Clinical and Hormonal Profile of Adolescents with PCOS and 'At Risk of PCOS': A Cross-Sectional Study

To determine the frequency of polycystic ovary syndrome (PCOS) among symptomatic adolescents and to evaluate their clinical and hormonal profiles.

Hundred post-menarcheal adolescents with menstrual irregularities, acne, and/or hirsutism were evaluated. Assessment included anthropometry, blood pressure, Ferriman-Gallwey (FG) scoring, acne grading and serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, sex hormone-binding globulin (SHBG), prolactin, and thyroid function tests. Free androgen index (FAI) was calculated. Participants were categorized as "PCOS" , "at risk of PCOS" , "others" , or "normal" per 2018 International Guidelines. Fifty age-matched healthy adolescents served as controls.

Among participants, 32% met criteria for PCOS, and 59% for 'at risk of PCOS'. Compared to 'at-risk' adolescents, those with PCOS had significantly higher BMI z-scores, serum LH, LH: FSH ratio, testosterone, and FAI. Over half of the affected adolescents were lean (17/32). Hyperandrogenemia markers (testosterone ≥2.1 nmol/L, FAI ≥97th percentile) and LH: FSH ≥3 were significantly more prevalent in the PCOS group. On multivariable logistic regression, FAI (AOR 1.18, 95% CI 1.06-1.33) and SHBG (AOR 1.08, 95% CI 1.04-1.14) were independently associated with PCOS/'at risk of PCOS' compared with controls. Among symptomatic adolescents, high FAI (AOR 1.26, 95% CI 1.07-1.56), and LH: FSH ratio (AOR 2.32, 95% CI 1.34-4.42) independently differentiated PCOS from the "at risk of PCOS" group.

Adolescents with PCOS and those 'at risk' represent a spectrum with escalating hormonal abnormalities. Early identification of symptomatic adolescents, including lean individuals, are essential for targeted intervention and reduction of long-term risks.