Endocrine Abstracts

Polycystic Ovary Syndrome (PCOS) is a multi-system disorder characterized by cutaneous, reproductive and metabolic sequelae with the potential to affect brain structure and function. In a large retrospective study of women with PCOS in the UK, we confirmed a significantly increased prevalence and incidence of depression and anxiety, in addition to bipolar disorder and eating disorder compared with matched controls. Linkage analysis found an increased risk of a recorded diagnosis of autism spectrum disorder and attention-deficit hyperactivity disorder in children born to mothers with PCOS, raising the possibility that increased exposure to androgens in utero might affect neonatal brain development. Cognitive function may also be affected: compared with age- and BMI-matched controls, subjects with PCOS displayed subtle decrements across a broad range of cognitive tests, despite similar education and premorbid intelligence. Advances in MRI technology allow for interrogation of the potential underlying mechanisms in unprecedented detail: in a diffusion MRI study, PCOS was associated with a widespread reduction in axial diffusivity and increased tissue volume fraction in the corpus callosum. Alterations in brain structure and function may also contribute to long-term health risks beyond mental health and cognition. Epidemiological studies have confirmed an increased risk of cardio- and cerebrovascular disease among people living with PCOS, with hypertension representing an important modifiable target. Using blood oxygen level-dependent functional MRI, we found evidence of enhanced sympathoexcitation in women with PCOS, accompanied by increased brain activation in the right orbitofrontal cortex. Studies of neurovascular coupling, cerebrovascular reactivity, dynamic cerebral autoregulation, cerebral blood flow and metabolic rate of oxygen consumption in the resting state were not different between subjects with PCOS and age/BMI-matched controls. However, an exaggerated rise in blood pressure was unmasked in PCOS subjects in response to an acute exercise stimulus.