The Role of Visceral Adipose Tissue and Skeletal Muscle in the Pathogenesis of Polycystic Ovary Syndrome

Author: Kabakchieva, Plamenа P.1,2, Kamenov, Zdravko A.1

1 Clinic of Endocrinology, Alexandrovska University Hospital, Department of Internal Medicine, Medical University, Sofia
2 Clinic of Internal Diseases, Naval Hospital – Varna, Military Medical Academy, Sofia


Insulin resistance (IR) and compensatory hyperinsulinemia are among the confirmed pathogenetic mechanisms for the development of polycystic ovary syndrome (PCOS). In conditions of systemic IR, insulin stimulates ovarian androgen production in the ovary through a variety of mechanisms and thus affects many of the most prevalent clinical manifestations: hyperandrogenism, menstrual disorders, polycystic ovaries, and infertility. On the other hand, systemic IR increases the risk of developing type 2 diabetes, dyslipidemia, arterial hypertension, and metabolic syndrome. A key role for this is played by visceral adipose tissue, which functions as an endocrine organ secreting various adipokines. Of interest is the fact that IR can also be observed in non-obese patients with PCOS, where skeletal muscles are considered to play a pivotal role. They function as an active endocrine organ mediating the synthesis and release of numerous cytokines and other peptides called myokines into circulation. The involvement of certain adipokines and myokines in the pathogenesis of IR in PCOS has already been confirmed, but the role of others remains debatable revealing a whole unexplored area. The aim of the present narrative review is to analyze and systematize the literature data accumulated to date regarding the role of visceral adipose tissue and skeletal muscle in the pathogenesis of PCOS and their relationship with insulin resistance in the context of the syndrome. The focus is additionally put on innovative and less studied adipo- and myokines with a putative role in the genesis of PCOS.

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Journal of the Bulgarian Society of Endocrinology

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