An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence
Top Cited Papers
Open Access
- 1 June 2017
- journal article
- research article
- Published by S. Karger AG in Hormone Research in Paediatrics
- Vol. 88 (6), 371-395
- https://doi.org/10.1159/000479371
Abstract
This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)1. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.Keywords
This publication has 234 references indexed in Scilit:
- Genome-Wide Methylated DNA Immunoprecipitation Analysis of Patients with Polycystic Ovary SyndromePLOS ONE, 2013
- Dietary Composition in the Treatment of Polycystic Ovary Syndrome: A Systematic Review to Inform Evidence-Based GuidelinesJournal of the Academy of Nutrition and Dietetics, 2013
- Diacylglycerol Activation of Protein Kinase Cε and Hepatic Insulin ResistanceCell Metabolism, 2012
- Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop GroupFertility and Sterility, 2012
- Polycystic ovary syndrome: an ancient disorder?Fertility and Sterility, 2011
- Depolarising and Hyperpolarising Actions of GABAA Receptor Activation on Gonadotrophin-Releasing Hormone Neurones: Towards an Emerging ConsensusJournal of Neuroendocrinology, 2011
- Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysisFertility and Sterility, 2011
- Divergent roles of growth factors in the GnRH regulation of puberty in miceJCI Insight, 2010
- Utility of Early Insulin Response and Proinsulin to Assess Insulin ResistanceThe Journal of Pediatrics, 2009
- Visually scoring hirsutismHuman Reproduction Update, 2009