title: Sleeve gastrectomy to treat concomitant polycystyc ovary syndrome, insulin and leptin resistance in a 27-years morbidly obese woman unresponsive to insulin-sensitizing drugs: A 3-year follow-up.
abstract: BACKGROUND
  Insulin resistance (IR), leptin resistance (LR), and polycystic ovary syndrome (PCOS) commonly coexists with obesity. IR and PCOS are often successfully treated with the use of insulin-sensitizing drugs (ISDs). However, some women are poorly responsive or intolerant to them. If we additionally consider that currently no medical treatment for LR exists, it is crucial for the physician to find different therapeutic ways to treat patients with such multifactorial endocrinopathy.
  
  
  METHODS
  We present a case where sleeve gastrectomy (SG) was applied to a 27-year-old obese woman affected by concomitant IR, LR and PCOS, and unresponsive to ISDs. At three years from surgery the patient is now 71.6kg. More importantly, her levels of insulin and leptin started to improve at postoperative month 6 and became normal at postoperative month 24. Patient's ovaries that at baseline had characteristic aspects related to PCOS, at postoperative month 36 were normal.
  
  
  CONCLUSIONS
  SG is one of the most commonly performed bariatric procedures. The literature has moved away from labeling SG as a purely restrictive procedure, as its interactions with several hormones (ghrelin, leptin, insulin, etc.) are now recognized.
  
  
  CONCLUSIONS
  In the present report, SG was applied to resolve an intricate endocrinological framework confirming its therapeutic value not only in determining weight loss but also as endocrine/metabolic surgery able to treat multifactorial endocrinopathy. The underlying molecular mechanisms contributing to these benefits remain largely undetermined, despite offering tremendous potential to reveal new targets for therapeutic intervention, mostly in those patients unresponsive to classical pharmacotherapy.
authors.affiliation: Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Italy; Integrated Assistential Department of General and Special Surgery (Cappella Cangiani), IX Division of General Surgery, Vascular and Applied Biotechnology, Italy. Electronic address: luigi.schiavo@unina2.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schiavo
authors.affiliation: Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Italy; Integrated Assistential Department of General and Special Surgery (Cappella Cangiani), IX Division of General Surgery, Vascular and Applied Biotechnology, Italy. Electronic address: giuseppe.scalera@unina2.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scalera
authors.affiliation: Department of Anaesthesiology, Surgery and Emergency Sciences, Second University of Naples, Italy; Integrated Assistential Department of General and Special Surgery (Cappella Cangiani), IX Division of General Surgery, Vascular and Applied Biotechnology, Italy. Electronic address: alfonso.barbarisi@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Barbarisi
keywords: Insulin resistance; Leptin resistance; Obesity; Polycystic ovary syndrome; Sleeve gastrectomy