Journal of endocrinological investigation
August 28, 2026 · via Europe PMC
Body mass index outperforms the Rotterdam criteria in defining phenotypic heterogeneity in polycystic ovary syndrome: a multicenter study from the Italian PCOS registry (PCOSOUTCOME.net).
Gambineri A, Federici S, Maseroli E, +14 more, Moretti C.
AI summary — for doctors, generated from the abstract only
BMI separated metabolic risk in women with PCOS better than the Rotterdam phenotypes.
What was studied
A multicenter Italian registry analysis of 1,314 Caucasian women with PCOS stratified by Rotterdam phenotype and by BMI.
Key findings
- Rotterdam phenotypes did not differ in BMI or metabolic complications
- Anxiety scores were highest in phenotype A
- Women with obesity or BMI 27 or more had higher rates of all metabolic complications, free androgen index and hirsutism
Clinical relevance
Weight status should guide metabolic assessment in PCOS.
Who should care
Limitations
Cross-sectional registry of Caucasian women only, limiting causal conclusions and generalizability.
Stratify women with PCOS by BMI when planning metabolic screening and treatment.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Purpose
Polycystic ovary syndrome (PCOS) is a common and highly heterogeneous endocrine-metabolic disorder. The Rotterdam criteria identify four diagnostic phenotypes; however, it remains unclear whether these phenotypes or body mass index (BMI) better predict metabolic risk. The PCOSOUTCOME.net registry collects data from multiple Italian centers and provides an opportunity to compare the effectiveness of Rotterdam phenotypes versus BMI in characterizing the clinical, metabolic, and psychological heterogeneity of women with PCOS.
Methods
We included 1,314 Caucasian women of reproductive age with PCOS. Participants were stratified according to Rotterdam phenotypes and BMI categories (normal weight, overweight, and obesity; and BMI < 27 kg/m² vs. ≥ 27 kg/m²). Clinical, hormonal, metabolic, gynecological, and psychological parameters were assessed and compared across subgroups.
Results
No significant differences in BMI or in the prevalence of metabolic complications (dyslipidemia, glucose intolerance, hypertension, and metabolic syndrome) were observed among the four Rotterdam phenotypes, although anxiety scores were highest in phenotype A. In contrast, BMI-based stratification identified clear differences in metabolic markers: women with obesity or a BMI ≥ 27 kg/m² showed a higher prevalence of all metabolic complications, as well as higher free androgen index (FAI) and hirsutism scores.
Conclusions
In this multicenter cohort, Rotterdam phenotypes failed to discriminate metabolic risk, whereas BMI-based stratification proved more informative in identifying cardiometabolic complications. Moreover, obesity in PCOS identifies a distinct hyperandrogenic phenotype. These findings underscore the need to integrate BMI into the classification of PCOS to better capture patient heterogeneity, with potential implications for metabolic assessment and risk stratification.
DOI
10.1007/s40618-026-02946-9
PMID
42663864
PMCID
PMC13627167
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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