Premature adrenarche, polycystic ovary syndrome and intrauterine growth retardation: does a relationship exist?

Abstract

Purpose of review: Describes the origin of premature adrenarche and polycystic ovary syndrome.

Recent findings: Growing evidence has emerged on the relationship between intrauterine growth retardation, premature adrenarche and polycystic ovary syndrome.

Summary: Experimental animal research and clinical observations underline the early developmental origin of premature adrenarche and polycystic ovary syndrome. Polycystic ovaries have been noted in girls before the onset of puberty which supports the suggestion that the origin of the syndrome depends on programming of the ovary in utero. Androgens during fetal life may initially be responsible for the programming of the ovary eventually leading to polycystic ovary syndrome. In addition, the development of the syndrome is proposed to be a linear process as a result of programming of the adrenal whereby hyperandrogenaemia starting in utero, during childhood and thereafter, plays a prominent role. At the beginning of puberty androgens produced by the adrenal initiate a vicious circle characterized by neuroendocrine abnormalities partly related to androgen-dependent decreases in gonadotropin-releasing hormone pulse generator sensitivity to the negative feedback actions of ovarian steroids. This promotes the progression towards the adult polycystic ovary syndrome phenotype.