PCOS and common androgen abnormalities in adolescents

Creator(s)

Tania S. Burgert, Children's Mercy HospitalFollow
Emily Paprocki, Children's Mercy Kansas CityFollow

Document Type

Book Chapter

Publication Date

2025

Identifier

DOI: 10.1016/B978-0-443-10512-8.00028-X

Abstract

Hyperandrogenism is an important feature of the PCOS diagnosis in adolescents. This chapter reviews the clinical and biochemical manifestations of hyperandrogenism and how they relate to the pathophysiology of PCOS. Other common endocrine conditions that present with hyperandrogenism such as congenital adrenal hyperplasia and insulin resistance syndromes are also discussed. The PCOS diagnosis in adolescents is based on two clinical entities: hyperandrogenism (clinical or biochemical) and menstrual dysregulation, under exclusion of other conditions known to present with similar symptoms. Adolescents with only one of these features can be considered “at risk” of PCOS and should be followed and treated according to symptomatology. PCOS is marked by insulin resistance which increases the risk of comorbidities such as type 2 diabetes mellitus. Common recommended treatment options include life-style counseling/coaching, low dose combined oral contraceptives or metformin, either as single agents or in combination. Given the variability of symptoms and individual concerns, shared decision making is the advocated therapeutic management style. Non-classical congenital adrenal hyperplasia (NCCAH) in adolescents often presents with hirsutism and menstrual dysfunction. Unlike classical congenital adrenal hyperplasia, NCCAH is rarely diagnosed on newborn screen and is clinically often undistinguishable from PCOS. Given that NCCAH is due to an adrenal enzyme defect that results in a build-up of pre-curser steroidogenic hormones, 17-hydroxyprogesterone levels are recommended in all adolescents presenting with hirsutism and menstrual dysregulation to rule in or rule out NCCAH. Genetic syndromes of insulin resistance can present with menstrual disturbance and hirsutism and are only clinically distinct from PCOS by their degree of insulin resistance and should be considered in those with severe acanthosis.

Journal Title

NASPAG Essentials of Pediatric & Adolescent Gynecology

First Page

190

Last Page

204

Recommended Citation

Burgert TS, Paprocki E. PCOS and common androgen abnormalities in adolescents. NASPAG Essentials of Pediatric & Adolescent Gynecology. Published online 2025:190-204. doi:10.1016/b978-0-443-10512-8.00028-x