1985.

    Google Scholar 

  73. Conway GS, Agrawal R, Betteridge DJ, Jacobs HS . Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome Clin Endocrinol 1992 37: 119–125.

    CAS  Google Scholar 

  74. Dunaif A, Finegood DT . β-Cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome J Clin Endocrinol Metab 1996 81: 942–947.

    CAS  Google Scholar 

  75. Morin-Papunen LC, Vauhkonen I, Koivunen RM, Ruokonen A, Tapanainen JS . Insulin sensitivity, insulin secretion, and metabolic and hormonal parameters in healthy women and women with polycystic ovarian syndrome Hum Reprod 2000 15: 1266–1274.

    CAS  Google Scholar 

  76. Grulet H, Heeart AC, Delemer B, Gross A, Sulmont V, Leutenegger M, Caron J . Roles of LH and insulin resistance in lean and obese polycystic ovary syndrome Clin Endocrinol (Oxf) 1993 38: 621–626.

    CAS  Google Scholar 

  77. Pasquali R, Gambineri A, Anconetani B, Vicennati V, Colitta D, Caramelli E, Casimirri F, Morselli-Labate AM . The natural history of the metabolic syndrome in young women with the polycystic ovary syndrome and the effect of long-term oestrogen-progestagen treatment Clin Endocrinol 1999 50: 517–527.

    CAS  Google Scholar 

  78. Galtier-Dereure F, Pujol P, Dewailly D, Bringer J . Choice of stimulation in polycystic ovarian syndrome: the influence of obesity Hum Reprod 1997 12: 88–96.

    Google Scholar 

  79. Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA . The association of obesity with infertility and related menstrual abnormalities in women Int J Obes 1979 3: 57–77.

    CAS  Google Scholar 

  80. Lobo RA, Gysler M, March CM, Goebelman U, Mischell D Jr . Clinical and laboratory predictors of clomiphene response Fertil Steril 1982 37: 168–174.

    CAS  Google Scholar 

  81. Morin-Papunene LC, Koivunen RM, Ruokonene A, Martikainen HK . Metformin therapy improves the menstrual pattern with minimal endocrine and metabolic effects in women with polycystic ovary syndrome Fertil Steril 1998 69: 691–696.

    Google Scholar 

  82. Velazquez EM, Mendoza S, Hamer T, Sosa F, Glueck CJ . Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy Metabolism 1994 43: 647–654.

    CAS  Google Scholar 

  83. Dunaif A, Scott D, Finegood D, Quintana B, Whitcomb R . The insulin-sensitizing agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome J Clin Endocrinol Metab 1996 81: 3299–3306.

    CAS  Google Scholar 

  84. Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R . Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome New Engl J Med 1998 25: 1876–1880.

    Google Scholar 

  85. Filicori M, Flamigni C, Dellai P . Treatment of anovulation with pulsatile gonadotropin-releasing hormone: prognostic factors and clinical results in 600 cycles J Clin Endocrinol Metab 1994 79: 1215–1220.

    CAS  Google Scholar 

  86. White DM, Polson DW, Kiddy D, Sagle P, Watson H, Gilling-Smith C, Hamilton-Fairley D, Franks S . Induction of ovulation with low-dose gonadotropins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women J Clin Endocrinol Metab 1996 81: 3821–3824.

    CAS  Google Scholar 

  87. Fedorcsák P, Dale PO, Storeng R, Tanbo T, Abyholm T . The impact of obesity and insulin resistance on the outcome of IVF or ICSI in women with polycystic ovarian syndrome Hum Reprod 2001 16: 1086–1091.

    Google Scholar 

  88. Fedorsak P, Storeng R, Dale PO, Tanbo T, Abyholm T . Obesity is a risk factor for early pregnancy loss after IVF or ICSI Acta Obstet Gynecol Scand 2000 79: 43–48.

    Google Scholar 

  89. Kirchengast S, Huber J . Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome Hum Reprod 2001 16: 1255–1260.

    CAS  Google Scholar 

  90. Douchi T, Ijuin H, Nakamura S, Oki T, Yamamoto S, Nagata Y . Body fat distribution in women with polycystic ovary syndrome Obstet Gynecol 1995 86: 516–519.

    CAS  Google Scholar 

  91. Holte J, Bergh T, Berne C, Wide L, Lithell H . Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome J Clin Endocrinol Metab 1995 80: 2586–2593.

    CAS  Google Scholar 

  92. Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R, Fabbri R, Balestra V, Melchionda N, Barbara L . Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss J Clin Endocrinol Metab 1989 68: 173–179.

    CAS  Google Scholar 

  93. Jakubowitz DJ, Nestler JE . 17α-Hydroxyprogesterone responses to leuprolide and serum androgens in obese women with and without polycystic ovary syndrome after dietary weight loss J Clin Endocrinol Metab 1997 82: 556–560.

    Google Scholar 

  94. Pasquali R, Gambineri A, Biscotti D, Vicennati V, Gagliardi L, Colitta D, Fiorini S, Cognini GE, Filicori M, Morselli-Labate AM . Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome J Clin Endocrinol Metab 2000 85: 2767–2774.

    CAS  Google Scholar 

  95. Guzick DS, Wing R, Smith D, Berga SL, Winters SJ . Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women Fertil Steril 1994 61: 598.

    CAS  PubMed  Google Scholar 

  96. Kiddy DS, Hamilton-Fairley D, Bush A, Short F, Anyaoku V, Reed MJ, Franks S . Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome Clin Endocrinol (Oxf) 1992 36: 105–111.

    CAS  Google Scholar 

  97. Grenman S, Konnemaa T, Iryale K, Kaihola HL, Grouroos M . Sex steroid, gonadotropin, cortisol and prolactin levels in healthy, massively obese women: correlation with abdominal fat cell size and effect of weight reduction J Clin Endocrinol Metab 1986 63: 1257–1261.

    CAS  Google Scholar 

  98. Nestler JE, Baralascini CO, Mett DW, Steingold KA, Plymate SR, Clore JN, Blackard WG . Suppression of serum insulin by diazoxide reduces serum testosterone levels in obese women with polycystic ovary syndrome J Clin Endocrinol Metab 1989 68: 1027–1032.

    CAS  Google Scholar 

  99. Nestler JE, Singh R, Matt DW, Clore JN, Blackard WG . Suppression of serum insulin level by diazoxide does not alter serum testosterone or sex hormone-binding globulin levels in healthy, nonobese women Am J Obstet Gynecol 1990 163: 1243–1246.

    CAS  Google Scholar 

  100. Bailey CJ, Turner RC . Metformin New Engl J Med 1996 334: 574–579.

    CAS  Google Scholar 

  101. Lehmann JM, Moore LB, Smith-Oliver TA, Wilkison WO, Wilson TM, Kliewer SA . An antidiabetic thiazolidinedione is a high affinity ligand for perixisome proliferation-activated receptor γ (PPARγ) J Biol Chem 1995 270: 12953–12956.

    CAS  Google Scholar 

  102. Larner J . Multiple pathways in insulin signalling-fitting the covalent and allosteric puzzle pieces together Endocr J 1994 2: 167–171.

    CAS  Google Scholar 

  103. Oberfield SE . Editorial: Metabolic lessons from the study of young adolescents with polycystic ovary syndrome—Is insulin, indeed, the culprit? J Clin Endocrinol Metab 2000 85: 3520–3525.

    CAS  Google Scholar 

  104. Moghetti P, Castello R, Negri C, Tosi F, Perrone F, Caputo M, Zanolin E, Muggeo M . Metformin effects on clinical, 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: 139–146.

    CAS  Google Scholar 

  105. Ehrmann DA, Cavaghan MK, Imperial J, Sturis J, Rosenfield RL, Polonsky KS . Effects of metformin on insulin secretion, insulin action, and ovarian steroidogenesis in women with polycystic ovary syndrome J Clin Endocrinol Metab 1997 82: 524–530.

    CAS  Google Scholar 

  106. Ehrmann DA, Schneider DJ, Sobel BE, Cavaghan MK, Imperial J, Rosenfield RL, Polonsky KS . Troglitazone improves defects in insulin action, insulin secretion, ovarian steroidogenesis, and fibrinolysis in women with polycystic ovary syndrome J Clin Endocrinol Metab 1997 82: 2108–2117.

    CAS  Google Scholar 

  107. Nestler JE, Jakubowicz DJ, Reamer RD, Gunn RD, Allan G . Ovulatory and metabolic effects of d-chiro-inositol in the polycystic ovary syndrome New Engl J Med 1999 340: 1314–1320.

    CAS  Google Scholar 

  108. De Leo V, Lanzetta D, Di Antona D, La Marka A, Morgante G . Hormonal effects of flutamide in young women with polycystic ovary syndrome J Clin Endocrinol Metab 1998 83: 99.

    CAS  Google Scholar 

  109. Dumesic DA, Abbott DH, Eisner JR, Herrmann RR, Reed JE, Welch TJ, Jensen MD . Pituitary desensitization to gonadotropin-releasing hormone increases abdominal adiposity in hyperandrogenic anovulatory women Fertil Steril 1998 70: 94–101.

    CAS  Google Scholar 

  110. Marshall JC . Estrogen–progestagen therapy in the management of the polycystic ovary syndrome J Endocrinol Invest 1998 21: 618–622.

    CAS  Google Scholar 

  111. Golland IM, Elstein ME . Results of an open one year study with Diane-35 in women with polycystic ovarian syndrome Ann NY Acad Sci 1993 687: 263.

    CAS  Google Scholar 

  112. Dahlgren E, Landin K, Krotkiewski M, Holm G, Janson PO . Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome Hum Reprod 1998 13: 2706–2711.

    CAS  Google Scholar 

  113. Falsetti L, Gambera A, Tisi G . Efficacy of the combination ethinyl oestradiol and cyproterone acetate on endocrine, clinical and ultrasonographic profile in polycystic ovarian syndrome Hum Reprod 2001 16: 36–42.

    CAS  Google Scholar 

  114. Rittmaster RS . Antiandrogen treatment of polycystic ovary syndrome Endocrinol Metab Clin N Am 1999 28: 409–421.

    CAS  Google Scholar 

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  1. Department of Internal Medicine, Endocrinology Unit, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Bologna, Italy

    A Gambineri, C Pelusi, V Vicennati, U Pagotto & R Pasquali

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  1. A Gambineri
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  2. C Pelusi
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  3. V Vicennati
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  4. U Pagotto
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  5. R Pasquali
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Correspondence to R Pasquali.

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Gambineri, A., Pelusi, C., Vicennati, V. et al. Obesity and the polycystic ovary syndrome. Int J Obes 26, 883–896 (2002). https://doi.org/10.1038/sj.ijo.0801994

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  • DOI: https://doi.org/10.1038/sj.ijo.0801994

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