By Mariagrazia Stracquadanio, Lilliana Ciotta
This ebook at the metabolic points of polycystic ovary syndrome (PCOS) reports the medical proof for the foremost etiological function of insulin resistance within the pathogenesis of PCOS. It additionally offers a brand new scientific and diagnostic method and obviously explains the price of insulin-sensitizing brokers, or “insulin sensitizers,” in decreasing hyperandrogenism and bettering fertility final result. specific info is equipped at the use of insulin sensitizers comparable to metformin and inositol and compatible healing protocols are defined. All too frequently, PCOS is handled through gynecologists in simple terms as an endocrine disease, with out popularity of the vitally important half that insulin performs within the syndrome. Practitioners will locate this booklet to be a invaluable resource of knowledge on PCOS as a metabolic syndrome and a complete advisor to attaining reliable remedy results.
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1 T he Role of the Adipocyte in Linking PCOS to Metabolic Syndrome Adipose tissue is nowadays considered not only a storage tissue but also a proper endocrine organ, metabolically active [89–92]. Adipose tissue responds to chronic changes in energy balance and nutrient content by altering the proliferation of pre-adipocytes, their differentiation into mature adipocytes, the growth and hypertrophy of adipocytes, and, finally, their apoptosis and necrosis [93]. In addition, rates of angiogenesis, extracellular matrix 28 3 Clinical Features remodeling, and the relative distribution of the resident immune cell population in adipose tissue are modified in response to changes in nutritional status [94].
The deposition of triglycerides into the hepatocytes depends on both of these reactions: thus, the development of a fatty liver is the consequence of a dysfunction in different metabolic pathways. 34 3 Clinical Features There are important relationships between peripheral insulin resistance and hepatic fat deposition. High intake of calories in sedentary individuals who are genetically susceptible induces a state of IR, which involves an increased lipolysis, as a result of free fatty acid and TNF-α circulating levels and of lower levels of adiponectin: this increases both insulin resistance and circulating levels of free fatty acids.
To underline the link between PCOS and metabolic syndrome, it is important to report that coronary heart disease, as well as cerebrovascular disease, is more common in postmenopausal PCOS patients. Persisting high androgen levels through the menopause, obesity, and maturity-onset diabetes mellitus are proposed as the main mechanisms accounting for the increased risk [88]. 1 T he Role of the Adipocyte in Linking PCOS to Metabolic Syndrome Adipose tissue is nowadays considered not only a storage tissue but also a proper endocrine organ, metabolically active [89–92].