Polycystic ovary syndrome in adolescents: pathophysiology and treatment implications

Polycystic ovary syndrome is a heterogeneous clinical syndrome, which has been defined as the association of hyperandrogenism with chronic anovulation in women without specific adrenal and pituitary gland disease. A family history of polycystic ovary syndrome may be present in a subset of patients; however, the genetic basis of the syndrome remains unclear. Most often, the age of onset is perimenarchal and it is characterized by the appearance of menstrual disturbances, hirsutism, acne, and more rarely, a male pattern of alopecia. In some cases, premature adrenarche may present as a precursor to the development of the syndrome. Polycystic ovary syndrome is also associated with metabolic disturbances, such as obesity and insulin resistance with hyperinsulinemia, for which the pathophysiological role in the development of the syndrome has been recognized. The therapeutic approaches to polycystic ovary syndrome include lifestyle modifications, dietary-induced weight loss, insulin-sensitizing agents, antiandrogens, and oral contraceptives. These treatments may improve the clinical manifestations of excess androgen production and normalize menses in many adolescents and young women with polycystic ovary syndrome. Early recognition of the syndrome and thus, early treatment, may prevent and possibly ameliorate all the symptoms and the potential later development of metabolic and cardiovascular complications.