Hyperandrogenism in adolescent girls.

When the symptoms of hyperandrogenism are mild in an adolescent girl, it is difficult to establish whether they are related to the physiological androgenization of puberty or to an incipient disease. The most frequent etiology is the polycystic ovary syndrome (PCOS). Its diagnosis is defined in adult women by precise criteria which need to be adapted to the particular case of the adolescent girl. Nonclassic adrenal hyperplasia is the main differential diagnosis to PCOS. Although much less frequent, other etiologies of peripubertal hyperandrogenism such as adrenal or ovarian tumors or Cushing's disease must be considered by analyzing the rapidity of installation and intensity of hyperandrogenic symptoms and by a systematic hormonal work-up. In addition to etiologic measures, the treatment consists of administration of an anti-androgen, mainly cyproterone acetate. In the case of PCOS, the patient needs to be educated regarding the metabolic risks.