Polycystic ovarian syndrome during puberty and adolescence

PCOS has reasonably well defined clinical, biochemical and radiological features in adult women, but in the adolescent population, some of these features may overlap with normal puberty leading to difficulties in making a diagnosis. In addition, the rising prevalence of obesity in the paediatric population may compound insulin resistance in girls predisposed to ovarian hyperandrogenism leading to younger age of presentation and more severe phenotype. It is important to distinguish between normal puberty and true ovarian hyperandrogenism, as well as excluding other causes of androgen excess such as adrenal tumours or non classical congenital adrenal hyperplasia. The long term co-morbidities associated with ovarian hyperandrogenism presenting during adolescence are not well defined but there is likely to be increased cardiovascular risk. There are little data on intervention in the adolescent population and studies in adult women often focus on ovulation and fertility which are less of a concern to adolescents. Current options include insulin sensitisation with metformin, anti androgens, or the oral contraceptive pill, with each girl being treated on an individual basis. There is a requirement for establishment of normative data in adolescence, in conjunction with physiological phenotyping in order to elucidate potential mechanisms thus informing potential intervention.

► Diagnosis of PCOS is challenging in adolescence due to overlap between puberty and features of PCOS.
► Rising obesity rates may compound insulin resistance leading to younger age of presentation.
► Normal puberty, in addition to pathological causes of androgen excess should be excluded.
► Long term co-morbidities with an adolescent presentation may include excess cardiovascular risk.
► Data on intervention in adolescence is limited and each girl should be treated on an individual basis.