title: Polycystic ovary syndrome in adolescent girls.
abstract: OBJECTIVE
  Polycystic ovary syndrome (PCOS) is a common heterogeneous disorder that appears to have its origins during the peripubertal years. The diagnostic conundrum is that the typical clinical features, irregular menses and acne, occur during normal female puberty. Understanding the physiologic origins and molecular basis of the dysregulated hypothalamic-pituitary-gonadal axis in PCOS is fundamental to interrupting the distinctive vicious cycle of hyperandrogenism and chronic anovulation.
  
  
  RESULTS
  Newer ultrasound technology with better spatial resolution has generated controversy regarding the optimal imaging criteria to define polycystic ovary morphology. Using such equipment, the Androgen Excess PCOS Society Task Force Report recommends a threshold of at least 25 follicles per ovary as the definition of polycystic ovary morphology. The implementation and results of genome-wide association studies has opened a new window into the pathogenesis of PCOS. Recent genome-wide association studies have identified several loci near genes involved in gonadotropin secretion, ovarian function, and metabolism. Despite the impediments posed by phenotypic and genetic heterogeneity among women with PCOS, investigation into one locus, the DENND1A gene, is providing insight into the ovarian steroidogenesis. Anti-Mullerian hormone (AMH) has long been recognized to play a major role in the ovarian dysfunction. Recent animal data implicate AMH in the neuroendocrine dysregulation by demonstrating AMH-stimulated increased gonadotropin releasing hormone and luteinizing hormone secretion.
  
  
  CONCLUSIONS
  PCOS is a common complex multifaceted disorder associated with genetic and environmental influences affecting steroidogenesis, steroid metabolism, neuroendocrine function, insulin sensitivity, pancreatic β cell function, and alternative adaptations to energy excess. Current research into the genetics and pathophysiology is reviewed. The difficulties inherent in diagnosing PCOS in adolescent girls are discussed.
authors.affiliation: Division of Pediatric Endocrinology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
authors.forename: Natalie Hecht
authors.initials: NH
authors.lastname: Baldauff
authors.forename: Selma Feldman
authors.initials: SF
authors.lastname: Witchel
mesh_terms: D000293:Adolescent; D000818:Animals; D000858:Anovulation; D054304:Anti-Mullerian Hormone / Q000502:physiology; D053418:Death Domain Receptor Signaling Adaptor Proteins / Q000235:genetics; D005260:Female; D055106:Genome-Wide Association Study; D007987:Gonadotropin-Releasing Hormone; D020662:Guanine Nucleotide Exchange Factors / Q000235:genetics; D006801:Humans; D017588:Hyperandrogenism / Q000503:physiopathology; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008599:Menstruation Disturbances; D010053:Ovary / Q000503:physiopathology; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D011627:Puberty
chemical_list: C571984:DENND1A protein, human; D053418:Death Domain Receptor Signaling Adaptor Proteins; D020662:Guanine Nucleotide Exchange Factors; D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone