Metabolic Syndrome in Polycystic Ovary Syndrome

Both prevalence and incidence of the metabolic syndrome is very high in women with polycystic ovary syndrome (PCOS). Obesity and visceral fat enlargement play a dominant role in determining the final phenotype of PCOS. Androgen excess and insulin resistance may be responsible for the development of all features of the metabolic syndrome. The major factors responsible for this association seem to be related to a triumvirate including androgen excess, insulin resistance and associated hyperinsulinemia, and obesity, particularly the abdominal-visceral phenotype. With respect to obesity, it can be suggested that the association may be bidirectional, in the sense that obesity can worsen the phenotype of PCOS when present and can also be responsible for the development of a secondary form of PCOS even in susceptible subjects. In spite of the strong association among a long list of cardiovascular risk factors, there is no evidence that women with PCOS may be affected by an increased risk for cardiovascular mortality. Future research should carry out a detailed investigation into the potential role of androgen excess in determining the insulin resistant state and, specifically, the very high risk of developing type 2 diabetes.