Lean PCOS in Adolescents Shows Elevated Insulin Resistance and Adipokine Dysfunction
Overview
In a cohort of adolescent females, those with lean PCOS (BMI <85th percentile) exhibited significantly higher insulin resistance and altered adipokine profiles compared to peers without PCOS. These metabolic abnormalities were not observed in adolescents with PCOS who had BMI ≥85th percentile, highlighting distinct cardiometabolic risks in lean PCOS.
Background
Polycystic ovary syndrome (PCOS) affects 10-15% of women and is characterized by reproductive and endocrine abnormalities, often accompanied by cardiometabolic comorbidities. While obesity exacerbates PCOS manifestations, PCOS also occurs in individuals with normal BMI, termed 'lean PCOS,' who may still experience metabolic dysfunction. Diagnosing PCOS in adolescence is challenging due to overlapping pubertal changes, yet early identification of metabolic risk is critical to mitigate long-term complications. This study investigates growth, adiposity, and cardiometabolic biomarkers in adolescents with PCOS stratified by BMI.
Data Highlights
Parameter
Lean PCOS (BMI <85th percentile)
Lean Non-PCOS
Difference (β, 95% CI)
Age at Peak Height Velocity (years)
Earlier by 0.57 years
Reference
−0.57 (−0.96, −0.18)
HOMA-IR (Insulin Resistance)
Higher
Reference
0.77 (0.23, 1.30)
Adiponectin-Leptin Ratio
Lower
Reference
−0.35 (−0.65, −0.06)
Adiposity Measures
No significant difference
Reference
NS
Key Findings
Among adolescents with BMI <85th percentile, those with PCOS had earlier peak height velocity by approximately 0.57 years compared to peers without PCOS.
Lean PCOS adolescents exhibited significantly higher insulin resistance as measured by HOMA-IR.
Adiponectin-leptin ratio, an indicator of adipose tissue function, was significantly lower in lean PCOS adolescents, suggesting adipose tissue dysfunction despite normal BMI.
Adiposity measures did not differ significantly by PCOS status within either BMI category, indicating metabolic dysfunction occurs independent of excess adiposity in lean PCOS.
Among adolescents with BMI ≥85th percentile, cardiometabolic biomarkers were similar regardless of PCOS status.
Clinical Implications
Clinicians should recognize that metabolic dysfunction in PCOS can occur even in adolescents with normal BMI, underscoring the importance of screening for insulin resistance and adipokine abnormalities beyond weight status. Early identification of lean PCOS may allow for timely interventions to reduce cardiometabolic risk. Reliance solely on adiposity measures may miss at-risk individuals with PCOS who are metabolically compromised.
Conclusion
This study demonstrates that lean adolescents with PCOS have distinct metabolic abnormalities characterized by increased insulin resistance and adipose tissue dysfunction, independent of adiposity. These findings highlight the need for comprehensive metabolic assessment in all adolescents with PCOS regardless of BMI.
References
Project Viva Cohort Study -- Lean PCOS in Adolescents Exhibits Elevated Insulin Resistance and Detrimental Adipokine Profiles
