Brain alteration of PCOS: neuroimaging and function

Polycystic ovary syndrome (PCOS), a common endocrine disorder affecting women, continues to be inadequately understood in terms of its pathogenesis. However, it is strongly associated with structural and functional abnormalities in the brain. This review examines neuroimaging alterations and cerebral functional changes observed in patients with PCOS, investigating their relationships with endocrine-metabolic profiles, behavioral patterns, cognitive performance, and emotional regulation. Neuroimaging studies have identified several key findings, including the enlargement of the pituitary gland (encompassing both the anterior and posterior regions, but excluding the infundibular stalk), a reduction in gray matter volume, and damage to the corpus callosum within the white matter. In patients with PCOS, structural alterations and changes in activity states within specific brain regions are associated with abnormal glucose metabolism, disordered eating behaviors, and cognitive and emotional changes. Notably, elevated μ-opioid receptor binding capacity in emotion-related brain regions and altered activity in the right orbitofrontal cortex under sympathetic activation has been observed. Collectively, these alterations point to a dysfunction of the limbic system circuitry, which may underlie the prevalent affective and cognitive symptoms in PCOS. Such neural imaging changes provide critical insights into PCOS pathophysiology and therapeutic development, though further investigations are warranted to address unresolved mechanistic questions.