POLYCYSTIC OVARY SYNDROME: ORIGINS AND IMPLICATIONS: The significance of functional adrenal hyperandrogenism in polycystic ovary syndrome across the lifespan.

In brief: The adrenal glands are an additional source of hyperandrogenemia in a significant proportion of women with polycystic ovary syndrome (PCOS). This review presents the evidence for the role of adrenal hyperandrogenism in the development and clinical manifestations of the syndrome across the lifetime. Abstract: Functional adrenal hyperandrogenism is a common feature of PCOS, observed in roughly 20-30% of affected women. The mechanisms of adrenal hyperandrogenism in PCOS require additional clarification but seem to be related to increased adrenal sensitivity to ACTH at the level of the adrenal gland. Studies in animal models and in girls at risk for PCOS suggest a potential role for early adrenal androgen exposure in the development of PCOS during reproductive maturity. Importantly, adrenal androgens may be elevated in at-risk girls from childhood through menopause, suggesting these androgens are clinically relevant over the lifetime. The presence or absence of adrenal hyperandrogenism is just one of a number of clinical phenotypes, which vary among women with PCOS. Recent exciting work has focused on defining distinct subtypes of PCOS based on these distinct phenotypes. This will be an important first step toward the development of more individualized treatment approaches in affected women.