Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women. Like women with PCOS, affected adolescents often present with irregular menses, hirsutism, and acne. Despite widespread agreement that the metabolic derangements of PCOS arise during puberty, the diagnosis is made more often in adults than in adolescents.
Adolescents with PCOS are at risk for dyslipidemia, hypertension, type 2 diabetes mellitus, infertility as adults, and coronary artery disease in adulthood. Prompt diagnosis is essential to optimize therapy, establish healthy diet and exercise, and prevent potential health consequences.
Obesity is not a cause of PCOS, but it exacerbates many of the symptoms. Acanthosis nigricans may be seen in adolescents with PCOS, particularly those who are obese. The velvety hyperpigmentation and thickening of the skin is often localized to the intertriginous areas such as the back of the neck, as seen here in a 13-year-old obese girl with metabolic syndrome.