251. The Prevalence of Metabolic Syndrome In Adolescents With Polycystic Ovary Syndrome Under Different Diagnostic Criteria

Abstract

There is ample evidence that increased risk of metabolic dysfunction is present in women with polycystic ovary syndrome (PCOS). Existing literature on the prevalence of metabolic syndrome (MBS) in the adolescent population with PCOS is inconsistent. A recently conducted meta-analysis found that the prevalence of MBS ranged from 4.9% to 43.6% in adolescent girls with PCOS. The discrepancy in the prevalence of MBS in adolescents is likely due to application of differing diagnostic criteria for both PCOS and MBS. The impact of the specific PCOS diagnostic criteria used on the prevalence of MBS in adolescents has not yet been evaluated. As such, the objective of the current study was to assess the prevalence of MBS in adolescents with PCOS under different diagnostic criteria. A retrospective chart review was conducted on female patients (N=37), ages 11-22 years, with PCOS who were seen at Nationwide Children’s Hospital between January 2013 and December 2017. Patients were included in the study only if they had received screening that would allow comparison across all PCOS diagnostic criteria including the National Institute of Health (NIH), Rotterdam, Androgen Excess Society (AES), Amsterdam, Endocrine Society (ES) and the Pediatric Endocrine Society (PES). The presence of MBS was established using the International Diabetes Federation criteria. Patients were categorized according to the 6 different PCOS diagnostic criteria and then the presence of MBS and risk factors were evaluated. Mean age of the study population was 15.4 ±1.66 years (range: 11.5-20.4). All patients met the diagnosis of PCOS utilizing the Rotterdam criteria; whereas only 15/37 (40.5%) met the diagnosis using the Amsterdam criteria. The prevalence of a PCOS diagnosis among the other diagnostic guidelines was 30/37 (81.1%) NIH, 32/37 (86.5%) AES, 29/37 (78.4%) ES, and 25/37 (67.6%) with the PES criteria. For the entire study cohort, MBS was present in 17/37 (45.9%) patients. Arterial hypertension was evident in 10/37 (27.0%), and no patients were on antihypertensive medication. Low HDL was observed in 28/37 (75.7%), high triglyceride in 12/37 (32.4%) and no patients were on lipid lowering medication. Elevated blood glucose was found in 9/37 (24.3%), and no patients had Type 2 diabetes mellitus. The highest prevalence of MBS was found among the subgroup of patients meeting the PES diagnostic criteria (13/25, 52.0%), while the lowest prevalence of MBS was in the subgroup meeting the Amsterdam criteria (6/15, 40.0%). Those diagnosed using the PES criteria also had the highest percentage of patients with 3 or more risk factors for MBS. This study of adolescents evaluated for PCOS found that the prevalence of MBS varied according to the specific PCOS diagnostic criteria used and ranged from 40 % to 52 % in the same patient population. Prevalence of MBS was highest when PES guidelines were used. The PES criteria are adolescent-specific, and thus have refined the definition of clinical hyperandrogenism and ovulatory dysfunction for this population. These results highlight the importance of validated adolescent specific PCOS diagnostic criteria.