Polycystic ovarian disease: current insights into an old problem.

Recent studies have led to significant advances in the understanding of the pathogenesis of polycystic ovary syndrome (PCOS), as well as to improvements in the treatment of the commonly associated symptoms. New data continue to implicate etiologic alterations in the hypothalamic-pituitary axis, beginning in the perimenarcheal period, as well as derangements in insulin and insulin-like growth factor metabolism. Current observations also support a role for an increase in adrenal androgen production and an increase in adrenal sensitivity to trophic hormone stimulation in the development of PCOS. Therapeutic regimens for those patients unsuccessfully treated with traditional approaches have been further validated, including the use of flutamide or gonadotropin-releasing hormone agonist-steroidal "add back" for the treatment of hirsutism. Novel approaches to the treatment of infertility are likewise discussed.