title: Hypothalamic-pituitary, ovarian and adrenal contributions to polycystic ovary syndrome.
abstract: Polycystic ovary syndrome (PCOS) is a prevalent heterogeneous disorder linked with disturbances of reproductive, endocrine and metabolic function. The definition and aetiological hypotheses of PCOS are continually developing to incorporate evolving evidence of the syndrome, which appears to be both multifactorial and polygenic. The pathophysiology of PCOS encompasses inherent ovarian dysfunction that is strongly influenced by external factors including the hypothalamic-pituitary axis and hyperinsulinaemia. Neuroendocrine abnormalities including increased gonadotrophin-releasing hormone (GnRH) pulse frequency with consequent hypersecretion of luteinising hormone (LH) affects ovarian androgen synthesis, folliculogenesis and oocyte development. Disturbed ovarian-pituitary and hypothalamic feedback accentuates the gonadotrophin abnormalities, and there is emerging evidence putatively implicating dysfunction of the Kiss 1 system. Within the follicle subunit itself, there are intra-ovarian paracrine modulators, cytokines and growth factors, which appear to play a role. Adrenally derived androgens may also contribute to the pathogenesis of PCOS, but their role is less defined.
authors.affiliation: The Leeds Centre for Reproductive Medicine, Seacroft Hospital, York Road, Leeds LS14 6UH, UK. Electronic address: nadine.baskind@nhs.net.
authors.forename: N Ellissa
authors.initials: NE
authors.lastname: Baskind
authors.affiliation: The Leeds Centre for Reproductive Medicine, Seacroft Hospital, York Road, Leeds LS14 6UH, UK. Electronic address: a.balen@nhs.net.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Balen
mesh_terms: D005260:Female; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D007987:Gonadotropin-Releasing Hormone / Q000378:metabolism; D006801:Humans; D017588:Hyperandrogenism / Q000209:etiology / Q000378:metabolism*; D006946:Hyperinsulinism / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D007986:Luteinizing Hormone / Q000378:metabolism; D009865:Oocytes / Q000254:growth & development; D006080:Ovarian Follicle / Q000254:growth & development; D010053:Ovary / Q000378:metabolism*; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000378:metabolism*
chemical_list: D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: hyperandrogenism; hypothalamic–hypophyseal system; ovary; physiopathology; polycystic ovary syndrome