Address correspondence and requests for reprints to: Leonid Poretsky, M.D., Beth Israel Medical Center, New York, New York 10003.
Polycystic Ovary Syndrome, G. T. Kovacs, Editor; Cambridge University Press, Publ. (Cambridge, UK), 2000, 225 pgs.
Polycystic ovary syndrome (PCOS) continues to fascinate practicing physicians and investigators by its great variety of clinical manifestations and by its still unknown etiology and pathogenesis. The reproductive manifestations of the syndrome have been well known since the initial description by Stein and Leventhal in 1935 (1). In the last decade or so, however, it has become apparent that the syndrome is also characterized by a variety of metabolic manifestations that may place women with this extremely common condition at higher than expected risk for developing diabetes, hypertension, and atherosclerosis. Thus, a monograph that summarizes the current state of knowledge on this subject is very timely and useful.
Dr. Gabor T. Kovacs of Monash Medical School in Melbourne, Australia, has assembled an impressive international cast of authors to take a comprehensive look at this heterogeneous group of disorders in a monograph, Polycystic Ovary Syndrome (2). The new concept that the authors promote is evident from the title of the introduction: "Polycystic ovary syndrome is not just a reproductive problem." The introduction is followed by chapters devoted to the history and genetics of PCOS, its pathogenesis, a variety of its clinical manifestations, surgical and medical methods of treatment, and long-term follow-up.
All the chapters are well written, logically organized, and easy to read. For those who have followed this field of knowledge closely, it is gratifying to notice that some consensus on previously heavily debated issues has emerged, at least among the authors of this book. First, all seem to agree that PCOS comprises a spectrum of disorders characterized by anovulation, hyperandrogenism, and the presence of polycystic ovaries. Clinical manifestations range from minimal symptoms to a fully blown hyperandrogenic state, as in the patients originally described by Stein and Leventhal (1). Second, the mere sonographic finding of polycystic ovaries in women with normal ovulatory function and without biochemical abnormalities should not be designated PCOS; this condition should, instead, be called PCO (polycystic ovaries).
Naturally, in a book that addresses a subject of great interest to many medical specialties, some chapters are more appealing to endocrinologists, whereas others are of greater interest to obstetricians-gynecologists or dermatologists. I particularly enjoyed the comprehensive chapters on the mode of inheritance and the genetic basis of PCOS, a very well illustrated chapter on ovarian pathology, and an interesting chapter on the role of lifestyle factors in the etiology and management of PCOS. Many chapters are written so well that they are likely to cross "specialty interest barriers." Although I am not a surgeon or gynecologist, I read the chapters on laparoscopic surgical approaches and in vitro fertilization methods used in the treatment of PCOS with great interest. I found a chapter on the need for long-term monitoring of women with PCOS to be particularly thoughtful; the authors of this chapter place the potential for effective intervention that could prevent diabetes or atherosclerosis in PCOS patients in its proper perspectivethat of likely, but still largely hypothetical, possibility.
If I were to write a "wish list" for the next edition of the book (which, I hope, will follow), I would want to see the basic mechanisms of the development of PCOS addressed in more detail. For example, a chapter on animal models of PCOS might have been of interest to many readers. A chapter devoted to a detailed discussion of the basic mechanisms of insulin and insulin-like growth factor (IGF) action in the ovary, as this action relates to the PCOS, would have been useful as well. Although the statements that PCOS patients are commonly insulin resistant and that insulin resistance may be instrumental in the development of PCOS are made repeatedly throughout the book, the molecular aspects of insulin action in the ovary [such as mechanisms of preserved ovarian sensitivity to insulin in the face of generalized insulin resistance; the effects of insulin on ovarian steroidogenic enzymes, on receptors for insulin and IGFs, or on IGF-binding proteins (IGFBPs) and their proteases] are not covered in depth. A chapter devoted entirely to the endocrinology of PCOS, covering the origin of its many hormonal abnormalities and their interrelationships, would be helpful as well. In the current volume, these abnormalities are described in various places in the text, but not in a comprehensive, unified way. Finally, one would hope that the multiple redundancies, perhaps not completely avoidable in a multiauthor monograph, could be reduced. In the present volume, chapters that closely follow one another often address similar material. For example, studies of specific genes are covered, although to various degrees, in chapter 3 ("The inheritance of polycystic ovary syndrome") and chapter 4 ("The genetic basis of polycystic ovary syndrome"); the role of obesity in the development of PCOS is covered in chapter 7 ("Long-term implications for women with PCOS") and chapter 9 ("Life-style factors in the etiology and management of PCOS").
Despite these minor weaknesses, the book in its current form will be extremely useful for a wide variety of practicing physicians as well as medical students, house officers, and investigators working in this rapidly developing area of knowledge. I recommend this volume to all those who are interested in this common and still poorly understood disorder, the importance of which extends beyond the admittedly important reproductive problems.
Received January 9, 2001.
Accepted January 9, 2001.
References
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