Polycystic ovary syndrome in adolescence

Abstract

Polycystic ovary syndrome (PCOS) is a syndrome of variable combinations of menstrual irregularity, hirsutism or acne, and obesity. It can be diagnosed in adolescence and has early childhood antecedents. PCOS is the single most common endocrine cause of an ovulatory infertility and a major risk factor for the metabolic syndrome and, in turn, development of type 2 diabetes mellitus in women. Thus, it appears that PCOS increases a woman's risk of developing cardiovascular disease. Therefore, identifying girls at risk for PCOS and implementing treatment early in the development of PCOS may be an effective means of preventing some of the long-term complications associated with this syndrome. This article reviews the definition, clinical features, diagnosis, and treatment of PCOS.

Fig. 1

Clinical manifestations of PCOS. The major clinical manifestations of PCOS are shown in approximate proportion to their relative incidence and coincidence. (Modified from Rosenfield RL. Current topics of polycystic ovary syndrome. Bailliere’s Clin Obstet Gynaecol 1997;11:307; with permission.)

Fig. 2

Laboratory manifestations of PCOS. The laboratory manifestations of PCOS are shown in approximate proportion to their relative incidence and coincidence. (Modified from Rosenfield RL. Polycystic ovary syndrome and insulin-resistant hyperinsulinemia. J Am Acad Dermatology 2001;45:5095; with permission.)

Fig. 3

Early clinical manifestations of PCOS. The clinical presentations are listed below the developmental stages in which they first appear, and the arrows indicate duration of the symptoms. (Modified from Baumann EE, Rosenfield RL. Polycystic ovary syndrome in adolescence. The Endocrinologist 2002;12:333; with permission.)

Fig. 4

Diagnosis of hirsutism using Ferriman-Gallwey system. Illustrated are the different areas on a woman’s body that constitute a male pattern of excessive sexual hair. The numbers in the diagram provide a scoring system to quantify the presence of excessive hair growth in each individual area, and a total score of less than 8 is normal in adult women. (Reproduced from Hatch R, Rosenfield RL, Kim MH, et al. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981;140:815; with permission.)

Fig. 5

Initial work-up of androgen excess. This algorithm rules out most disorders that can mimic PCOS.

Fig. 6

Algorithm to determine the source of androgen excess. This algorithm helps to determine the source of excess androgen production.