OB/GYN Resident Perceptions about Adolescent Health Care Training

Abstract

Background: Perimenarchal onset of polycystic ovary syndrome (PCOS), the most common endocrinopathy of the premenopausal years, is increasingly appreciated. In adolescents meeting clinical criteria for PCOS, transabdominal pelvic ultrasonography (TAUS) is often utilized for evaluation of ovarian morphology. While polycystic appearing ovaries (PCO) constitute a diagnostic criterion for PCOS (Rotterdam criteria 2003), it remains to be determined if PCO as assessed by TAUS in adolescents tracks with other diagnostic criteria of PCOS such as biochemical hyperandrogenism. Methods: Thirty-two adolescent females were recruited from a multispecialty adolescent PCOS clinic into an ongoing IRB approved cohort study. Participants underwent a complete history and physical examination. TAUS was performed by a single trained radiologist and readings were divided into three groups: normal appearing ovaries (NAO), classic PCO (ovarian volume O10cm with $12 follicles measuring 2e9mm in diameter) and variant polycystic ovaries (VPO; normal ovarian volume with $12 small follicles). Biochemical measures of hyperandrogenism included total testosterone (T) and sex hormone binding globulin (SHBG); free T (%) was calculated. Statistical analyses were performed using one-way analysis of variance (ANOVA), t-test and Pearson correlation as appropriate. Data are presented as mean standard deviation. Results: Of the 32 adolescents (ages 15.5 1.9 years, BMI 30.4 7.6 kg/m), 29 (91%) reported oligomenorrhea or amenorrhea; clinical features of hyperandrogenism (acne and/or hirsutism) were acknowledged by all. The mean serum T level was 52.5 29.0 ng/dl (range 10e55 ng/dl). TAUS criteria as specified identified NAO in 41% of participants (13/32), PCO in 34% (11/32) and VPO in 25% (8/32). Those with classic PCO demonstrated significantly higher serum T levels compared to VPO (70.6 27.2 ng/dl vs. 41.4 20.6 ng/dl; p 5 0.004) and to NAO (38.6 21.9 ng/dl; p 5 0.02) groups. There was no difference in total T levels between the NOA and VPO groups, nor were there any differences in free T or SHBG levels between the 3 groups (pO0.05). While no relationship was observed between BMI and total T (p50.8), those demonstrating classic PCO were significantly heavier (BMI 32.1 8.3 kg/m) compared to those with VPO (25.3 3.2 kg/m, p50.04). Adolescents with NAO had a similar BMI as those with classic PCO (32.5 þ 7.9 kg/ m) and were also significantly heavier than the VPO group (p 5 0.03). Conclusions: In adolescents, TAUS is a meaningful component of the evaluation of polycystic ovary syndrome. A significant proportion of adolescents with menstrual irregularity and clinical features of hyperandrogenism had ovaries that did not demonstrate the classic PCO appearance. The VPO group had a significantly lower BMI than the NAO and PCO groups, and similar T levels as the NAO group; this group may represent a population of adolescents in whom weight gain would lead to the classic PCO phenotype. Metabolic analyses in these patients will provide further assessment of parameters that affect ovarian dysfunction.