PCOS in adolescence: Diagnostic dilemmas and management considerations

Abstract

Polycystic ovary syndrome (PCOS) is a difficult diagnosis in adolescents due to overlapping symptoms of puberty. However, signs and symptoms of PCOS arise in the peri-pubertal years; therefore, irregular menses in adolescents should be addressed by thorough evaluation. Establishing the presence of hyperandrogenemia is key to the diagnosis of PCOS in adolescents, although controversy exists about the accuracy and comparability of testosterone testing across laboratories. Insulin resistance is closely linked to the pathophysiologic perpetuation of the condition and is targeted by safe and effective treatment with metformin. Other treatments include oral contraceptive pills and anti-androgens. Given that there are no long-term treatment studies on the effects of different treatment modalities as they apply to obese and non-obese phenotypes of adolescent PCOS, current management is guided by the general therapeutic principles of these drugs, targeting the individual phenotype. More treatment and long-term outcome studies need to be performed for this age group in order to gain a better understanding of the benefits of early intervention in terms of medical sequelae.