Clinical analysis of polycystic ovary syndrome in adolescence associated with homosexual precocious puberty diagnosed in girls

Abstract

Objective The report was focused on polycystic ovary syndrome(PCOS) in female adolescents related to homosexual precocious puberty, and the new awareness of its influence on long-term health of homosexual precocious girls. Methods A girl with idiopathic central precocious puberty(ICPP) but diagnosed as PCOS in adolescence was reported and the data were reviewed. Results A girl was diagnosed as ICPP when she was near 8 years old with obesity, but without hyperinsulinemia, then she received the treatment of a 3.75 mg dose gonadotropin hormone analogues(GnRHa) every 28 days. Her gonads development was under control while her growth was arrested. Growth hormone(GH) injection started at 13 months. She stopped all medications when finished GH and GnRHa treatment for 12 months and 25 months. She went to see doctors again because of no menarche after discontinuing medication for nearly 2 years. She appeared obese and acne, hirsutism, athanens negricans and purple purple striae on the skin. Hyperinsulinemia and hypertestosterone were demonstrated. Pelvic B ultrasonography showed polycystic ovary, and she was diagnosed as PCOS. She was ordered to lose weight and to take metformin. And adrenocorticotropic hormone stimulating test was done, and B ultrasonography again ruled out atypical congenital adrenal hyperplasia and tumor of adrenal gland. She got her menarche 1 month later. Twelve months after the PCOS diagnosis and treatment, she had 4 menses, her insulin level decreased, glucose tolerance and her serum testosterone level turned normal. At the same time, the form of ovarian and follicular was significantly reduced. After taking metformin for 20 months, her height and weight did not change, her menstrual was regular every 35-40 days, each time lasting about 7 days. She was followed up. We also reviewed literatures and learnt that precocious puberty might not be a benign situation and it might have an intrinsic relation to obesity, precocious puberty and PCOS. It might be the cofactors for causing PP and PCOS that accessed luteinizing hormone(LH)secretion and disorder of hypothalamus pituitary gonad(HPG) axis except obesity with hyperinsulinemia. Reported pubertas praecox in childhood developed to PCOS at 30% with high prevalence of obesity. GnRHa suppressive therapy might relate to PCOS and had disputation for improving final height. There were fewer investigations on adolescent PCOS, and no consensus guideline on it in China. Conclusions Girls with ICPP may deve-lop to PCOS some time later. The clinical features of the reported girl and the knowledge from literatures support the hypothesis that inner relationship between the CPP and the PCOS. The LH high secretion and disorder of HPG axis may be the causes of them; LH treatment on suppressing obesity should be cautious during treatment. The benefit and risk from GnRHa treatment should be evaluated thoroughly. Further clinical research should be conducted on adolescent PCOS. Key words: Idiopathic central precocious puberty; Adolescence; Polycystic ovary syndrome; Hyperinsulinemia