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Hyperinsulinaemic androgen excess in adolescent girls

Nature Reviews Endocrinology volume 10, pages 499–508 (2014)Cite this article

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A Correction to this article was published on 29 July 2014

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Abstract

Hyperinsulinaemic androgen excess is the most common cause of hirsutism, acne and menstrual irregularity in adolescent girls. Here, we propose that the disorder frequently originates from an absolute or relative excess of lipids in adipose tissue, and from associated changes in insulin sensitivity, gonadotropin secretion and ovarian androgen release. Girls from populations with genotypes attuned to nutritionally harsh conditions seem to be particularly vulnerable to the development of hyperinsulinaemic androgen excess in today's obesogenic environment. We propose that hirsutism, hyperandrogenaemia and menstrual irregularity (≥2 years after menarche) is used as a diagnostic triad for the disorder. No pharmacological therapy has been approved for girls with androgen excess; however, lifestyle intervention is essential to reduce adiposity. In girls without obesity who are not sexually active, insulin sensitization has more broadly normalizing effects than estradiol–progestogen combinations. The early recognition of girls at risk of developing hyperinsulinaemic androgen excess might enable prevention in childhood.

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Figure 1: Distributions of BMI and the risk of anovulatory subfertility.

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  • 29 July 2014

    In the version of this article originally published online and in print, there was an error in Figure 1. The dotted blue line in the bottom panel should have extended down to the axis. This has now been corrected in the HTML and PDF versions of the article.

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Acknowledgements

L.I. is a Clinical Investigator of CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain). F.d.Z is a Clinical Investigator supported by the Clinical Research Council of the Leuven University Hospitals. A.L.B is a Clinical Investigator of the I3 Fund for Scientific Research (Ministry of Science and Innovation, Spain). The authors wish to thank E. Codner and three unnamed experts for their comments as peer reviewers, which helped improve the article.

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Authors and Affiliations

  1. Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain

    Lourdes Ibáñez

  2. MRC Epidemiology Unit, Box 285

    Ken K. Ong

  3. Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0QQ, UK

    Ken K. Ong

  4. Department of Paediatrics, Box 116, Level 8, Addenbrooke's Hospital Hills Road

    David B. Dunger

  5. University of Cambridge, Cambridge, CB2 0QQ, UK

    David B. Dunger

  6. Paediatric Endocrinology, Dr Josep Trueta Hospital and Girona Institute for Biomedical Research, Avenue de França s/n, Girona, 17007, Spain

    Abel López-Bermejo

  7. Paediatric Endocrinology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven, 3000, Belgium

    Francis de Zegher

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  1. Lourdes Ibáñez
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L.I. and F.d.Z. researched data for the article and reviewed and edited the manuscript before submission. All authors wrote the manuscript and contributed substantially to discussions of the content.

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Ibáñez, L., Ong, K., López-Bermejo, A. et al. Hyperinsulinaemic androgen excess in adolescent girls. Nat Rev Endocrinol 10, 499–508 (2014). https://doi.org/10.1038/nrendo.2014.58

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