Management of Adolescent Hyperandrogenism: Still a Challenge?

  • Charles SultanEmail author
  • Laura Gaspari
  • Laurent Maïmoun
  • Nicolas Kalfa
  • Françoise Paris
Part of the ISGE Series book series (ISGE)


Androgen excess in adolescent girls produces a variety of clinical signs that must be appropriately recognized, evaluated, and treated. Hyperandrogenism must be considered in any adolescents with excessive development of acne, hirsutism, menstrual irregularities, abdominal obesity, or masculinization of the body habitus. Management of adolescent girls with hyperandrogenism is sometimes difficult and must distinguish the so-called physiological hyperandrogenism that occurs during puberty, especially in obese girls, from an endocrine pathology. We also have to eliminate severe causes of hyperandrogenism, such as ovarian tumors and nonclassical congenital adrenal hyperplasia. In about 30% of cases, PCOS is revealed by peri-pubertal hyperandrogenism. Its diagnostic criteria should follow the international consensus. Other causes include abdominal obesity and hypersensitivity to androgens. Each diagnosis implies a specific treatment to reduce clinical signs as well as psychological concerns of hyperandrogenism.


Adolescent hyperandrogenism Hirsutism PCOS NC-CAH Abdominal obesity 


  1. 1.
    Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, Pugeat M, Qiao J, Wijeyaratne CN, Witchel SF, Norman RJ. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012;18(2):146–70. Epub 2011 Nov 6CrossRefPubMedGoogle Scholar
  2. 2.
    West S, Lashen H, Bloigu A, Franks S, Puukka K, Ruokonen A, Järvelin MR, Tapanainen JS, Morin-Papunen L. Irregular menstruation and hyperandrogenaemia in adolescence are associated with polycystic ovary syndrome and infertility in later life: Northern Finland Birth Cohort 1986 study. Hum Reprod. 2014;29(10):2339–51. Epub 2014 Aug 1CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Pinola P, Lashen H, Bloigu A, Puukka K, Ulmanen M, Ruokonen A, Martikainen H, Pouta A, Franks S, Hartikainen AL, Järvelin MR, Morin-Papunen L. Menstrual disorders in adolescence: a marker for hyperandrogenaemia and increased metabolic risks in later life? Finnish general population-based birth cohort study. Hum Reprod. 2012;27(11):3279–86. Scholar
  4. 4.
    Anderson AD, Solorzano CM, McCartney CR. Childhood obesity and its impact on the development of adolescent PCOS. Semin Reprod Med. 2014;32(3):202–13. Scholar
  5. 5.
    Fénichel P, Paris F, Philibert P, Hiéronimus S, Gaspari L, Kurzenne JY, Chevallier P, Bermon S, Chevalier N, Sultan C. Molecular diagnosis of 5α-reductase deficiency in 4 elite young female athletes through hormonal screening for hyperandrogenism. J Clin Endocrinol Metab. 2013;98(6):E1055–9. Scholar
  6. 6.
    Navarro G, Allard C, Xu W, Mauvais-Jarvis F. The role of androgens in metabolism, obesity, and diabetes in males and females. Obesity (Silver Spring). 2015;23(4):713–9. Epub 2015 Mar 6CrossRefGoogle Scholar
  7. 7.
    Catteau-Jonard S, Cortet-Rudelli C, Richard-Proust C, Dewailly D. Hyperandrogenism in adolescent girls. Endocr Dev. 2012;22:181–93. Epub 2012 Jul 25.CrossRefPubMedGoogle Scholar
  8. 8.
    Elhassan YS, Idkowiak J, Smith K, Asia M, Gleeson H, Webster R, Arlt W, O’Reilly MW. Causes, patterns, and severity of androgen excess in 1205 consecutively recruited women. J Clin Endocrinol Metab. 2018;103(3):1214–23. Scholar
  9. 9.
    Rothenberg SS, Beverley R, Barnard E, Baradaran-Shoraka M, Sanfilippo JS. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018;48:103–14. Epub 2017 Sep 1CrossRefPubMedGoogle Scholar
  10. 10.
    Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibáñez L, Pena A, Horikawa R, Gomez-Lobo V, Joel D, Tfayli H, Arslanian S, Dabadghao P, Garcia Rudaz C, Lee PA. The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr. 1 Apr 2015.Google Scholar
  11. 11.
    Sultan C, Paris F. Clinical expression of polycystic ovary syndrome in adolescent girls. Fertil Steril. 2006;86(Suppl 1):S6.CrossRefGoogle Scholar
  12. 12.
    Trimèche S, Thuan Dit Dieudonne JF, Jeandel C, Paris F, Simoni-Brum I, Orio F, Sultan C. Polycystic ovary syndrome in pubertal period: clinical, biological, metabolic and genetic polymorphism. Gynecol Obstet Fertil. 2004;32(1):3–17.CrossRefGoogle Scholar
  13. 13.
    Pal Singh Kochar I, Ramachandran S, Sethi A. Metformin in adolescent PCOS: the way forward. Pediatr Endocrinol Rev. 2017;15(2):142–6. Scholar
  14. 14.
    Carmina E, Dewailly D, Escobar-Morreale HF, Kelestimur F, Moran C, Oberfield S, Witchel SF, Azziz R. Non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency revisited: an update with a special focus on adolescent and adult women. Hum Reprod Update. 2017;23(5):580–99. Scholar
  15. 15.
    Azziz R, Carmina E, Sawaya ME. Idiopathic hirsutism. Endocr Rev. 2000;21(4):347–62.PubMedGoogle Scholar
  16. 16.
    Maimoun L, Philibert P, Bouchard P, Ocal G, Leheup B, Fenichel P, Servant N, Paris F, Sultan C. Primary amenorrhea in four adolescents revealed 5α-reductase deficiency confirmed by molecular analysis. Fertil Steril. 2011;95(2):804.e1–5. Scholar
  17. 17.
    Lizneva D, Gavrilova-Jordan L, Walker W, Azziz R. Androgen excess: investigations and management. Best Pract Res Clin Obstet Gynaecol. 2016;37:98–118. Epub 2016 May 19CrossRefGoogle Scholar
  18. 18.
    Pugeat M, Plotton I, de la Perrière AB, Raverot G, Déchaud H, Raverot V. Hyperandrogenic states in women: pitfalls in laboratory diagnosis. Eur J Endocrinol. 2018;178(4):R141–54. Epub 2018 Feb 16CrossRefPubMedGoogle Scholar
  19. 19.
    Unluhizarci K, Kaltsas G, Kelestimur F. Non polycystic ovary syndrome-related endocrine disorders associated with hirsutism. Eur J Clin Invest. 2012;42(1):86–94. Epub 2011 May 30CrossRefPubMedGoogle Scholar
  20. 20.
    Sultan C, Gaspari L, Paris F. Management of adolescent hyperandrogenism. In: Genazzani AR, editor. Frontiers in gynecological endocrinology, ISGE series. Cham: Springer; 2015. p. 33–9.CrossRefGoogle Scholar

Copyright information

© International Society of Gynecological Endocrinology 2019

Authors and Affiliations

  • Charles Sultan
    • 1
    • 2
    Email author
  • Laura Gaspari
    • 1
  • Laurent Maïmoun
    • 2
    • 3
  • Nicolas Kalfa
    • 2
    • 4
  • Françoise Paris
    • 1
    • 2
  1. 1.Pediatric Endocrinology and Gynecology Unit, Department of PediatricsArnaud de Villeneuve Hospital, CHU Montpellier, Montpellier UniversityMontpellierFrance
  2. 2.University of MontpellierMontpellierFrance
  3. 3.Department of Nuclear MedicineLapeyronie Hospital, CHU Montpellier, Montpellier UniversityMontpellierFrance
  4. 4.Department of Pediatric Surgery and UrologyLapeyronie Hospital, CHU Montpellier, Montpellier UniversityMontpellierFrance

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