SAT353 Relevance of Ovarian Morphology Among Adolescents With Polycystic Ovary Syndrome (PCOS)

Abstract

Abstract Disclosure: J.P. Christ: None. K. Shinkai: None. J. Corley: None. L. Pasch: None. M.I. Cedars: None. H. Huddleston: None. Background: The 2018 international guidelines for the assessment and management of PCOS exclude ovarian morphology from the diagnosis of PCOS in adolescents due to limited data regarding normative values in this population. Adolescents with oligo-amenorrhea (OA) or hyperandrogenism (HA) alone are thus excluded from diagnosis and ultrasonography has been removed from clinical use without an assessment of its utility in this population. Objective: To characterize ovarian morphology among adolescents with PCOS and evaluate the relevance of PCOM among those currently excluded from diagnosis. Methods: A cross-sectional analysis of patients that underwent a standardized evaluation for PCOS at a single tertiary center from 2006 to 2022 was completed. Participants were included if they were within 8 years of menarche or were <20 years of age at screening and had data on ovarian morphology. Follicle number per ovary (FNPO) and ovarian volume (OV) were assessed by transvaginal ultrasound, or if not tolerated, transabdominal (in which case FNPO was omitted) or transrectal approach. PCOM was defined as a FNPO of >20 follicles or an OV >10cc in either ovary. Maximum FNPO and OV in either ovary was used for analyses. Age based criteria were used to define irregular menstrual cycles and were characterized among those >1 year post menarche. Patients were grouped into those with OA and HA (PCOS-NIH), with OA or HA as well as PCOM (PCOS-Rotterdam), and with one or no features (non-PCOS). Results: Of the 133 subjects included, 95 met PCOS-NIH criteria, 22 met PCOS-Rotterdam criteria and 16 met non-PCOS criteria. Prevalence of PCOM among PCOS-NIH was 82.1%. Significant differences were seen between Non-PCOS, PCOS-Rotterdam, and PCOS-NIH for FNPO (15.5±8.7 vs 30.9±12.5 vs 31.8±14.6), OV (6.1±4 vs 10.8±4.5 vs 11.4±6.4), waist:hip ratio (WHR) (0.7±0.1 vs 0.8±0.1 vs 0.8±0.1), 2-hour glucose (99.5±17.1 vs 84.8±18.9 vs 105.6±41 uIU/mL), QUICKI (0.4±0 vs 0.4±0.1 vs 0.3±0.1), and HOMA-IR (1.9±1.2 vs 2.4±2.1 vs 4.7±5.7) (p<0.05 for overall comparisons between groups). Among PCOS-Rotterdam and Non-PCOS, in multivariable models controlling for WHR, systolic blood pressure (β=0.5, p=0.09) and free testosterone (β=0.03, p=0.03) associated with FNPO and QUICKI (β=69.1, p=0.003) associated with OV. Conclusion: Adolescents meeting NIH criteria appear to be at greatest metabolic risk. Ovarian morphology, however, may reflect degree of hyperandrogenism and metabolic dysfunction among adolescents currently excluded from diagnosis of PCOS (i.e. PCOS-Rotterdam and non-PCOS groups). The inclusion of ultrasound assessment may thus be able to aid in risk stratification and phenotyping among those without a definitive PCOS diagnosis. Presentation Date: Saturday, June 17, 2023