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Background <p>Hyperandrogenism represents a prevalent yet diagnostically challenging endocrine condition in adolescents, with polycystic ovary syndrome (PCOS), non-classic congenital adrenal hyperplasia, and androgen-secreting tumors constituting the most common etiologies. The physiological overlap with normal pubertal development creates significant diagnostic complexity, necessitating evidence-based approaches tailored to this unique population.</p> Data sources <p>This narrative review synthesizes evidence from a comprehensive literature search (PubMed/Scopus/Web of Science/EMBASE/Cochrane, 2000–2025) evaluating diagnostic and therapeutic approaches for adolescent hyperandrogenism. We prioritized clinical practice guidelines (including 2023 international PCOS guidelines), randomized controlled trials, and large cohort studies (<i>n</i> ≥ 50), excluding conference abstracts and non-peer-reviewed sources. Data extraction focused on diagnostic accuracy, treatment efficacy, safety profiles, and quality-of-life outcomes across 122 included studies.</p> Results <p>Current diagnostic frameworks demonstrate critical limitations in adolescent populations, particularly regarding age-specific biochemical cutoffs (testosterone, dehydroepiandrosterone sulphate, and 17-hydroxyprogesterone) and imaging interpretation. While combined oral contraceptives remain first-line therapy, emerging data highlight both metabolic risks (particularly with long-term use) and the potential of insulin sensitizers such as myo-inositol. Psychological comorbidities (anxiety, depression) are prevalent (38%–45% prevalence) yet are frequently under-addressed in clinical management. Key knowledge gaps persist regarding optimal (1) diagnostic thresholds for diverse ethnic groups; (2) longitudinal safety of hormonal therapies; and (3) integrated mental health interventions.</p> Conclusions <p>Adolescent hyperandrogenism demands multidisciplinary management involving endocrinologic, gynecologic, dermatologic, and psychological expertise. Future research must prioritize (1) validated age- and puberty-stage-specific diagnostic criteria; (2) safety/efficacy data for emerging therapies; and (3) standardized protocols for mental health screening. This synthesis provides a framework for evidence-based, individualized care while highlighting urgent research priorities.</p> Graphical abstract <p></p>

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Adolescent hyperandrogenism: diagnostic challenges and therapeutic approaches

  • 期刊论文

  • 发表日期：

    2025年9月11日

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  • Marcio J. Concepción-Zavaleta,
  • Jenyfer M. Fuentes-Mendoza,
  • Francisca E. Zavaleta-Gutiérrez,
  • Bryan Y. Arias-Cantor,
  • Maria V. Figueredo-Rueda,
  • Julia C. Coronado-Arroyo,
  • José Paz-Ibarra

摘要

Background

Hyperandrogenism represents a prevalent yet diagnostically challenging endocrine condition in adolescents, with polycystic ovary syndrome (PCOS), non-classic congenital adrenal hyperplasia, and androgen-secreting tumors constituting the most common etiologies. The physiological overlap with normal pubertal development creates significant diagnostic complexity, necessitating evidence-based approaches tailored to this unique population.

Data sources

This narrative review synthesizes evidence from a comprehensive literature search (PubMed/Scopus/Web of Science/EMBASE/Cochrane, 2000–2025) evaluating diagnostic and therapeutic approaches for adolescent hyperandrogenism. We prioritized clinical practice guidelines (including 2023 international PCOS guidelines), randomized controlled trials, and large cohort studies (n ≥ 50), excluding conference abstracts and non-peer-reviewed sources. Data extraction focused on diagnostic accuracy, treatment efficacy, safety profiles, and quality-of-life outcomes across 122 included studies.

Results

Current diagnostic frameworks demonstrate critical limitations in adolescent populations, particularly regarding age-specific biochemical cutoffs (testosterone, dehydroepiandrosterone sulphate, and 17-hydroxyprogesterone) and imaging interpretation. While combined oral contraceptives remain first-line therapy, emerging data highlight both metabolic risks (particularly with long-term use) and the potential of insulin sensitizers such as myo-inositol. Psychological comorbidities (anxiety, depression) are prevalent (38%–45% prevalence) yet are frequently under-addressed in clinical management. Key knowledge gaps persist regarding optimal (1) diagnostic thresholds for diverse ethnic groups; (2) longitudinal safety of hormonal therapies; and (3) integrated mental health interventions.

Conclusions

Adolescent hyperandrogenism demands multidisciplinary management involving endocrinologic, gynecologic, dermatologic, and psychological expertise. Future research must prioritize (1) validated age- and puberty-stage-specific diagnostic criteria; (2) safety/efficacy data for emerging therapies; and (3) standardized protocols for mental health screening. This synthesis provides a framework for evidence-based, individualized care while highlighting urgent research priorities.

Graphical abstract