Polycystic Ovary Syndrome In Adolescents Research Articles

Изучение роли глипикана-4, инсулинорезистентности и маркеров овариального резерва в патогенезе синдрома поликистозных яичников у подростков

Изучение роли глипикана-4, инсулинорезистентности и маркеров овариального резерва в патогенезе синдрома поликистозных яичников у подростков

Impact of Polycystic Ovary Syndrome on Periodontal Status of Women of Adolescent and Adult Age Groups: A Cross-Sectional Study

Objective: Polycystic ovary syndrome (PCOS) is identified as the most common endocrine disorder in reproductive-aged women, and symptoms of PCOS appear during the early pubertal age. There is a gap in knowledge in recognizing the status of gingival inflammation/periodontal destruction and high-sensitivity C-reactive protein levels (hsCRP) in adolescents versus adults with PCOS. This study aimed to observe the impact of PCOS on periodontal status and systemic inflammation in adolescents and compared them with adults with PCOS. Methods: A total of 100 newly diagnosed female subjects with PCOS were enrolled into two groups: adolescents (11–19 years, n = 50) and adult females (20–40 years, n = 50). Periodontal parameters, anthropometric parameters, PCOS phenotype, hirsutism score, and serum hsCRP levels were recorded. Results: High levels of mean hsCRP, gingival index, and bleeding on probing % were observed in adolescent and adult PCOS groups, though nonsignificant between the groups (p > 0.05). Significantly more sites with probing pocket depth 3–4 mm, higher mean clinical attachment level (CAL) and sites with CAL 1–2 mm, and high frequency of patients (n = 11) with periodontitis (stage 1) were observed in adults with PCOS compared to adolescents (p ≤ 0.05). Similar and predominant prevalence of PCOS phenotype A (66%) and moderate hirsutism (46% adolescents vs. 58% adults) were observed in both groups. Conclusion: Similar levels of hsCRP and periodontal inflammation were found in adolescents and adults with PCOS. More periodontal tissue destruction was observed in adults with PCOS as compared to adolescents with PCOS.

Is There a Difference in Hirsutism Score in Adolescents with Polycystic Ovary Syndrome on the Basis of Ethnicity and Race?

BackgroundThe complex correlation between ethnicity and race, clinical hyperandrogenism as signified by hirsutism, and biochemical androgen concentrations in Polycystic Ovary Syndrome (PCOS) is poorly understood. Study ObjectiveThe study aims to define the correlation between ethnicity/race and hirsutism score in patients with PCOS. MethodsWe conducted a retrospective chart review of a total of 251 patients with PCOS at the time of diagnosis. Patients were categorized by their ethnicity and race into five main groups: Asian (n=19, 7.6%), Black or African American (n=11, 4.4%), Hispanic or Latino (n=26, 10.3%), White (n=177, 70.5) and others (n=18, 7.2%). General Linear Model was applied using BlueSky Software. ResultsFor the entire study population, the mean age at diagnosis was (15.6±1.7), the mean body mass index (BMI) was (30.6±9.8), the mean hirsutism score using the modified Ferriman-Gallwey (mFG) score chart was (6.2±3.8), and the mean total testosterone was (40.1±20). The hirsutism score was the highest in Asian population (mean=9.1, p=0.002) and Hispanic or Latino population (mean=7.8, p=0.02) followed by others (mean=7.4, p=0.04) and Black or African American population (mean=7.1, p=0.2) compared to White population (mean=5.4). This correlation remained significant despite accounting for BMI and androgen levels (p<0.001). ConclusionThere are factors likely related to hair follicle sensitivity or endogenous response to circulating free androgens that differ between ethnicities and races, such that similar biochemical concentrations lead to differing severity of hirsutism, despite accounting for differences in BMI and androgen levels. More research is needed in this realm to understand the pathophysiologic basis of this interaction.

Pregnancy and Early Life Complications of PCOS

This presentation delves into the wide-ranging effects of Polycystic Ovary Syndrome (PCOS) on women’s lives, specifically exploring its manifestations during adolescence and pregnancy. Starting with PCOS in early life, we delve into the hormonal shifts of puberty and their connection to PCOS development. Challenges of diagnosing PCOS in adolescents are discussed, along with the distinct cardiometabolic and psychological issues they face. The section concludes with pragmatic insights into the 2023 PCOS Guideline’s recommendations for managing PCOS during these pivotal years. Moving to PCOS during pregnancy, attention shifts to the complex hormonal and physiological adjustments the female body undergoes to support foetal growth. PCOS-related mechanisms that might contribute to pregnancy complications are examined. In addition, we present evidence from 2023 PCOS Guideline meta-analyses revealing the various pregnancy complications in this high-risk population. Concluding, we navigate antenatal care terrain aligned with the 2023 Guideline and present evidence on metformin’s role in PCOS pregnancies. This presentation provides a comprehensive view of PCOS from adolescence to pregnancy. By integrating up-to-date guidelines and evidence, it aims to equip healthcare professionals with practical insights for navigating PCOS’s complexities, ultimately improving patient care.

The Role of the Gut Microbiome in Youth with Polycystic Ovary Syndrome: A Systematic Review.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age and female adolescents. The diagnosis of PCOS is difficult during puberty due to overlapping of the criteria with normal variations of menstruation during this age period. There are insufficient data on the gut microbiome and PCOS and potential mechanisms linking the two. The present systematic review aimed to detect dysbiosis patterns in youth with PCOS, compared with healthy controls. One hundred seventy-eight studies were identified by a databases search and sixty-eight by a full-text assessment for eligibility; four were included in the systematic review and underwent quality control. The results of the study were controversial in accordance to findings from the literature. A change in gut microbiome α diversity was found in PCOS adolescents, with no significant alterations in β diversity. Almost all studies found Firmicutes, Bacteroidetes, and Actinobacteria in abundance in both groups, with changes in family composition and fluctuations at the phylum level. A statistically significant association between these changes and clinical or biochemical features of the syndrome was described. This systematic review confirmed gut microbiota dysbiosis in youth with PCOS. However, further data are needed to clarify these changes and to build a strategy to prevent the syndrome.

Beneficial Effects of RESMENA Diet on Anthropometric, Metabolic, and Reproductive Profile in Adolescents with Obesity and Polycystic Ovary Syndrome: A Randomized Controlled Intervention Study

Introduction: The optimal dietary strategy to improve the metabolic and reproductive endocrine profile in adolescents with obesity and polycystic ovary syndrome (PCOS) is undefined. This study was conducted to evaluate the efficacy of the MEtabolic Syndrome REduction in NAvarra (RESMENA) diet versus a control diet based on American Heart Association (AHA) recommendations for the treatment of PCOS in adolescents with PCOS. Methods: A total of 40 adolescents diagnosed with PCOS between the ages of 13–18 years were randomized to either a RESMENA or control diet for 6 months. Dietary status, anthropometry, body composition, biochemical parameters, and reproductive endocrine hormones were compared between the 2 groups before and after the intervention. Results: Both diet groups showed significant decreases in anthropometric parameters, whereas the RESMENA diet provided a greater decrease in all these parameters except neck circumference and fat percentage (p <0.05). At the end of the study, fasting insulin, ALT, and total cholesterol levels decreased in both control and RESMENA groups; HbA1c, HOMA-IR, and hs-CRP levels decreased; and QUICKI score increased in the RESMENA group (p <0.05). There was no statistical difference in the androgen levels of the control group compared to the baseline. In the RESMENA group, there were a significant decrease in total testosterone, free testosterone, 17-OH progesterone, androstenedione, LH levels and LH/FSH ratio, and free androgen index and a significant increase in SHBG levels (p <0.05). Conclusions: Both dietary patterns resulted in significant improvement in anthropometric measurements and body composition, but the RESMENA diet showed beneficial effects on insulin resistance parameters and androgen levels.

Eating behavior, physical activity, and exercise training in adolescent polycystic ovary syndrome

Eating behavior, physical activity, and exercise training in adolescent polycystic ovary syndrome

Adolescent polycystic ovary syndrome without obesity: HOTAIR rs1443512 genotype relates to fat mass and to the redistribution of fat mass on low-dose pioglitazone.

Adolescent polycystic ovary syndrome (PCOS) is characterized by androgen excess and oligo-amenorrhea, and often results from ectopic lipid storage due to a mismatch between early adipogenesis and later lipogenesis. Endogenous HOX transcript antisense RNA (HOTAIR) and exogenous pioglitazone are enhancers of subcutaneous adipogenesis, particularly in the gluteofemoral region. The A allele of HOTAIR rs1443512 is an equivalent of a natural knock-down and is, thus, a candidate to influence the distribution of fat mass, and also the redistribution of fat mass by pioglitazone in adolescent PCOS-without-obesity. We performed two post hoc analyses by HOTAIR rs1443512 genotype. In the first, we analyzed the pooled pre-treatment data (auxology; endocrinology; body composition by dual X-ray absorptiometry; abdominal fat distribution by magnetic resonance imaging) of 65 adolescent girls with PCOS-without-obesity in three reported studies (ISRCTN45546616; ISRCTN29234515; ISRCTN11062950). In the second, we analyzed the results of 24 adolescent girls with PCOS-without-obesity, who received pioglitazone (7.5 mg/d for 1 year) as part of a randomized combination treatment (with spironolactone and metformin) in two reported studies (ISRCTN29234515; ISRCTN11062950). All data had been obtained in a blinded-to-genotype way. The pre-treatment data disclosed that the girls-with-A-allele of HOTAIR rs1443512 had developed PCOS with a lower BMI (22.3 ± 2.3 kg/m2; N = 17) than the other girls (24.1 ± 2.7 kg/m2; N = 48), this difference being essentially attributable to a lower fat mass (mean difference 4.6 kg; P < 0.01). On low-dose pioglitazone, girls-with-A-allele (N = 12) raised their fat mass while the other girls (N = 12) did not (total fat mass + 2.2 ± 1.8 kg vs - 0.9 ± 2.2 kg; P < 0.001), particularly in the gynoid area (gluteofemoral fat + 0.6 ± 0.4 kg vs - 0.1 ± 0.5 kg; hip circumference + 2.3 ± 1.9 cm vs - 1.7 ± 3.1 cm; both P < 0.001). The present findings suggest that the HOTAIR rs1443512 genotype influences not only the distribution of fat mass in adolescent girls with PCOS-without-obesity but also the redistribution of fat mass during prolonged treatment with low-dose pioglitazone. ISRCTN45546616 ( https://doi.org/10.1186/ISRCTN45546616 ). ISRCTN29234515 ( https://doi.org/10.1186/ISRCTN29234515 ). ISRCTN11062950 ( https://doi.org/10.1186/ISRCTN11062950 ).

SAT352 Reliability Of Two- And Three-dimensional Ultrasonographic Assessments Of Ovarian Morphology In Adolescents

Abstract Disclosure: E. Rahman: None. B. Smith: None. H. Vanden Brink: None. N. Zaman: None. A. Malik: None. T. Burgert: None. R. Barral: None. M.E. Lujan: None. Background: Distinct features of ovarian morphology using transabdominal ultrasonography (TAUS) have been observed in adolescents with polycystic ovary syndrome (PCOS). Standardized approaches to assess ovarian morphology using transvaginal ultrasonography result in excellent reliability and close agreement among multiple raters, which can lead to more precise estimates of follicle counts and ovarian size. The degree to which these methods translate to TAUS is unknown. Establishing standardized methods to analyze ovarian features via TAUS are needed to clarify the utility of ovarian morphology in the clinical evaluation of PCOS in adolescence. Objectives: To determine the reliability of follicle counts and ovarian size assessments obtained using 2D and 3D TAUS in early adolescence. Methods: Three raters evaluated images of 30 ovaries garnered from adolescents via TAUS (n=19, 6 - 20 months post-menarche) for the following 2D parameters: follicle number per ovary (2D FNPO), follicle number per cross-section (FNPS), ovarian volume (2D OV), ovarian area (OA) and stromal area (SA). Three dimensional assessments of follicle counts (3D FNPO) and ovarian volume (3D OV) were also performed using SonoAVCantralTM and VOCALTM software (GE Healthcare), respectively. Intraclass correlation coefficients (ICCs) were used to determine interrater reliability for each variable. An ICC &amp;lt;0.5 was defined as poor, 0.50-0.75 as moderate, 0.75-0.90 as good, and &amp;gt;0.900 as excellent reliability. Results: Across 2D measures of ovarian morphology, interrater reliability was highest for 2D FNPO (ICC = 0.698), followed by OA (0.655), SA (0.619), and FNPS (0.516). Ovarian volume measurements by 2D methods demonstrated poor reliability (0.297). Three-dimensional assessments of follicle counts were not associated with improved interrater agreement (0.609). By contrast, better reliability was detected for 3D OV versus 2D OV - albeit 3D measures still met criteria for poor reliability (0.397 vs 0.297). Conclusions: Assessments of ovarian morphology using TAUS are associated with moderate-to-poor reliability using standardized approaches. Follicle counts per ovary were moderately reliable with 2D and 3D TAUS, in contrast to OV which demonstrated poor reliability across raters irrespectively of modality. Poor reliability for measures of OV is concerning given current practice guidelines for the ultrasonographic assessment of PCOS advocate for measures of OV over FNPO when using TAUS. Factors impacting reliability, such as gynecological age, body habitus, and image quality will be evaluated in subsequent investigations to refine training, image acquisition protocols, and method development. Presentation: Saturday, June 17, 2023

Hepatokine Profile in Adolescents with Polycystic Ovary Syndrome: A Case-Control Study.

The current guidelines suggest routine screening for non-alcoholic fatty liver disease (NAFLD) in patients with polycystic ovary syndrome (PCOS). Hepatokines seem to be promising surrogate endpoints for the diagnosis and severity of NAFLD. PCOS has its onset in adolescence and its metabolic sequalae begin during the same period. There are scarce data on the hepatokine profile of adolescent PCOS patients. This case-control study examined the serum profile of the hepatokines sex hormone-binding globulin (SHBG), selenoprotein P, fibroblast growth factor 21 (FGF21), and fetuin A in a sample of adolescent PCOS patients, and their association to metabolic and hormonal parameters. The selenoprotein P and SHBG serum concentrations were significantly decreased in PCOS patients vs. the controls (median (IQR), 2.47 (0.40) vs. 2.66 (0.36) μg/mL, p = 0.025; mean ± SD, 41.71 ± 19.41 vs. 54.94 ± 22.12 nmol/L, p = 0.011, respectively), whereas selenoprotein P was significantly and positively associated with testosterone (r = 0.325, p = 0.007) and the free androgen index (r = 0.361, p = 0.002). The SHBG demonstrated multiple significant negative correlations with adverse metabolic parameters. Among the PCOS patients, the FGF21 concentrations were significantly higher in those with NAFLD, whereas a 1 pg/mL increase in the FGF21 concentration increased the odds of NAFLD diagnosis by liver ultrasound by 1%, suggesting FGF21 as a potential biomarker for hepatic disease in females with PCOS in adolescence. Fetuin A was the least differentiated hepatokine between the PCOS patients and controls with the least associations with metabolic and hormonal parameters.

Awareness of polycystic ovarian syndrome in adolescents: A cross-sectional study

Awareness of polycystic ovarian syndrome in adolescents: A cross-sectional study

Low-Calorie Ketogenic Diet: Potential Application in the Treatment of Polycystic Ovary Syndrome in Adolescents.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Hyperandrogenism, hyperinsulinism and insulin resistance (IR) are the main drivers of clinical, metabolic and reproductive phenotypes of PCOS. In adolescence, the cornerstones of PCOS treatment are lifestyle and dietary interventions. In particular, the quality and quantity of carbohydrates introduced with the diet play a crucial role in the benefits of diet on PCOS. Recently, the ketogenic diet (KD) has attracted significant interest for the treatment of IR and for the control of carbohydrate metabolism, which has proven to be beneficial for several dysmetabolic conditions, including PCOS. The goal of the KD is to induce a fasting-like metabolism with production of chetonic bodies. Ketosis is a good regulator of calorie intake and mimics the starvation effect in the body, leading to body weight control and consequent metabolism. Additionally, during ketogenesis, insulin receptor sensitivity is also promoted. We proposed a broad overview of the available literature regarding KD indications and considered its metabolic benefits useful for improving PCOS management. The reported data support that a low-calorie ketogenic diet (LCKD) plays a positive role as a regulator of control weight, IR, glucose and lipid homeostasis and hormonal profile. Unfortunately, the evidence concerning the benefits of the very LCKD in adolescents with PCOS and excessive body weight is still numerically scarce. Further studies are necessary to understand whether these effects are due to weight loss or to the nutritional characteristics of this diet. Considering the long-term consequences of PCOS, it is crucial to detect the prospects of nutritional interventions to protect fertility, starting in adolescence.

Prevalence of Polycystic Ovarian Syndrome in Girls with a History of Idiopathic Central Precocious Puberty

Introduction: The prevalence of polycystic ovarian syndrome (PCOS) in adolescent girls is between 1 and 4.3%. It remains controversial whether women with a history of idiopathic central precocious puberty (ICPP) are at increased risk for PCOS. Our objective was to assess the prevalence of PCOS in adolescents with a history of ICPP compared with healthy adolescents and the prevalence of PCOS among ICPP girls who have received or not gonadotropin-releasing hormone analogue (GnRHa) treatment. Methods: We assessed post-menarcheal girls with a history of ICPP. Girls were evaluated at gynecological age ≥2.5 years. Data collected were age at menarche, menstrual cycle characteristics, BMI, clinical hyperandrogenism (HA), total and free testosterone levels. PCOS diagnosis was defined by criteria for adolescents. Subjects were also analyzed regarding whether or not they had received GnRHa treatment. Results: Ninety-four subjects were assessed, and 63 had been treated with GnRHa. Menstrual disorders were found in 29%, clinical HA in 36%, and biochemical HA in 23%. Twelve percent met the diagnostic criteria for PCOS. There was no difference in BMI or in the incidence of menstrual dysfunction or hyperandrogenemia between treated and untreated patients. A higher proportion of clinical HA was found in untreated patients when compared to treated girls. The relative risk (RR) of developing PCOS in ICPP girls was 2.5 compared to a population of healthy adolescents. This RR was not higher in patients who received treatment with GnRHa than in those who did not. Conclusion: Adolescent girls with a history of ICPP have an increased risk of PCOS. This risk seems not to be related to GnRHa treatment.

Probiotics and Polycystic Ovary Syndrome: A Perspective for Management in Adolescents with Obesity.

Polycystic ovary syndrome (PCOS) affects a considerable percentage of females of reproductive age. PCOS is an obesity-related condition and its effects are greatly amplified by obesity. Even though the pathogenesis of PCOS remains complex and has not been fully elucidated, a link between obesity, PCOS, and dysbiosis has been described. The potential role of the gut microbiota in the development and progression of PCOS and its associated symptoms has also been reported. The aim of this narrative review is to present a non-systematic analysis of the available literature on the topic of probiotics and PCOS in adolescents with obesity in order to revise the beneficial effects of probiotics/symbiotic supplementation on hormonal and metabolic profiles and inflammatory conditions. The effectiveness of probiotics/synbiotics in PCOS has been supported. The literature suggests that probiotic/symbiotic supplementation may ameliorate hormonal profiles, inflammatory indicators, and lipid metabolism disturbances caused by PCOS. Studies also show improvements in weight, BMI, insulin, and HOMA-IR, including a potential role it plays in protecting fertility. Even though further studies are needed to confirm these findings, particularly in adolescent patients, probiotic supplementation may be considered a solution for managing PCOS in adolescents with obesity.

Polycystic Ovarian Syndrome In Some Sample Of Iraqi Adolescents: Implementation Of Consensus Guidelines

Background: The diagnosis of polycystic ovarian syndrome (PCOS) in adolescent girls can be difficult because symptoms are shared with normal pubertal development. The updated consensus guideline for PCOS diagnosis in adolescents sought to encourage accurate and timely diagnosis, optimize therapy, and improve health outcomes. Aim: the present study aims to implement an updated consensus criteria in the diagnosis of PCOS in adolescents complaining of clinical features of hyperandrogenism or menstrual abnormalities. Methods: A total of 60 patients with clinical features of hyperandrogenism and/or menstrual abnormalities were studied. A detailed history followed by clinical examination was taken. Serum Thyroid Stimulating Hormone, Cortisol, Total Testosterone, Dehydroepiandrosterone, Luteinizing Hormone (LH), and Prolactin were performed for all patients. Consensus criteria were used for PCOS diagnosis. Results: Menstrual irregularity was reported by 20 (33.3%) and hyperandrogenism features in 21(35%) of the participants. PCOS was confirmed in 14 (23%) participants. Patients diagnosed with PCOS were shown to have substantially higher rates of menstrual irregularity, hirsutism, elevated serum testosterone, and LH (P0.001, P0.001, P=0.002, and P0.002 respectively). Seven patients (50%) had both clinical and biochemical hyperandrogenism. Association between testosterone rise was more significant with hirsutism (P&lt;0.001) than with acne (P=0.001). Morbid obesity was observed in 21% of patients, 7% had their diastolic blood pressure 90mm Hg, and 39% had and fasting blood sugar ≥100 mg/dL. Conclusion: PCOS was diagnosed in 23% of adolescent girls who had features of hyperandrogenism and menstrual irregularities. Obesity and family history were more frequent in PCOS adolescents. Concordant clinical and biochemical hyperandrogenism was confirmed in only half of PCOS patients. PCOS patients may be at higher risk of metabolic syndrome.

The role of metabolic syndrome in the development of polycystic ovary syndrome in adolescence

The review article presents an analysis of the metabolic syndrome problem in children and adolescents, its role in the development of polycystic ovary syndrome (PCOS) in accordance with the latest International guidelines and modern literature. The urgency of the problem lies in the rapid spread of overweight among children in the world and, consequently, the growth of alimentary-dependent pathology. One of the major consequences of weight problems is metabolic syndrome (MS). There are still no clear MS criteria for children and adolescents. IDF suggests using IDF criteria for adults. Priority in the pathogenesis of MS is given to insulin resistance (IR), which is associated with puberty. The problem of IR assessment remains. HOMA-IR and QUICKI methods are not considered reliable tests to determine IR, so the assessment is based on clinical signs (hyperglycemia, dyslipidemia, abdominal obesity, hypertension). Obesity and IR can be predictors of PCOS, which can often be associated with puberty. Pathological signs of the syndrome typical for adults in adolescence may be a manifestation of the physiological course of puberty. Obligative criteria for the diagnosis of PCOS in adolescence are irregular menstruation/oligomenorrhea, proven biochemically and clinically hyperandrogenemia). First-line therapy for PCOS in adolescents with MS is weight loss and dosed exercise, which helps to normalize a hormonal balance. Drug treatment may include insulin-sensitizing drugs (metformin), antiandrogens (spironlactone, flutamide, cyproterone acetate), 5-alpha-reductase inhibitors (finasteride), combined oral contraceptives, inositol. Prevention of overweight, obesity in children can prevent the development of IR and, accordingly, associated MS and PCOS, reproductive health disorders. Prevention measures are aimed at avoiding maternal obesity, gestational diabetes, malnutrition and smoking during pregnancy, promoting breastfeeding and physical activity.

Plasma visfatin and apelin levels in adolescents with polycystic ovary syndrome

Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder that usually begins during adolescence. Patients may have severe metabolic disorders. Objective To investigate the levels of visfatin and apelin in adolescent girls with PCOS and to explore the importance of visfatin and apelin in glucose and lipid metabolism. Methods A total of 88 girls (aged 12–20 years) were prospectively and consecutively recruited during two years for the PCOS group (n = 44) and the control group (n = 44). Serum visfatin, apelin and other metabolic parameters were measured. Receiver operator characteristics (ROC) curve analysis was performed to reveal the diagnostic potential. Results Visfatin, apelin and indicators of glucose and lipid-metabolism were not different for PCOS patients compared to control. However, insulin resistance (IR) in the PCOS-group was more frequent (p < 0.05). Visfatin in non-IR patients was higher than in IR-patients in the PCOS-group (p < 0.05). However, there was no difference in apelin levels between IR and non-IR patients in the PCOS-group (p > 0.05). ROC-curve analyses demonstrated that the optimal value of visfatin for predicting IR in PCOS-patients was 7.14 ng/mL, with 78.1% sensitivity and 68.7% specificity. In the PCOS-group, visfatin was positively correlated with high density lipoprotein cholesterol (HDL-C), and negatively correlated with HOMA-IR, apolipoprotein B (Apo-B), cholesterol (CHO), low density lipoprotein cholesterol (LDL-C) and CHO/HDL-C ratio (p < 0.05). Apelin had no correlation with all indices (p > 0.05). Conclusions Higher visfatin levels may prevent IR in adolescent PCOS patients, showing a positive predictive value for IR and also reflecting a beneficial effect on lipids. It is a possible protective factor at certain stages of metabolic syndrome.

Adolescent PCOS: a postpubertal central obesity syndrome.

Adolescent polycystic ovary syndrome (PCOS) is a highly prevalent, reversible, endocrine-metabolic mode essentially driven by ectopic fat, which, in turn, often results from a mismatch between early adipogenesis and later lipogenesis, or between prenatal and postnatal weight gain. The key features of adolescent PCOS are menstrual irregularity and androgen excess (hirsutism, acne, and/or high testosterone). Adolescent PCOS is frequently preceded by rapid maturation (early variants of adrenarche/pubarche and puberty/menarche, also accelerated by ectopic fat) and is diagnosed between 2 and 8 years after menarche, thus during late adolescence or early adulthood. Treatment of adolescent PCOS should not only focus on symptoms, but also reduce the amount of ectopic fat, thereby aiming for an overall state of preconception health.

Practical considerations for diagnosis and treatment of polycystic ovary syndrome in adolescence - distilling guidelines into clinical practice.

The diagnostic criteria for polycystic ovary syndrome (PCOS) in adults may overdiagnose PCOS in adolescents. Since 2015, three guidelines have developed adolescent-specific diagnostic criteria and treatment recommendations. In this review, we compare and contrast the recommendations to assist in the practical application to clinical practice. The guidelines agree that hyperandrogenism with menstrual irregularity be diagnostic criteria for PCOS in adolescents yet have slight differences in how to diagnose hyperandrogenism and in the definition of menstrual irregularity. The diagnostic option of 'at risk for PCOS' is recommended for those girls presenting with criteria within 3 years of menarche or with hyperandrogenism without menstrual irregularity, with re-assessment later in adolescence. Lifestyle changes is first line treatment. Treatment with combined oral contraceptives or metformin is suggested, using patient characteristics and preferences to guide decision-making. PCOS is associated with long term reproductive and metabolic complications and will present during adolescence. Yet, diagnostic features may overlap with normal adolescent physiology. The recent guidelines strove to develop criteria to accurately identify girls with PCOS allowing early surveillance and treatment yet avoid overdiagnosis of normal adolescents.

PCOS in Adolescents-Ongoing Riddles in Diagnosis and Treatment.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a "two-hit" theory. This refers to a stepwise process in which the first "hit" is an inborn congenitally programmed predisposition, while the second "hit" arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21-45 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2-3 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard.