Neuroendocrine Impairments of Polycystic Ovary Syndrome

Abstract Polycystic ovary syndrome (PCOS) is a prevalent and distressing disorder of largely unknown etiology. Although PCOS defined by ovarian dysfunction, accumulating evidence supports a critical role for the brain in the ontogeny and pathophysiology of PCOS. A critical pathological feature of PC...

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Bibliographic Details
Published in:Endocrinology (Philadelphia) 2019-10, Vol.160 (10), p.2230-2242
Main Authors: Ruddenklau, Amy, Campbell, Rebecca E
Format: Article
Language:English
Subjects:
Androgens
Brain
Development and progression
Endocrinology
Etiology
Feedback
Fertility
Gonadotropin releasing hormone
Health aspects
Hyperactivity
Impairment
Negative feedback
Ontogeny
Polycystic ovary syndrome
Progesterone
Psychological aspects
Risk factors
Stein-Leventhal syndrome
Steroids
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Summary:Abstract Polycystic ovary syndrome (PCOS) is a prevalent and distressing disorder of largely unknown etiology. Although PCOS defined by ovarian dysfunction, accumulating evidence supports a critical role for the brain in the ontogeny and pathophysiology of PCOS. A critical pathological feature of PCOS is impaired gonadal steroid hormone negative feedback to the GnRH neuronal network in the brain that regulates fertility. This impairment is associated with androgen excess, a cardinal feature of PCOS. Impaired steroid hormone feedback to GnRH neurons is thought to drive hyperactivity of the neuroendocrine axis controlling fertility, leading to a vicious cycle of androgen excess and reproductive dysfunction. Decades of clinical research have been unable to uncover the mechanisms underlying this impairment, because of the extreme difficulty in studying the brain in humans. It is only recently, with the development of preclinical models of PCOS, that we have begun to unravel the role of the brain in the development and progression of PCOS. Here, we provide a succinct overview of what is known about alterations in the steroid hormone–sensitive GnRH neuronal network that may underlie the neuroendocrine defects in clinical PCOS, with a particular focus on those that may contribute to impaired progesterone negative feedback, and the likely role of androgens in driving this impairment.
ISSN:1945-7170
0013-7227
1945-7170
DOI:10.1210/en.2019-00428