Hyperuricemia is part of the "metabolic syndrome". The aim of this study was to investigate the regulation and role of serum uric acid in the cardiovascular risk factor profile of obese children and adolescents. Serum levels of uric acid and selected risk factors and hormones were determined in 269 children aged 10.0-15.9 years with a BMI >90th percentile (mean 24.0 kg/m2, SD 5.43). Stepwise regression adjusted for age and sex revealed that testosterone (p < 0.0001), BMI (p < 0.0001), systolic blood pressure (p < 0.0017), triglycerides (p < 0.0345) and cholesterol/HDL ratio (p < 0.0393) were positively correlated with serum uric acid and accounted for 42.1% of the variance. Additional regression models with the same set of variables indicated that uric acid contributed significantly to levels of cholesterol/HDL, total cholesterol, BMI and systolic blood pressure, respectively. These results suggest a not yet described impact of androgens in the regulation of serum uric acid in obese children and adolescents. Furthermore, they show that uric acid is a reliable indicator for the "pre-metabolic syndrome" in obese youths.