From the Guidelines
Polycystic ovary syndrome (PCOS)-like conditions in the pediatric population typically present as premature pubarche, hirsutism, acne, menstrual irregularities, and obesity in adolescent girls, and management should focus on lifestyle modifications and hormonal therapy to prevent long-term metabolic complications, as suggested by the most recent study 1.
Conditions and Presentation
These conditions include premature adrenarche, functional ovarian hyperandrogenism, and congenital adrenal hyperplasia. The presentation of these conditions can be similar to PCOS, but the pathophysiology and exact mechanisms may differ, especially during pubertal development.
Management and Treatment
Management focuses on lifestyle modifications with weight management through balanced nutrition and regular physical activity as the cornerstone of treatment. Hormonal therapy may be indicated, with combined oral contraceptives containing ethinyl estradiol (20-35 mcg) with anti-androgenic progestins like drospirenone or norgestimate being first-line for menstrual regulation and hyperandrogenism.
- Metformin (500-1000 mg twice daily) may be added for insulin resistance, particularly in overweight patients, as insulin resistance is a key factor in the development of metabolic complications, as seen in studies 1.
- Anti-androgens such as spironolactone (50-200 mg daily) can be used for persistent hirsutism or acne, but must be combined with contraception due to teratogenicity risks.
Importance of Early Intervention
Early intervention is crucial as these conditions can lead to metabolic complications, including insulin resistance, dyslipidemia, and increased cardiovascular risk. The pathophysiology often involves hyperandrogenism, insulin resistance, and hypothalamic-pituitary-ovarian axis dysfunction, though the exact mechanisms differ from adult PCOS and continue to evolve during pubertal development, as discussed in 1 and further elaborated in the most recent study 1.
From the Research
PCOS-like Conditions in the Pediatric Population
- PCOS-like conditions in the pediatric population are characterized by hyperandrogenic anovulation, which can be indicated by abnormal uterine bleeding, persistent elevation of serum testosterone, and moderate-severe hirsutism or acne vulgaris 2.
- The diagnosis of PCOS in adolescents is based on otherwise unexplained persistent hyperandrogenic anovulation using age- and stage-appropriate standards 2.
- Treatment of PCOS is symptom-directed, with cyclic estrogen-progestin oral contraceptives being the preferred first-line medical treatment for improving menstrual abnormality and hyperandrogenism 2.
Clinical Presentation and Diagnostic Evaluation
- Clinical presentation of PCOS in adolescents may include menstrual irregularity, obesity, hirsutism, acne, and acanthosis nigricans 3, 4.
- Diagnostic evaluation for PCOS should include assessment of hyperandrogenism, anovulation, and exclusion of other primary etiologies for amenorrhea 5, 6.
- Laboratory measurements, such as serum testosterone and hemoglobin A1c, and physical examination findings, such as hirsutism and acne, are important components of the diagnostic evaluation 3, 4.
Management Strategies
- Management strategies for PCOS in adolescents include lifestyle modification, such as calorie restriction and increased exercise, and medical treatment, such as oral contraceptive pills and metformin 2, 5, 3.
- A multidisciplinary approach to care, including endocrinology, gynecology, dermatology, psychology, and nutrition, can provide comprehensive care for adolescents with PCOS 3.
- Prescribing patterns for PCOS treatment may vary among pediatric subspecialties, with endocrinologists more likely to prescribe metformin and gynecologists more likely to prescribe oral contraceptive pills 5.