Objective: Hyperandrogenia and insulin resistance are heritable family traits, likely to cluster in children of PCOS mothers.

Design: We performed a case control study of PCOS children (N =32) compared to children from control women (N = 38) for reproductive and metabolic abnormalities, stratifying results by three Tanner stage groupings. The children underwent history and physical examinations, a 3-hour timed urine collection, and a 2-hour oral glucose tolerance test, and abdominal ultrasound exam (females only). Serum was obtained in older children (Age > 8y) who consented.

Results: Urine LH levels were significantly lower in the Tanner 4–5 PCOS girls compared to controls (P = 0.04). Urine testosterone levels were significantly elevated in Tanner 2–3 PCOS boys compared to controls (P = 0.007). There were no significant differences in DHEA levels. We validated the correlation between salivary and serum levels of insulin (Insulin AUCs) in an adult population (N =30, Pearson correlation coefficient (r) = 0.67, P < 0.0001) which also replicated in the children (2h insulin r = 0.57, P = 0.0004). Mean AUC salivary insulin levels were significantly higher in the Tanner 4–5 PCOS girls in the later stages of puberty when compared to controls (3625 ± 1372 vs. 1766 ± 621 min\xµU/mL, 95% confidence interval 475-3242, P < 0.02).

Conclusions: Hyperinsulinism may be a familial characteristic of PCOS children (or at least girls), but does not appear until the later stages of puberty. Other reproductive abnormalities that characterize PCOS may develop later.