Clinical review: Identifying children at risk for polycystic ovary syndrome.
BACKGROUND
Polycystic ovary syndrome (PCOS) appears to arise as a complex trait with contributions from both heritable and nonheritable 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.


METHODS
This study consisted of 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 physiological 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.


CONCLUSIONS
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.
Rosenfield
Robert L
RL
The University of Chicago Pritzker School of Medicine, Department of Pediatrics, Chicago, Illinois 60637, USA. robros@peds.bsd.uchicago.edu
D000293:Adolescent; D050499:Adrenarche / Q000502:physiology; D000858:Anovulation / Q000209:etiology; D002648:Child; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000503:physiopathology; D008954:Models, Biological; D009765:Obesity / Q000209:etiology; D010053:Ovary / Q000503:physiopathology; D010902:Pituitary Gland / Q000503:physiopathology; D011085:Polycystic Ovary Syndrome / Q000151:congenital / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011629:Puberty, Precocious / Q000209:etiology; D012307:Risk Factors