Challenges in diagnosis of polycystic ovary syndrome in adolescence

Abstract

Objective

we evaluated clinical features, the hormonal status, and ovarian morphological characteristics using ultrasound (US) in adolescents with polycystic ovary syndrome (PCOS) and an ‘increased risk’ of PCOS, and compared the data to age-matched controls.

Methods

the prospective study involved 154 adolescents (≥2 and <8 years post menarche): Group I-adolescents with PCOS (n = 60), Group II- adolescents with an ‘increased risk’ of PCOS (n = 48), and Group III- control group (n = 46). PCOS patients met all 3 diagnostic criteria of the Rotterdam consensus (2003), an ‘increased risk’ of PCOS was accepted as ‘menstrual irregularities and clinical and/or biochemical hyperandrogenism’.

Results

In adolescents with PCOS and ‘increased risk’ of PCOS, AMH and SHBG did not differ significantly. In Group I and Group II, the average AMH level was significantly higher, while SHBG was significantly lower than in the controls (p < .001). Androgen levels and mFG in Group I and Group II did not differ significantly, but were significantly higher than in controls (p < .001). In Group I, index of insulin resistance and the number of antral follicles (AFC) were significantly higher than in the comparison groups (p < .05). There was no significant difference in ovarian volume between comparison groups (p < .001).

Conclusions

A combination of AMH, SHBG, clinical and biochemical hyperandrogenism and menstrual irregularities may be considered as diagnostic markers of PCOS in adolescents and for the identification of a ‘risk group’ for developing PCOS. Ultrasound estimation of AFC are a more specific marker of ovarian morphology in adolescents with PCOS, rather than ovary volume.

青春期多囊卵巢综合征诊断的挑战 摘要

目的：我们使用超声（ultrasound, US）评估患有多囊卵巢综合征（polycystic ovary syndrome, PCOS）和PCOS“风险增加”的青少年的临床特征、激素状态和卵巢形态特征, 并将数据与年龄匹配的对照组进行比较。

方法：前瞻性研究涉及154名青少年(月经初潮后≥2年并<8年）：第I组为患有PCOS的青少年（n=60）, 第II组为PCOS“风险增加”的青少年（n=48）, 第III组为对照组（n=46）。PCOS患者符合鹿特丹共识（2003年）的所有3项诊断标准, PCOS的“风险增加”是指“月经异常、临床和/或生化高雄激素血症”。

结果：在患有PCOS和PCOS “风险增加”的青少年中, AMH和SHBG没有显著差异。在I组和II组中, AMH平均水平显著高于对照组, 而SHBG显著低于对照组（p<0.001）。I组和II组的雄激素水平和mFG没有显著差异, 但显著高于对照组（p<0.001）。I组胰岛素抵抗指数和窦卵泡数（antral follicles, AFC）显著高于对照组（p<0.05）。比较组之间卵巢体积无显著差异（p<0.001）。

结论：AMH、SHBG、临床和生化高雄激素血症以及月经不调可作为青少年PCOS的诊断标志物, 并可用于确定PCOS的“高风险组”。超声评估AFC, 而不是卵巢体积, 是PCOS青少年卵巢形态的一个更为特异的指标。

Keywords:

• Polycystic ovary syndrome (PCOS)
• adolescents
• anti-mullerian hormone (AMH)
• hyperandrogenism
• adolescents with an ‘increased risk’ risk of PCOS

Disclosure statement

No potential conflict of interest was reported by the author(s).

Figure 1. Distribution of patients according to the clinical and biochemical hyperandrogenism (n168).