Carmina E, et al. - In a large homogeneous (Sicilian) Mediterranean population with a low prevalence of obesity, researchers described the metabolic alterations in different phenotypes of polycystic ovary syndrome (PCOS). For this retrospective study, 1215 consecutively assessed women with PCOS divided into 4 Rotterdam phenotypes (A, B, C and D) and in 108 matched ovulatory, non hyperandrogenic women. Data reported that the overall obesity prevalence was 31%, metabolic syndrome 6.6%, diabetes 2.1%, altered glucose metabolism, 13.1%, and abnormal lipid profile, 60%. In Mediterranean females with PCOS from Sicily with lower obesity prevalence, diabetes prevalence, altered glucose metabolism and metabolic syndrome were much lower than reported in US studies. Phenotype B, followed by phenotype A, was the most metabolically affected phenotype. Phenotype C had an intermediate disorder with an elevated incidence of modified metabolism of glucose and lipid changes. Findings revealed that only the normoandrogenic phenotype D had no metabolic abnormalities.