Approach to the Girl with Early Onset of Pubic Hair

Oberfield, Sharon E.; Sopher, Aviva B.; Gerken, Adrienne T.

doi:10.1210/jc.2011-0225

Cited by 67 publications

(36 citation statements)

References 79 publications

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“…Hence, it is reasonable to hypothesize that altered gonadotropin secretory profiles could impact the cardinal features of PCOS, including hyperandrogenism and ovulatory dysfunction [3, 4]. In fact, increased circulating LH levels, increased LH:FSH ratios, elevated LH pulse frequency and/or amplitude, as well as relatively decreased FSH levels have been typically described in women with PCOS [3, 65].…”

Section: A Pathophysiologymentioning

confidence: 99%

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An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

Ibáñez¹,

et al. 2017

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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.

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Section: A Pathophysiologymentioning

confidence: 99%

“…Further, the early onset of adrenarche may represent the initial clinical feature of PCOS for some girls [4]. By the time patients present for medical attention, this multisystem disorder often has become a self-perpetuating derangement in which identification of initiating factors are difficult.…”

Section: Introductionmentioning

confidence: 99%

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

Ibáñez¹,

et al. 2017

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“…It is primarily characterized by ovulatory dysfunction and hyperandrogenism (1,2), but the clinical presentation is heterogeneous and patients may present some of various signs and symptoms (Table 1). This heterogeneity seems to be modulated by multiple factors, such as prenatal androgen exposure, nutritional status in the uterus, genetic factors, as well as ethnicity, insulin resistance of puberty and/or exaggerated adrenarche and changes in body weight (4)(5)(6). Environmental factors, such as obesity, appear to exacerbate the underlying genetic predisposition.…”

Section: Introductionmentioning

confidence: 99%

Polycystic ovary syndrome: reviewing diagnosis and management of metabolic disturbances

Spritzer

2014

Arq Bras Endocrinol Metab

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Polycystic ovary syndrome (PCOS) is a common condition in women at reproductive age associated with reproductive and metabolic dysfunction. Proposed diagnosed criteria for PCOS include two out of three features: androgen excess, menstrual irregularity, and polycystic ovary appearance on ultrasound (PCO), after other causes of hyperandrogenism and dysovulation are excluded. Based on these diagnostic criteria, the most common phenotypes are the "classic PCOS" -hyperandrogenism and oligomenorrhea, with or without PCO; the "ovulatory phenotype" -hyperandrogenism and PCO in ovulatory women; and the "non-hyperandrogenic phenotype" , in which there is oligomenorrhea and PCO, without overt hyperandrogenism. The presence of obesity may exacerbate the metabolic and reproductive disorders associated with the syndrome. In addition, PCOS women present higher risk for type 2 diabetes and higher prevalence of cardiovascular risk factors that seems to be associated with the classic phenotype. The main interventions to minimize cardiovascular and metabolic risks in PCOS are lifestyle changes, pharmacological therapy, and bariatric surgery. Treatment with metformin has been shown to improve insulin sensitivity, lowering blood glucose and androgen levels. These effects are more potent when combined with lifestyle interventions. In conclusion, besides reproductive abnormalities, PCOS has been associated to metabolic comorbidities, most of them linked to obesity. Confounders, such as the lack of standard diagnostic criteria, heterogeneity of the clinical presentation, and presence of obesity, make management of PCOS difficult. Therefore, the approach to metabolic abnormalities should be tailored to the risks and treatment goals of each individual woman. Arq Bras Endocrinol Metab. 2014;58(2):182-7 Keywords PCOS; obesity; insulin resistance; metformin RESUMO A síndrome dos ovários policísticos (PCOS) é um distúrbio frequente em mulheres em idade reprodutiva, associado com disfunção reprodutiva e metabólica. Os critérios diagnósticos atuais para PCOS incluem pelo menos dois dos três seguintes: hiperandrogenismo, irregularidade menstrual e aparên-cia policística dos ovários à ultrassonografia (PCO), após exclusão de outras causas de hiperandrogenismo e anovulação. Com base nesses critérios diagnósticos, os fenótipos mais comuns são "PCOS clássico"-hiperandrogenismo e oligomenorreia, com ou sem PCO; o "fenótipo ovulatório" -hiperandrogenismo e PCO em mulheres ovulatórias; e o "fenótipo não hiperandrogênico"-no qual ocorrem oligomenorreia e PCO sem hiperandrogenismo evidente. A presença de obesidade pode exacerbar os distúrbios metabólicos e reprodutivos associados com a síndrome. Além disso, mulheres com PCOS apresentam maior risco para diabetes tipo 2 e maior prevalência de fatores de risco cardiovascular, que parecem estar associados com o fenótipo clássico. As principais intervenções para minimizar riscos metabólicos e cardiovasculares em PCOS são mudanças de estilo de vida, tratamento farmacológico e cirurgia bariátrica. O tr...

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“…Activation of CYP17A1 in the adrenal reticular region leads to an increase levels of DHEA [24]. A study has demonstrated the increased size of the adrenal reticular band and increased in normal adolescent P450c17α activity to increase the synthesis of DHEA, which is onset of premature adrenal function to the process of PCOS [25]. The adrenal androgens have feedback effect on increasing the hypothalamic secretion of LH, which, in turn, leads to increase the synthesis of ovarian androgen.…”

Section: Adrenal Dysfunctionmentioning

confidence: 99%

Diagnosis, Pathogenesis and Management of Polycystic Ovary Syndrome

Wang¹

2017

Testes and Ovaries - Functional and Clinical Differences and Similarities

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Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine diseases occurs among women of childbearing age, which is affected by many factors, but its precise pathophysiology has not yet been determined. The heterogeneous of PCOS is reflected in its complex endocrine dysfunction of the hypothalamic-pituitarygonadal axis (HPG axis) and its multiple clinical features, such as obesity, insulin resistance, hyperandrogenism and anovulation. Meanwhile, women with PCOS also have an increased risk of major cardiovascular events, most notably type 2 diabetes, cardiovascular disease and atherosclerosis. So far, many therapies are available for improving reproductive and metabolic abnormalities in PCOS patients, in which lifestyle modification and insulin-sensitizing agents are more effective management strategies.

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Approach to the Girl with Early Onset of Pubic Hair

Cited by 67 publications

References 79 publications

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

Polycystic ovary syndrome: reviewing diagnosis and management of metabolic disturbances

Diagnosis, Pathogenesis and Management of Polycystic Ovary Syndrome

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