Hyperinsulinaemic androgen excess in adolescent girls.
Hyperinsulinaemic androgen excess is the most common cause of hirsutism, acne and menstrual irregularity in adolescent girls. Here, we propose that the disorder frequently originates from an absolute or relative excess of lipids in adipose tissue, and from associated changes in insulin sensitivity, gonadotropin secretion and ovarian androgen release. Girls from populations with genotypes attuned to nutritionally harsh conditions seem to be particularly vulnerable to the development of hyperinsulinaemic androgen excess in today's obesogenic environment. We propose that hirsutism, hyperandrogenaemia and menstrual irregularity (≥2 years after menarche) is used as a diagnostic triad for the disorder. No pharmacological therapy has been approved for girls with androgen excess; however, lifestyle intervention is essential to reduce adiposity. In girls without obesity who are not sexually active, insulin sensitization has more broadly normalizing effects than estradiol-progestogen combinations. The early recognition of girls at risk of developing hyperinsulinaemic androgen excess might enable prevention in childhood.
Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
Lourdes
L
Ibáñez
MRC Epidemiology Unit, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK.
Ken K
KK
Ong
Paediatric Endocrinology, Dr Josep Trueta Hospital and Girona Institute for Biomedical Research, Avenue de França s/n, 17007 Girona, Spain.
Abel
A
López-Bermejo
Department of Paediatrics, Box 116, Level 8, Addenbrooke's Hospital Hills Road, University of Cambridge, Cambridge CB2 0QQ, UK.
David B
DB
Dunger
Paediatric Endocrinology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
Francis
F
de Zegher
D000293:Adolescent; D000728:Androgens / Q000096:biosynthesis*; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000175:diagnosis; D005260:Female; D005485:Flutamide / Q000627:therapeutic use; D006628:Hirsutism / Q000188:drug therapy; D006801:Humans; D017588:Hyperandrogenism / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006946:Hyperinsulinism / Q000188:drug therapy*; D008599:Menstruation Disturbances / Q000175:diagnosis; D008687:Metformin / Q000627:therapeutic use; D009765:Obesity / Q000150:complications*; D000077205:Pioglitazone; D045162:Thiazolidinediones / Q000008:administration & dosage
D000728:Androgens; D045162:Thiazolidinediones; D005485:Flutamide; D008687:Metformin; D000077205:Pioglitazone