Adolescent PCOS: a postpubertal central obesity syndrome

Adolescent polycystic ovary syndrome (PCOS) has long been thought to be a gynecological disorder. However, emerging evidence suggests that it is not a disorder but a reversible, endocrine mode in response to ectopic fat. A simple way of screening for ectopic fat is to verify whether there has been an upward percentile crossing from weight at birth to body mass index (BMI) in adolescence.Adolescent PCOS has so far been viewed as a disorder starting post menarche. The present view is that adolescent PCOS can only be understood by looking backward into early life: relatively high concentrations of circulating luteinizing hormone (LH), thyroid-stimulating hormone (TSH), free T3, testosterone, dehydroepiandrosterone sulfate (DHEAS), and/or fasting insulin are reminiscent of a childhood wherein the same adaptive responses to ectopic fat enabled girls to accelerate their growth and maturation (with early pubarche/puberty/menarche) to outgrow their ectopic fatness and generate evolutionary fitness.The definition of adolescent PCOS continues to be a matter of debate. We propose to merge the latest definitions of adolescent PCOS into a single set of diagnostic criteria.Traditional treatment of adolescent PCOS focuses on symptoms. There is now evidence that treatment should also target ectopic fat and ultimately aim for preconception health. Adolescent polycystic ovary syndrome (PCOS) is a highly prevalent, reversible, endocrine-metabolic mode essentially driven by ectopic fat, which, in turn, often results from a mismatch between early adipogenesis and later lipogenesis, or between prenatal and postnatal weight gain. The key features of adolescent PCOS are menstrual irregularity and androgen excess (hirsutism, acne, and/or high testosterone). Adolescent PCOS is frequently preceded by rapid maturation (early variants of adrenarche/pubarche and puberty/menarche, also accelerated by ectopic fat) and is diagnosed between 2 and 8 years after menarche, thus during late adolescence or early adulthood. Treatment of adolescent PCOS should not only focus on symptoms, but also reduce the amount of ectopic fat, thereby aiming for an overall state of preconception health.