Skip to main content
Log in

Genetic and environmental aspect of polycystic ovary syndrome

  • Review Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome determined in most patients by the association of two main factors: hyperandrogenism and insulin resistance. These characters are probably independent of each other and seem to be inherited by several different mechanisms. In some patients homozygous gene alteration has been found but in most patients PCOS seems to be determined by the association of gene polymorphisms that are common in the general population but alone are unable to determine phenotypic consequences. Alteration of genes that regulate the initial steps of ovarian steroidogenesis is probably the main causal factor of hyperandrogenism. Insulin resistance may be the result of many different gene alterations including insulin receptor substrate (IRS)-1 and 2, calpain-10 and peroxisome proliferator-activated receptor γ (PPARγ). Some polymorphisms may be protective against other gene alterations. Insulin sensitivity is also modified by socioeconomic and cultural factors that influence quantity and quality of food and energy expenditure. However, even eating behavior and weight response to food intake may be under genetic regulation. Different combinations of multiple gene polymorphisms and of environmental factors explain the heterogeneity of PCOS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935, 29: 181–91.

    Google Scholar 

  2. Franks S. Polycystic ovary syndrome. N Engl J Med 1995, 333: 853–61.

    Article  PubMed  CAS  Google Scholar 

  3. Legro RS. Polycystic ovary syndrome: the new millennium. Mol Cell Endocrinol 2001, 184: 87–93.

    Article  PubMed  CAS  Google Scholar 

  4. Lobo RA, Carmina E. The importance of diagnosing the polycystic ovary syndrome. Ann Intern Med 2000, 132: 989–93.

    Article  PubMed  CAS  Google Scholar 

  5. Ehrmann DA, Barnes RB, Rosenfield RL. Polycystic ovary syndrome: a form of functional ovarian hyperandrogenism due to a dysregulation of androgen secretion. Endocr Rev 1995, 16: 322–53.

    Article  PubMed  CAS  Google Scholar 

  6. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997, 18: 774–800.

    PubMed  CAS  Google Scholar 

  7. Legro RS, Strauss JF. Molecular progress in infertility: polycystic ovary syndrome. Fertil Steril 2002, 78: 569–76.

    Article  PubMed  Google Scholar 

  8. Norman RJ, Davies MJ, Lord J, Moran LJ. The role of lifestyle modification in polycystic ovary syndrome. Trends Endocrinol Metab 2002, 13: 251–7.

    Article  PubMed  CAS  Google Scholar 

  9. Shoupe E, Lobo RA. The influence of androgens on insulin resistance. Fertil Steril 1984, 41: 385–8.

    PubMed  CAS  Google Scholar 

  10. Moghetti P, Tosi F, Castello R, et al. The insulin resistance in women with hyperandrogenism is partially reversed by antiandrogen treatment: evidence that androgens impair insulin action in women. J Clin Endocrinol Metab 1996, 81: 952–60.

    PubMed  CAS  Google Scholar 

  11. Barbieri RL, Makris A, Randall RW, Daniels G, Kistner RW, Ryan KJ. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986, 62: 904–10.

    Article  PubMed  CAS  Google Scholar 

  12. Nestler JE, Jakubowicz DJ, de Vargas AF, Brick C, Quintero N, Medina F. Insulin stimulates testosterone biosynthesis by human theca cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab 1998, 83: 2001–5.

    PubMed  CAS  Google Scholar 

  13. Lobo RA, Carmina E. Polycystic ovary syndrome. In: Lobo RA, Mishell DR Jr, Paulson RJ, Shoupe D eds. Mishell’s Textbook of Infertility, Contraception and Reproductive Endocrinology. 4th ed. Boston: Blackwell. 1997, 363–83.

    Google Scholar 

  14. Dunaif A, Green G, Futterweit W, Dobrjansky A. Suppression of hyperandrogenism does not improve peripheral or hepatic insulin resistance in the polycystic ovary syndrome. J Clin Endocrinol Metab 1990, 70: 699–704.

    Article  PubMed  CAS  Google Scholar 

  15. Vidal-Puig A, Munoz-Torres M, Garcia-Calvente C, et al. Reduction of endogenous ovarian and adrenal androgens with ketoconazole does not alter insulin response in the polycystic ovary syndrome. J Endocrinol Invest 1994, 17: 647–52.

    Article  PubMed  CAS  Google Scholar 

  16. Glass AR. Endocrine aspects of obesity. Med Clin North Am 1989, 73: 139–60.

    PubMed  CAS  Google Scholar 

  17. Carmina E. Antiandrogens for the treatment of hirsutism. Exper Opin Invest Drugs 2002, 11: 357–63.

    Article  CAS  Google Scholar 

  18. Azziz R, Ehrmann D, Legro RS, et al. Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double-blind, placebo controlled trial. J Clin Endocrinol Metab 2001, 86: 1626–32.

    PubMed  CAS  Google Scholar 

  19. Abbott DH, Dumesic DA, Eisner JR, et al. The prenatal-ly androgenized female rhesus monkey as a model for PCOS. In: Azziz R, Nestler JE, Dewailly D eds. Androgen Excess Disorders in Women. Philadelphia: Lippincott-Raven. 1977, 369–82.

    Google Scholar 

  20. Abbott DH, Dumesic DA, Franks S. Developmental origin of polycystic ovary syndrome — a hypothesis. J Endocrino 2002, 174: 1–5.

    Article  CAS  Google Scholar 

  21. Givens JR. Familial polycystic ovarian disease. Endocrino Metab Clin North Am 1988, 17: 1–17.

    Google Scholar 

  22. Hague WM, Adams J, Feeders ST, Peto TEA, Jacobs HS. Familial polycystic ovaries: a genetic disease. Clin Endocrinol (Oxf) 1988, 38: 65–9.

    Google Scholar 

  23. Carey AH, Chan KL, Short F, White D, Williamson R, Franks S. Evidence for a single gene effect causing polycystic ovaries and male pattern baldness. Clin Endocrinol (Oxf) 1993, 38: 653–9.

    Article  CAS  Google Scholar 

  24. Cooper HE, Spellacy WN, Prem KA, Cohen WD. Hereditary factors in Stein-Leventhal syndrome. Am J Obstet Gynecol 1968, 100: 371–87.

    PubMed  CAS  Google Scholar 

  25. Govind A, Obhrai MS, Clayton RN. Polycystic ovaries are inherited as an autosomal inherent trait: analysis of 29 polycystic ovary syndrome and 10 control families. J Clin Endocrinol Metab 1999, 84: 38–43.

    Article  PubMed  CAS  Google Scholar 

  26. Franks S, Gharani N, McCarthy M. Candidate genes in polycystic ovary syndrome. Hum Reprod Update 2001, 7: 405–10.

    Article  PubMed  CAS  Google Scholar 

  27. Lund O, Magnus P, Sandvik L, Hoglo S. Familial clustering in the polycystic ovarian syndrome. Gynecol Obstet Invest 1989, 28: 23–30.

    Article  Google Scholar 

  28. Azziz R, Kahsar-Miller MD. Family history as a risk factor for the polycystic ovary syndrome. J Pediatr Endocrino Metab 2000, 13 (Suppl 5): 1303–6.

    Google Scholar 

  29. Kahsar-Miller MD, Nixon C, Boots LR, Go RC, Azziz R. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil Steril 2001, 75: 53–8.

    Article  PubMed  CAS  Google Scholar 

  30. Legro RS, Bentley-Lewis R, Driscoll D, Wang SC, Dunaif A. Insulin resistance in the sisters of women with polycystic ovary syndrome: association with hyperandrogenism rather than menstrual irregularities. J Clin Endocrinol Metab 2002, 87: 2128–33.

    Article  PubMed  CAS  Google Scholar 

  31. Jahanfar S, Eden JZ, Warren P, Seppala M, Jagger H. A twin study of polycystic ovary syndrome. Fertil Steril 1995, 61: 478–86.

    Google Scholar 

  32. Carmina E, Lobo RA. Adrenal hyperandrogenism in the pathophysiology of polycystic ovary syndrome. J Endocrinol Invest 1998, 21: 580–8.

    Article  PubMed  CAS  Google Scholar 

  33. Franks S, Gilling-Smith C, Gharani N, McCarthy M. Pathogenesis of polycystic ovary syndrome: evidence for a genetically determined disorder of ovarian androgen production. Hum Fertil (Camb) 2001, 3: 77–9.

    Article  Google Scholar 

  34. Strauss JF 3rd, Wood JR, Christenson LK, Mc Allister JM. Strategies to elucidate the mechanism of excessive theca cell androgen production in PCOS. Mol Cell Endocrino 2002, 186: 183–8.

    Article  CAS  Google Scholar 

  35. Gilling-Smith C, Willis DS, Beard RW, Franks S. Hypersecretion of androstenedione by isolated cells from polycystic ovaries. J Clin Endocrinol Metab 1994, 79: 1158–65.

    PubMed  CAS  Google Scholar 

  36. Nelson VL, Legro RS, Strauss JF, Mc Allister JM. Augmented androgen production is a stable phenotype of propagated theca cells from polycystic ovaries. Mol Endocrinol 1999, 13: 946–57.

    Article  PubMed  CAS  Google Scholar 

  37. Wickenheisser JK, Quinn PG, Nelson VL, Legro RS, Strauss JF, Mc Allister JM. Differential activity of the cytochrome P450 17α-hydroxylase and steroidogenic acute regulatory protein gene promoters in normal and polycystic ovary syndrome theca cells. J Clin Endocrinol Metab 2001, 85: 2304–11.

    Google Scholar 

  38. Nelson VL, Qin K, Rosenfield RL, et al. The biochemica basis for increased testosterone production in theca cells propagated from patients with polycystic ovary syndrome. J Clin Endocrinol Metab 2001, 86: 5925–33.

    Article  PubMed  CAS  Google Scholar 

  39. San Millan JL, Sancho J, Calvo RM, Escobar-Morreale HF. Role of the pentanucleotide (tttta) (n) polymorphism in the promoter of the gene CYP11α gene in the pathogenesis of hirsutism. Fertil Steril 2001, 75: 797–802.

    Article  PubMed  CAS  Google Scholar 

  40. Wood JR, Nelson VL, Ho C, et al. The molecular pheno-type of polycystic ovary syndrome (PCOS). Theca cells and new candidate PCOS genes defined by microarray analysis. J Biol Chem 2003, 278: 26380–90.

    Article  PubMed  CAS  Google Scholar 

  41. Hickey T, Chandy A, Norman RJ. The androgen receptor CAG repeat polymorphism and X-chromosome inactiva-tion in Australian Caucasian women with infertility related to polycystic ovary syndrome. J Clin Endocrinol Metab 2002, 87: 161–5.

    Article  PubMed  CAS  Google Scholar 

  42. Hogeveen KN, Cousin P, Pugeat M, Dewailly D, Soudan B, Hammond GL. Human sex hormone-binding globulin variants associated with hyperandrogenism and ovarian dysfunction. J Clin Invest 2002, 109: 973–81.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Dunaif A, Xia J, Book C, Schenker E, Tang Z. Excessive insulin receptor serine phosphorylation in cultured fibroblasts and in skeletal muscle: a potential mechanism for insulin resistance in the polycystic ovary syndrome. J Clin Invest 1995, 96: 801–10.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  44. Ciaraldi TP. Molecular defects of insulin action in the polycystic ovary syndrome: possible tissue specificity. J Pediatr Endocrinol Metab 2000, 13 (Suppl 5): 1291–3.

    PubMed  Google Scholar 

  45. Waterworth DM, Bennett ST, Gharani N, et al. Linkage and association of insulin gene VNTR regulator polymorphism with polycystic ovary syndrome. Lancet 1997, 349: 986–90.

    Article  PubMed  CAS  Google Scholar 

  46. Bennett ST, Todd JA, Waterworth DM, Franks S, McCarthy MI. Association of insulin gene VNTR polymorphism with polycystic ovary syndrome. Lancet 1997, 349: 1771–2.

    Article  Google Scholar 

  47. Huxtable SJ, Saker PJ, Haddad L, et al. Analysis of parent-offspring trios provides evidence for linkage and association between the insulin gene and type II diabetes mediated exclusively through paternally transmitted class III variable number tandem repeat alleles. Diabetes 2000, 49: 126–30.

    Article  PubMed  CAS  Google Scholar 

  48. Vankova M, Vrbikova J, Hill M, Cinek O, Bendlova B. Association of insulin gene VNTR polymorphism with polycystic ovary syndrome. Ann NY Acad Sci 2002, 967: 558–65.

    Article  PubMed  CAS  Google Scholar 

  49. Siegel S, Futterweit W, Davies TF, et al. A C/T single nucleotide polymorphism at the tyrosine kinase domain of the insulin receptor gene is associated with polycystic ovary syndrome. Fertil Steril 2002, 78: 1240–3.

    Article  PubMed  Google Scholar 

  50. El Mkadem SA, Lautier C, Macari F, et al. Role of allelic variants Gly972Arg of IRS-1 and Gly1057Asp of IRS-2 in moderate to severe insulin resistance of women with polycystic ovary syndrome. Diabetes 2001, 50: 2164–8.

    Article  PubMed  Google Scholar 

  51. Ehrmann DA, Tang X, Yoshiuchi I, Cox NJ, Bell GI. Relationship of insulin receptor substrate-1 and -2 genotypes to phenotypic features of polycystic ovary syndrome. J Clin Endocrinol Metab 2002, 87: 4297–300.

    Article  PubMed  CAS  Google Scholar 

  52. Peral B, San Millan JL, Castello R, Moghetti P, Escobar-Morreale HF. The methionine 196 arginine polymorphism in exon 6 of the TNF receptor 2 gene (TNFRSF1B) is associated with the polycystic ovary syndrome and hyperandrogenism. J Clin Endocrinol Metab 2002, 87: 3977–83.

    Article  PubMed  CAS  Google Scholar 

  53. Korhonen S, Romppanen EL, Hiltunen M, et al. Lack of association between C-850T polymorphism of the gene encoding tumor necrosis factor-alpha and polycystic ovary syndrome. Gynecol Endocrinol 2002, 16: 271–4.

    Article  PubMed  CAS  Google Scholar 

  54. Carafoli E, Molinari M. Calpain: a protease in search of function? Biochem Biophys Res Commun 1998, 18: 193–203.

    Article  Google Scholar 

  55. Cox NJ, Frigge M, Nicolae DL, et al. Loci on chromosome 2 (NIDDM1) and 15 interact to increase susceptibility to diabetes in Mexican Americans. Nat Genet 1999, 21: 213–5.

    Article  PubMed  CAS  Google Scholar 

  56. Horikawa Y, Oda N, Cox NJ, et al. Genetic variation in the gene encoding calpain-10 is associated with type II diabetes mellitus. Nat Genet 2000, 26: 163–75.

    Article  PubMed  CAS  Google Scholar 

  57. Rasmussen SK, Unhammer SA, Berglund L, et al. Variants within the calpain-10 gene on chromosome 2q37 (NID-DM1) and relationship to type 2 diabetes, insulin resistance and impaired acute insulin secretion among Scandinavian Caucasians. Diabetes 2002, 51: 3561–7.

    Article  PubMed  CAS  Google Scholar 

  58. Orho-Melander M, Klannemark M, Svensson MK, Ridderstrale M, Lindgren CM, Groop L. Variants of calpain-10 gene predispose to insulin resistance and elevated free fatty acid levels. Diabetes 2002, 51: 2658–64.

    Article  PubMed  CAS  Google Scholar 

  59. Ehrmann D, Schwarz PE, Hara M, et al. Relationship of calpain-10 genotype to phenotypic features of polycystic ovary syndrome. J Clin Endocrinol Metab 2002, 87: 1669–73.

    Article  PubMed  CAS  Google Scholar 

  60. Gonzalez A, Abril E, Roca A, et al. CAPN10 alleles are associated with polycystic ovary syndrome. J Clin Endocrinol Metab 2002, 87: 3971–6.

    Article  PubMed  CAS  Google Scholar 

  61. Haddad L, Evans JC, Gharani N, et al. Variation within the type 2 diabetes susceptibility gene calpain-10 and Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2002, 87: 2606–10.

    Article  PubMed  CAS  Google Scholar 

  62. Francis GA, Fayard E, Picard F, Auwerx J. Nuclear receptors and the control of metabolism. Annu Rev Physiol 2003, 65: 261–311.

    Article  PubMed  CAS  Google Scholar 

  63. Hauner H. The mode of action of thiazolidinediones. Diabetes Metab Res Rev 2002, 18 (Suppl 2): S10–5.

    Article  PubMed  CAS  Google Scholar 

  64. McIntyre FA, Walker M. Genetics of type 2 diabetes and insulin resistance: knowledge from human studies. Clin Endocrinol (Oxf) 2002, 57: 303–11.

    Article  CAS  Google Scholar 

  65. Hara M, Alcoser SY, Qaadir A, Belswenger KK, Cox NJ, Ehrmann DA. Insulin resistance is attenuated in women with polycystic ovary syndrome with the Pro(12)Ala polymorphism in the PPARgamma gene. J Clin Endocrino Metab 2002, 87: 772–5.

    CAS  Google Scholar 

  66. Orio F Jr, Matarese G, Di Biase S, et al. Exon 6 and 2 polymorphisms of peroxisome proliferators activated receptor γ in women with Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2003 (in press).

    Google Scholar 

  67. Stumvoll M, Stefan N, Fritsche A, et al. Interaction effect between common polymorphism in PPARgamma2 (Pro12Ala) and insulin receptor substrate (Gly972Arg) on insulin sensitivity. J Mol Med 2002, 80: 1–2.

    Article  CAS  Google Scholar 

  68. Savage DB, Agostini M, Barroso I, et al. Digenic inheritance of severe insulin resistance in a human pedigree. Nat Genet 2002, 31: 379–84.

    PubMed  CAS  Google Scholar 

  69. Jacobs HS. Environmental factors in PCOS. In: Azziz R, Nestler JE, Dewailly D eds. Androgen Excess Disorders in Women. Philadelphia: Lippincott-Raven. 1997, 339–45.

    Google Scholar 

  70. Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrino Metab 1999, 84: 1897–9.

    Article  CAS  Google Scholar 

  71. Knochenhauer ES, Key TJ, Kashar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the Southeastern United States: a prospective study. J Clin Endocrinol Metab 1998, 83: 3078–82.

    PubMed  CAS  Google Scholar 

  72. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected women from Spain. J Clin Endocrinol Metab 2000, 85: 2434–8.

    PubMed  CAS  Google Scholar 

  73. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyper-androgenism and insulin resistance in Polycystic Ovary Syndrome? Am J Obstet Gynecol 1992, 167: 1807–12.

    Article  PubMed  CAS  Google Scholar 

  74. Kauffman RP, Baker VM, Dimarino I, Gimpel T, Castracane VD. Polycystic ovarian syndrome and insulin resistance in white and Mexican American women: a comparison of two distinct populations. Am J Obstet Gynecol 2002, 187: 1362–9.

    Article  PubMed  Google Scholar 

  75. Carmina E, Legro RS, Stamets K, Lowell JE, Lobo RA. Difference in body weight between US and Sicilian women with PCOS: influence of the diet. Hum Reprod 2003, 11: 2289–93.

    Article  Google Scholar 

  76. Bougneres P. Genetics of obesity and type 2 diabetes: tracking pathogenetic traits during the predisease period. Diabetes 2002, 51 (Suppl 3): S295–303.

    Article  PubMed  CAS  Google Scholar 

  77. Clement K, Boutin P, Froguel P. Genetics of obesity. Am J Pharmacogenomics 2002, 2: 177–87.

    Article  PubMed  CAS  Google Scholar 

  78. Steinle NI, Hsueh WC, Snitker S, et al. Eating behavior in the old order Amish: heritability analysis and a genome-wide linkage analysis. Am J Clin Nutr 2002, 75: 1098–106.

    PubMed  CAS  Google Scholar 

  79. Taylor AE, Hubbard JL, Anderson EJ, Hall JE. Dietary composition in the pathophysiology of polycystic ovary syndrome: diet composition in normal and PCOS women. Program of the 84th Ann. Meeting of the Endocrine Society, San Francisco. 2002, p. 468 (abstract P2-633).

    Google Scholar 

  80. Carmina E, Legro R, Stamets K, Lowell J, Lobo RA. The influence of diet in the obesity and metabolic alterations in polycystic ovary syndrome. Program of the 83rd Annua Meeting of the Endocrine Society, Denver, Colorado, USA, June 20–23, 2001, p. 394 (abstract P2-467).

    Google Scholar 

  81. Weiss EP, Brown MD, Shuldiner AR, Hagberg JM. Fatty acid binding protein-2 gene variants and insulin resistance: gene and gene-environment interaction effects. Physio Genomics 2002, 10: 145–57.

    CAS  Google Scholar 

  82. Luan J, Browne PO, Harding AH, et al. Evidence for the gene-nutrient interaction at the PPARgamma locus. Diabetes 2001, 50: 686–9.

    Article  PubMed  CAS  Google Scholar 

  83. Ibanez L, Valls C, Potau N, Marcos MV, De Zegher F. Polycystic ovary syndrome after precocious pubarche: ontogeny of the low birth weight effect. Clin Endocrinol (Oxf) 2001, 55: 667–72.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Carmina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carmina, E. Genetic and environmental aspect of polycystic ovary syndrome. J Endocrinol Invest 26, 1151–1159 (2003). https://doi.org/10.1007/BF03345266

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345266

Key-words

Navigation