Detection of insulin resistance and its treatment in adolescents with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) appears to be a lifelong disorder. The stigmata of insulin resistance, including obesity and premature adrenarche, may be early forms of its presentation. Girls with premature pubarche, characterized by elevated dehydroepiandrosterone levels and hyperinsulinemia, are at high risk for developing the full PCOS phenotype, including ovarian hyperandrogenism and chronic anovulation. Because PCOS is associated with a 40% prevalence of abnormal glucose tolerance, every adolescent patient should be evaluated regularly for glucose intolerance with a 2-hour oral glucose tolerance test and for lipid abnormalities with a fasting lipid profile. The role of insulin-sensitizing medications such as metformin in adolescents with PCOS is unclear; short-term studies suggest that these agents improve circulating androgens and ovulatory frequency. Primary prevention of diabetes mellitus and cardiovascular disease by lifestyle modification, including regular exercise and a balanced diet, is particularly important in adolescents, who have the opportunity to establish healthy habits before entering adulthood. The findings of diabetes prevention trials suggest that these interventions may be more efficacious than pharmacological therapy.