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This version published online on December 19, 2006
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2006-2012
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Submitted on September 13, 2006
Accepted on December 7, 2006

Identifying Children at Risk for Polycystic Ovary Syndrome

Robert L Rosenfield MD*

The University of Chicago Pritzker School of Medicine, Department of Pediatrics, Section of Pediatric Endocrinology, The University of Chicago Comer Children's Hospital, 5841 S Maryland Ave, MC-5053, Chicago, IL 60637, Phone: 773-702-6432, Fax: 773-702=0443, E-mail: robros@peds.bsd.uchicago.edu

* To whom correspondence should be addressed. E-mail: robros{at}peds.bsd.uchicago.edu.

Context: Polycystic ovary syndrome (PCOS) appears to arise as a complex trait with contributions from both heritable and non-heritable factors. Polygenic influences appear to account for about 70% of the variance in pathogenesis. In view of this evidence for congenital contributions to the syndrome, childhood manifestations may be expected.

Objective: The objective has been to review the evidence that risk factors for PCOS can be recognized in childhood.

Design/Setting: Screening of the PCOS literature for articles pertaining to potential childhood and adolescent antecedents.

Results: Congenital virilizing disorders; above-average or low birth-weight for gestational age; premature adrenarche, particularly exaggerated adrenarche; atypical sexual precocity; or intractable obesity with acanthosis nigricans, metabolic syndrome, and pseudo-Cushing syndrome or pseudo-acromegaly in early childhood have been identified as independent prepubertal risk factors for the development of PCOS. During adolescence, PCOS may masquerade as physiologic adolescent anovulation. Asymptomatic adolescents with a polycystic ovary occasionally (8%) have subclinical PCOS, but often (42%) have a subclinical PCOS-type of ovarian dysfunction, the prognosis for which is unclear.

Conclusion: Identifying children at risk for PCOS offers the prospect of eventually preventing some of the long-term complications associated with this syndrome once our understanding of the basis of the disorder improves.
Key words: adolescent anovulation • birth-weight • congenital virilization • obesity • polycystic ovary • premature adrenarche • premature puberty • pseudo-acromegaly • pseudo-Cushing syndrome




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