Polycystic ovarian syndrome (PCOS) is a common disorder characterized by ovulatory dysfunction and hyperandrogenemia (HA). Neuroendocrine abnormalities including increased gonadotropin-releasing hormone (GnRH) pulse frequency, increased luteinizing hormone (LH) pulsatility, and relatively decreased follicle stimulating hormone contribute to its pathogenesis. HA reduces inhibition of GnRH pulse frequency by progesterone, causing rapid LH pulse secretion and increasing ovarian androgen production. The origins of persistently rapid GnRH secretion are unknown but appear to evolve during puberty. Obese girls are at risk for HA and develop increased LH pulse frequency with elevated mean LH by late puberty. However, even early pubertal girls with HA have increased LH pulsatility and enhanced daytime LH pulse secretion, indicating the abnormalities may begin early in puberty. Decreasing sensitivity to progesterone may regulate normal maturation of LH secretion, potentially related to normally increasing levels of testosterone during puberty. This change in sensitivity may become exaggerated in girls with HA. Many girls with HA—especially those with hyperinsulinemia—do not exhibit normal LH pulse sensitivity to progesterone inhibition. Thus, HA may adversely affect LH pulse regulation during pubertal maturation leading to persistent HA and the development of PCOS.

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Background: The coronavirus disease 2019 (COVID-19) pandemic is straining health care worldwide with >31 million confirmed cases. Currently, 1 in every 100 U.S. residents and 245,000 in New York City are confirmed positive. The Bronx, with high-risk comorbidities, due in part to socioeconomic factors, has seen disproportionately higher rates of COVID-19related complications. Poor health care access is exacerbated as in-person visits now pose viral transmission risk. There has been limited discourse regarding widespread disparities underlying transitions to telemedicine. Methods: We review perspectives in recent literature on telemedicine and its potential within neurology. Results: While telemedicine has reduced strain on in-person visits, preliminary reflections highlight implementation successes and challenges. Conclusions: To provide effective care beyond this crisis, fundamental changes in training, technological accessibility, and health care policy are needed. We propose open access to telehealth training, screening of patient's potential technological inequities and socioeconomic insecurities, and advocacy to secure broad long-term access to telehealth care.

Day-to-night changes in LH pulse secretion are blunted in postmenarcheal obese adolescent girls. This phenomenon may in part reflect hyperandrogenemia.

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