Early Polycystic Ovary Syndrome as a Possible Etiology of Unexplained Premenarcheal Ovarian Torsion

Abstract

Study Objective To study evidence of polycystic ovary syndrome (PCOS) in premenarcheal adolescents with unexplained ovarian torsion. Design Retrospective observational case series. Setting Tertiary university clinical center Participants Six premenarcheal adolescents and six adults with acute ovarian torsion Intervention A chart review. Main Outcome Measures Contralateral ovarian size, operative findings, ovarian pathology, hormone testing Results Five of the six premenarcheal cases had no pathologic explanation for their ovarian torsion. In four of the cases, size measurements of the contralateral ovary were noted to be larger than the criterion of their respective age group. Three of the four cases had either an ovarian volume (28.5 cm 3) or an area (16.0 cm 2 and 57.6 cm 2) that was above the size criterion for a polycystic ovary (volume >10 cm 3 or area > 5.5 cm 2). Pathology of a wedge biopsy of one of the contralateral ovaries suggested evidence of polycystic ovary. Finally, hormone testing available in three of the cases revealed elevated testosterone levels in two. Among the adults, half of the cases had a pathologic explanation for ovarian torsion. One out of the five cases had a contralateral ovary that was significantly enlarged and this was noted in a woman with a diagnosis of PCOS. The remaining two cases had extensive necrosis of the torsed ovary and no other diagnosis was made. Conclusion We propose that premenarcheal girls presenting with ovarian torsion, without obvious ovarian pathology, be screened for ultrasound and biochemical evidence of PCOS. In those with evidence of PCOS, treatment with oral contraceptives should be considered taking into account the age and pubertal development, to decrease ovarian volume.