Pathogenesis, Diagnosis and Management of PCOS in the Adolescent

Background: Polycystic ovary syndrome (PCOS) is a disorder of reproductive-aged women characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovary morphology. This heterogeneous disease presents as a constellation of symptoms including menstrual disturbances (amenorrhea, oligomenorrhea, and irregular menstrual cycles), clinical features of hyperandrogenism (acne/hirsutism), biochemical hyperandrogenism, polycystic ovarian morphology on ultrasound, and features of metabolic syndrome. Despite being the most common endocrine disorder of reproductive aged women, much remains controversial regarding this disorder especially in adolescents where normal puberty can overlap with PCOS phenotype. Recent Findings: Recent publications have emphasized the challenges of diagnosing PCOS in adolescents as the criteria for diagnosis can be seen during normal pubertal development. Adherence to a strict guideline and workup will help prevent over diagnosis while assuring that appropriate patients are monitored and receive therapy. A timely diagnosis of PCOS leads to awareness of this lifelong condition associated with hormonal and possibly metabolic complications. Lifestyle modification is imperative but may need to be supplemented by medical therapy. Conclusion: PCOS is a complex disorder, our understanding of the cause, diagnosis, and treatment continues to evolve. The disease process and presentation is unique in adolescents. Further research is needed to help define diagnostic criteria of PCOS in the adolescent, evaluate therapy, and study long term outcomes. A multi-disciplinary team can help assure all aspects of the disorder are properly addressed.