Hyperandrogenemia is generally determined by the excessive androgen secretion by the adrenal gland's cortex, by the ovaries (in girls), or testes (in boys). Other clinicall manifestations of hyperandrogenemia are represented by menstrual disorders, the enlargement of the clitoris, breast atrophy, masculine body habitus, voice changes and male-pattern baldness. The magnitude of the signs and symptoms of androgen excess are not always correlated with the serum androgen concentrations.
The symptoms of polycystic ovary disease usually begin around menarche . Premature pubarche, the result of early secretion of adrenal steroids, may be heralding the following disturbances. Almost 80% of the girls with polycystic ovary disease first notice the hirsutism.
Hirsutism representss the presence of excessive hair growth which appears in a male pattern in women.It usually presents as the appearance of coarse terminal hairs in areas known as androgen-dependent in a female. The parents and the patients often consider hirsutism as a strictly cosmetic problem and may postpone seeing a physician.
The women with polycystic ovary disease often have a LH hypersecretion which commonly leads to chronic anovulation which most often manifests as oligomenorrhea (less than nine menses with a reduced menstrual flow per year) or amenorrhea. An increased risk of endometrial hyperplasia may occur due to these menstrual abnormalities. There should be made a difference between primary amenorrhea and secondary amenorrhea. Primary amenorrhea represents the absencee of menarche (the first period) by the age of 16 in the presence of normally developed breast and pubic hair.
The absence of menses for three months (consecutively) after a period or regular (relatively regular) menses represents secondary amenorrhea. The anovulatory cycles may have as a consequence dysfunctional uterine bleeding and lead to a decreased fertility and later in life miscarriage or ectopic pregnancy can occur due to the endometrial abnormalities.
A great amount of women with polycystic ovary disease are overweight; even obese. Even though obesity is not considered to be the most relevant feature of the disease, the excess weight can lead to an exacerbation of the associated metabolic disturbances characterising the disease.
The teenage and adult women with polycystic ovary disease have a higher risk to develop the metabolic syndrome. This syndrome consists of a wide range of disturbances including hypertension, insulin resistance, and dyslipidemia. The insulin resistance will lead to an increased risk for impaired glucose tolerance and diabetes mellitus type 2.