Etiological Factors of Obesity-Associated Hyperandrogenemia in Peripubertal Girls

Inclusion Criteria: * Peripubertal (Tanner stage 1 to 5) girl, age 8-16 years * Obesity (BMI-for-age ≥ 95th percentile) * Generally healthy (save for exogenous obesity) * Ability and willingness of subject/parents to provide informed assent/consent Exclusion Criteria: * Age \< 8 or \> 16 y * Greater than 4 y post-menarche * Obesity associated with a diagnosed (genetic) syndrome (e.g., Prader-Willi syndrome, leptin deficiency), obesity related to medications (e.g., glucocorticoids), etc. * Pregnancy or lactation * Virilization * Total testosterone \> 150 ng/dl, which suggests the possibility of a virilizing neoplasm * DHEAS greater than twice upper limit of age-appropriate normal range * 17-OHP greater than 250 ng/dl, which suggests the possibility of congenital adrenal hyperplasia (if postmenarcheal, the 17-OHP will be collected during the follicular phase, or \> 60 if oligomenorrheic) NOTE: If a 17-OHP \> 250 ng/dl is confirmed on repeat testing, an ACTH stimulation test will be offered, with a post-ACTH 17-OHP \< 1000 ng/dl being required for study participation * History of premature adrenarche (i.e., appearance of pubic and/or axillary hair before age 8) * Fasting glucose \> 125 mg/dl or hemoglobin A1c \> 7.0% * Abnormal TSH or prolactin * Evidence of Cushing's syndrome by history or physical exam (e.g., history of impaired growth, striae) * Hematocrit \< 36% or hemoglobin \< 12 g/dl * Significant and current cardiac or pulmonary dysfunction (e.g., known or suspected c…