Polycystic ovary syndrome (PCOS) accounts for the vast majority of anovulatory symptoms and hyperandrogenism in women [1-3]. The diagnosis of PCOS has life-long implications with increased risk for infertility, metabolic syndrome, type 2 diabetes mellitus, and possibly cardiovascular disease [4,5]. It should be considered in any adolescent girl with hirsutism, persistent acne, menstrual irregularity, or obesity.
The definition, pathophysiology, and etiology of PCOS in adolescents will be presented here. The clinical features, diagnosis, and treatment of PCOS in adolescents are discussed separately. (See "Clinical features and diagnosis of polycystic ovary syndrome in adolescents" and "Treatment of polycystic ovary syndrome in adolescents".)
The classic syndrome originally was described by Stein and Leventhal as the association of amenorrhea with polycystic ovaries, and variably, hirsutism and obesity . It is now recognized that polycystic ovary syndrome (PCOS) represents a spectrum of disease characterized primarily by the following features:
- Cutaneous hyperandrogenism (eg, hirsutism, treatment-resistant acne, and/or male- or female-pattern balding [androgenetic alopecia])
- Menstrual irregularity (eg, oligo- or amenorrhea, or irregular bleeding)
- Polycystic ovaries (one or both)
- Obesity and insulin resistance
It is important to appreciate that PCOS is a syndrome, not a disease, reflecting multiple potential etiologies with variable clinical expression of these and other features in adolescents with PCOS. (See "Clinical features and diagnosis of polycystic ovary syndrome in adolescents".)