Insulin sensitizers in adolescents with polycystic ovary syndrome

Polycystic Ovary Syndrome in Adolescence: Challenges in Diagnosis and Management

“…7 Since there is a considerable convergence between normal pubertal milestones (such as acne, irregular menses, and polycystic ovaries) and PCOS phenotypes, experts considered the ahead criteria (NIH, Rotterdam and AES criteria) led to an overdiagnosis within this age group. 1 Therefore, several societies started including adolescents as a specific group within their guidelines for the diagnosis of PCOS. 7,10,13 The Amsterdam criteria, in 2012, was the first official consensus directed toward the specificities of adolescents, 13,14 followed by the Endocrine Society (ES) guidelines in 2013 13 and by an adolescent-specific expert consensus by the Pediatric Endocrine Society (PES) in 2015.…”

“…33 Nevertheless, there is a high degree of relapse and a suboptimal adherence. 1,32,34 As for therapeutic interventions, COCs with 20 to 35 µg of ethinylestradiol combined with a progestin are widely recommended as first-line pharmacological treatment. These agents target both menstrual dysfunction and clinical manifestations of hyperandrogenism, further providing hormonal contraception.…”

“…In fact, COCs are considered the most Abbreviations: BMI, body mass index; COC, combined oral contraceptive; FG, Ferriman Gallwey; IR, insulin resistance. Source: Le et al, 1 Ibáñez et al, 3 Fitzgerald et al, 4 Trent and Gordon, 5 DiVall and Merjaneh, 10 Kostopoulou et al, 11 Peña et al, 16 Morin-Papunen, 18 Pal Singh Kochar et al, 31 Pkhaladze et al, 32 Abdolahian et al 33 and Wong et al 34 effective treatment for hirsutism, with up to 70% improvement in unwanted hair growth. 5,10 Nevertheless, insulin sensitivity does not change.…”

“…31 Some authors do not recommend other insulin sensitizers, such as thiazolidinediones, for the treatment of PCOS in adolescents due to safety concerns, but this is also controversial. 1,11 Since adolescent girls with PCOS require long-term treatments, alternative therapies with less unwanted effects are under investigation (►Chart 3). 1,4,5,23,32 Even though data in adolescents is still very limited and further studies are needed, the following seem to be the most promising options.…”

“…2 Although the pathophysiology of PCOS remains unclear, it may result from multiple interactions (►Fig. 1) leading to heterogeneous manifestations among patients. 2,3 Even though it seems to mimic an autosomal dominant trait with variable penetrance, no single gene has yet been identified as responsible for all manifestations.…”