ESPE Abstracts

Polycystic ovary syndrome is the most common cause of hirsutism and menstrual irregularity in adolescent girls and young women. It is often accompanied by obesity and insulin resistance and is associated to lifelong co-morbidities, including subfertility, type 2 diabetes, non-alcoholic fatty liver disease, pre-menopausal cancer, depression, low health-related Qol, and pregnancy and offspring complications. PCOS in adolescent girls is commonly driven by fat excess in subcutaneous adipose tissue, leading to insulin resistance and ectopic (hepato-visceral) fat excess. There is still no approved pharmacological therapy for adolescent PCOS. The most common treatment is an intervention focusing on symptoms; oral estro-progestagens are used off-label as first-line treatment, even in young girls who don’t need contraception. However, this approach does not address the core problem, so upon treatment discontinuation, the clinical symptoms may re-emerge. Over the last years, the research in progress has been directed towards a reduction of body adiposity, and specifically, hepato-visceral fat excess. There are promising results with sustained lifestyle changes, albeit they are difficult to maintain. In PCOS girls with obesity, Glucagon-Like-Peptide-1 (GLP-1) agonists are under investigation. In PCOS girls without obesity, a low-dose combination of medications with additive effects, for example, a combination of spironolactone, pioglitazone and metformin, has proved to be effective and safe in pilot studies and is now under further investigation within the scope of SPIOMET4HEALTH, a multi-centric, double-blind, placebo-controlled clinical trial funded by the European Union's H2020 Research and Innovation Programme.