Polycystic Ovary Syndrome In Adolescents Research Articles

Polycystic ovary syndrome in adolescence associated with obesity

![Figure][1] Dr. Rosenfield Polycystic ovary syndrome (PCOS) is now commonly recognized in adolescence in association with the increased prevalence of obesity. Obesity is a“ stress” that unmasks the disorder. PCOS has been redefined as the result of recent research. Originally termed

RAISING PERIPUBERTAL TESTOSTERONE LEVELS IN FEMALE MACAQUES: FIRST PHASE OF A PROSPECTIVE STUDY TO EVALUATE THE ROLE OF PERIPUBERTAL HYPERANDROGENEMIA IN THE PATHOGENESIS OF POLYCYSTIC OVARY SYNDROME.

Background Polycystic ovary syndrome (PCOS), a syndrome of hyperandrogenism, polycystic ovaries, and oligo-anovulation, is a major cause of infertility in American women. Observational studies suggest that women first develop PCOS in adolescence. Recent studies show that testosterone (T) levels are elevated in prepubertal obese girls in comparison with normal weight age and puberty-matched controls and this trend continues throughout puberty. Although insulin resistance is a common finding in PCOS and is implicated in the pathogenesis of PCOS, the causal role of T in the development of PCOS is less clear. Purpose of Study The long-term goal of our study is to determine whether raised peripubertal T levels in female macaques lead to the hypothalamic-pituitary-ovarian sequelae of PCOS. During the first phase of the study presented here our goals are threefold: to obtain normative data for peripubertal T levels in female macaques, to choose a raised T target range, and to devise a method for raising the T levels. Methods Used Sera obtained from five female macaques starting at prepuberty (age 12 months) and through menarche (average age 29 months) were used to determine normative T data. The commercially available RIA T assay DSL-4100 was used. We used surgically placed Silastic tube implants to raise T levels to target range in eight experimental animals. Six control animals were implanted with cholesterol-containing Silastic implants. Summary of Results The mean peripubertal T in female macaques was 0.36 ± 0.16 ng/mL. Since obese peripubertal adolescent girls have T levels 3 to 4 times the normal-weight controls, we chose a target T range of 0.12 to 0.16 ng/mL. Subcutaneously placed Silastic implants containing 5 mm of T:cholesterol (1:12 or 1:15) are used to achieve the target T range. Monkeys are phlebotomized weekly and the frequency of implant change (on average every 6 weeks) is determined by the serum T levels. Conclusions Peripubertal female macaques have a low circulating level of T, which can be raised reliably to a narrow target range with surgically placed Silastic tubes and close monitoring of resultant circulating T levels. We will maintain the raised T levels throughout puberty as we compare the T-treated animals9 ovarian changes (menstrual/ovarian follicles) and hypothalamic-pituitary parameters (LH pulse and response to GnRH/progesterone) with those in control animals. This work is supported by the following NIH grants: HD18185, DK007674-13, and RR00163.

P-880: The clinical characteristics of polycystic ovary syndrome in adolescence

P-880: The clinical characteristics of polycystic ovary syndrome in adolescence

Adolescent Polycystic Ovary Syndrome: Randomized Study of Metformin

Adolescent Medicine| July 01 2006 Adolescent Polycystic Ovary Syndrome: Randomized Study of Metformin AAP Grand Rounds (2006) 16 (1): 81–82. https://doi.org/10.1542/gr.16-1-81 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Adolescent Polycystic Ovary Syndrome: Randomized Study of Metformin. AAP Grand Rounds July 2006; 16 (1): 81–82. https://doi.org/10.1542/gr.16-1-81 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: metformin, polycystic ovary syndrome Source: Bridger T, MacDonald S, Baltzer F, et al. Randomized placebo-controlled trial of metformin for adolescents with polycystic ovary syndrome. Arch Pediatr Adolesc Med. 2006;160:241–246; doi:10.1001/archpedi.160.3.241 Polycystic ovary syndrome (PCOS) is a common disorder among women, diagnosed in at least 5% to 10% of women between adolescence and menopause. Symptoms include menstrual dysfunction and hyperandrogenism. Insulin resistance and hyperinsulinemia may play a role in PCOS by promoting excess androgen production, and insulin sensitizing agents like metformin have resulted in improved clinical status in some adult women. Investigators from the University of Newfoundland in St. Johns and McGill University in Montreal performed a randomized, placebo-controlled, double-blind trial using metformin for PCOS in adolescents. A total of 22 adolescents with hyperinsulinemia and PCOS were enrolled from the ambulatory endocrinology adolescent clinic at Montreal Children’s Hospital between 1999 and 2002. Participants were between 13 and 18 years of... You do not currently have access to this content.

Clinical expression of polycystic ovary syndrome in adolescent girls

Polycystic ovary syndrome (PCOS) is one of the major causes of adolescent hyperandrogenism and menstrual disorders. Because there is no universal definition for adolescent PCOS, we recommend four out of five criteria: clinical and biologic evidence of hyperandrogenism, hyperinsulinism, oligo-/amenorrhea, and polycystic ovaries on ultrasonography.

Type 2 diabetes and polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) have multiple factors that contribute to increased diabetes risk, including: insulin resistance, beta-cell dysfunction, obesity, especially centripetal obesity, family history of type 2 diabetes, and personal history of gestational diabetes. Additionally there is some evidence to suggest that polycystic ovaries and chronic anovulation per se are risk factors. Identifying glucose intolerance and treating it are important aspects of the care for women with PCOS.

Treatment of PCOS in adolescence

Polycystic ovary syndrome (PCOS) is increasingly being recognized in adolescent girls seeking treatment for signs and symptoms of hyperandrogenism. It is difficult to diagnose PCOS in adolescents, therefore a high index of suspicion is necessary. Timely screening and treatment are crucial because another important component of the syndrome is insulin resistance/hyperinsulinemia increasing the risk for type 2 diabetes, dyslipidemia, and cardiovascular sequelae. Diagnosis of PCOS in adolescents should include a thorough family history, exclusion of other causes of hyperandrogenism, and appropriate laboratory evaluation. The scarcity of controlled clinical trials makes treatment controversial. Therapeutic options include lifestyle intervention, oral contraceptive pills, and insulin sensitizers. Long-term follow-up is needed to determine the effectiveness of these approaches in changing the natural history of the reproductive and metabolic outcomes without causing undue harm.

Low-dose flutamide-metformin therapy for hyperinsulinemic hyperandrogenism in non-obese adolescents and women

Polycystic ovary syndrome (PCOS) is a variable disorder that is characterized in adolescents and young women by a broad spectrum of anomalies, including hyperandrogenemia, insulin resistance, dyslipidemia, body adiposity and low-grade inflammation. At present, there is no approved therapy for PCOS. Recent studies indicate that a low-dose combination of flutamide (Flu; a generic androgen-receptor blocker) and metformin (Met; a generic insulin-sensitizer) normalizes the adolescent PCOS spectrum more than an oral contraceptive (OC); in young women, the PCOS spectrum was found to be more normalized by OC plus Flu-Met than by OC alone. Within the pathophysiological cascade of PCOS, Flu-Met seems to counter upstream anomalies like hyperinsulinemia or hyperandrogenism, thereby preventing or reversing downstream effects. In contrast, an OC essentially masks downstream symptoms like hirsutism, acne or irregular menses, whereas the upstream aberrations remain unaltered or may even be worsened. The available experience with Flu-Met is limited but promising. We emphasize that Flu-Met may (as part of its efficacy) induce ovulation but is contra-indicated post-conception because of potential embryotoxicity; therefore, it seems wise to combine Flu-Met with an oral or a transdermal oestro-progestagen or with a non-endocrine method of contraception. May this update prompt further research into Flu-Met's therapeutic potential in patients with PCOS. Until the abovementioned effects have been broadly confirmed, Flu-Met should not be regarded as a standard therapy for widespread clinical practice.

Diagnosis and Management of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a syndrome, which can be defined as a group of recognisable patterns of symptoms or abnormalities that indicate a particular medical situation. The current definition of PCOS requires the presence of two of the following three conditions: (i) oligo- and/or anovulation; (ii) clinical and/or biochemical signs of hyperandrogenism; and (iii) polycystic ovaries--and the exclusion of other aetiologies. It is generally accepted that the prevalence of PCOS is approximately 5-10%, and that of polycystic ovaries alone is 21-23%. Other features of PCOS are obesity, insulin resistance, impaired glucose tolerance and type 2 diabetes mellitus, dyslipidaemia, cardiovascular disease, obstructive sleep apnoea and infertility. An approach to a patient with possible PCOS should be directed towards making a diagnosis and screening for associated endocrine abnormalities. Therapeutic interventions are directed towards addressing the needs of the patient at present and towards preventing long-term complications of the syndrome. Body mass index, which is a primary mediator in the relationship between PCOS and health-related quality of life in obese PCOS adolescents, may play a similar role in other PCOS patients. Any intervention directed at reducing central obesity will not only improve quality of life but also correct hyperinsulinism and improve fertility and lipid and androgen profiles. It is also the only currently available intervention that can have a lifelong impact on reducing possible long-term complications of the syndrome. Lifestyle modification is the cardinal intervention. Pharmacological treatments are available for specific indications. Infertility can be treated with clomifene (clomiphene citrate), metformin, gonadotropins or surgery to the ovaries. Cyproterone (alone or in combination with ethinylestradiol) and spironolactone are the main drugs used in the treatment of hirsutism. Other drugs that can be considered include flutamide, ketoconazole and finasteride. Women with PCOS require ongoing surveillance to detect impaired glucose tolerance, hyperlipidaemia, endometrial hyperplasia and consequent complications. Obese women, in particular, require regular glucose tolerance testing because of the potential for rapid progression from normal to impaired glucose tolerance and diabetes. The focus of this article is the epidemiology, diagnosis and management of this common endocrine disorder. Diagnostic and co-morbid features are discussed separately to facilitate understanding of PCOS. Symptom-directed strategies, as well as short- and long-term goals of treatment, are outlined.

Overweight Status of Adolescent Girls With Polycystic Ovary Syndrome: Body Mass Index as Mediator of Quality of Life

Adolescent girls with polycystic ovary syndrome (PCOS) have significant disruption in health-related quality of life (HRQL) compared to their healthy peers, but it is unclear which aspects of the disorder have the greatest impact on these quality-of-life changes. Studies of adult women have indicated that weight status has a significant impact on subjective symptomatology; however, a similar effect of weight status on HRQL in adolescents with PCOS has not been established. This study evaluated the effect of body mass index (BMI) on quality-of-life disturbances in adolescent girls with PCOS. Data were derived from the Adolescent PCOS Quality of Life Study, a cross-sectional study of healthy (n = 186) and PCOS-affected adolescent girls (n = 97). The study was conducted at an urban, hospital-based adolescent medicine clinical practice. Medical staff obtained anthropomorphic measurements. Participants in both groups completed the Child Health Questionnaire-Version CF-87 as a measure of HRQL. BMI was tested as a mediator of HRQL using bivariate analyses and multivariate linear regression models. The average BMI was 31.7 kg/m(2) (standard deviation [SD] = 8.4) for adolescents with PCOS and 23.5 kg/m(2) (SD = 4.2) for healthy adolescents. BMI was associated with PCOS status and HRQL. Girls with PCOS scored lower on the general health perceptions scale, physical functioning scale, family activities scale, and the general behavior scale and higher on the change in health in the last year subscale. When BMI was added to the multivariate linear regression models, coefficients were reduced on average by 3 points and became nonsignificant, indicating that the HRQL differences are mediated by the higher BMI. This study demonstrates that BMI is a primary mediator in the relationship between PCOS and the HRQL reductions experienced by girls with the disorder. Clinical interventions that effectively address weight issues in adolescents with PCOS may improve overall HRQL and other obesity-related clinical outcomes.

Approach to Adolescent Polycystic Ovary Syndrome (PCOS) in the Pediatric Endocrine Community in the USA

Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy in adult women, and is emerging as a common cause of menstrual disturbances in the adolescent population. Insulin resistance, which is considered one of its underlying causes, has increased substantially in the past decade, putting more adolescent girls at risk for PCOS and its complications. Our objective was to survey pediatric endocrinologists' approach to diagnosis and treatment of PCOS in the adolescent population, as there is presently no structured recommended approach to this emerging problem. A questionnaire survey was sent to 839 members of the Lawson Wilkins Pediatric Endocrine Society (LWPES). A total of 176 (21%) responses was received and analyzed. REDULTS: The majority of the participants would consider initiating work-up in an adolescent with oligomenorrhea or secondary amenorrhea 12-24 months after menarche. The following work-up was selected as a baseline for a teenager with oligomenorrhea or secondary amenorrhea by more than 50% of participants: LH and FSH, total and free testosterone, prolactin, 17-OH-progesterone, DHEAS and glucose/insulin measurements. For treatment of PCOS, the majority of surveyed endocrinologists suggested estrogen/progesterone combination. Metformin was considered appropriate treatment in the general adolescent population with PCOS by 30% and in obese teenagers with PCOS by 68% of surveyed endocrinologists. Our findings indicate the trend among pediatric endocrinologists towards earlier work-up of menstrual irregularities in adolescents--unlike the traditional practice of waiting for 2 years after menarche. Most pediatric endocrinologists would consider evaluation for insulin resistance using glucose/insulin measurement, but only a small percentage considers performing OGTT in these patients. Even though using estrogen/progesterone combination is the preferred therapeutic approach, 30% of surveyed endocrinologists consider metformin therapy for the general adolescent population with PCOS, and 68% would consider using it in obese adolescents with PCOS.

Screening for and treatment of polycystic ovary syndrome in teenagers.

Polycystic ovary syndrome (PCOS) usually arises during puberty and is marked by hyperinsulinemia and hyperandrogenism. Adolescents with PCOS are at an increased risk of developing health problems later on in life such as type 2 diabetes, cardiovascular disease, and infertility. Furthermore, the physical signs of PCOS can be detrimental to a teenage girl's self-image. Early diagnosis and treatment of PCOS in adolescents are essential in ensuring adulthood health and restoring self-esteem. Treatments for an adolescent with PCOS include diet and exercise, metformin, and oral contraceptive pills. Each of these options has been shown to be effective in improving certain aspects of PCOS, and probably the best treatment plan involves some combination of them.

Polycystic ovary syndrome in adolescence--a therapeutic conundrum

The polycystic ovary syndrome (PCOS) often presents in adolescence with menstrual disorders, acne and hirsutism. The early diagnostic signs are sometimes dismissed as 'normal' changes of adolescence, and the opportunity to save the teenager from the stigmata of the syndrome is missed. The finding that the metabolic syndrome is a possible long-term sequela of PCOS now presents a challenge to make an early diagnosis, educate patients regarding the importance of weight control and exercise, and treat accordingly both symptomatically and prophylactically. The use of long-term insulin sensitizers, particularly metformin, for these purposes in adolescents is now the subject of an inter-disciplinary debate. Good, hard supportive data are not yet forthcoming but, as in the adult, the establishment of metformin treatment for the hyperinsulinaemic adolescent with PCOS may precede the evidence.

Polycystic Ovary Syndrome in Adolescence

Polycystic ovary syndrome (PCOS) is a common disorder among reproductive-age women, yet the diagnosis may be overlooked during adolescence. Although the clinical and metabolic features are similar to those found in adult women, it can be difficult to distinguish the young woman with PCOS from a normal adolescent. Irregular menses, anovulatory cycles, and acne are not uncommon in adolescent women. Adolescents with a history of premature pubarche, a family history of PCOS, Caribbean-Hispanic and African-American ancestry, and/or obesity are at risk for PCOS and deserve close surveillance. The laboratory evaluation of the adolescent with suspected PCOS or hyperandrogenism should be individualized based on the history, symptoms, and examination findings. The cornerstone of management of PCOS in adolescence includes either a combination oral contraceptive or progestin. Consideration of insulin-sensitizing agents, antiandrogens, topical treatments for acne, and various treatments for hair removal are dependent on the patient's symptoms and concerns. Healthy eating, regular exercise, and for the overweight adolescent, weight reduction, are encouraged to reduce the risk of cardiovascular disease and type II diabetes mellitus. Numerous studies have shown that weight loss and exercise decrease androgen levels, improve insulin sensitivity, and lead to the resumption of ovulation. Although initial studies suggest that Metformin may be particularly useful for treating the PCOS adolescent with insulin resistance and obesity, additional studies are needed to determine the efficacy and long-term outcome. Management of the adolescent with PCOS is challenging and requires a supportive, multidisciplinary team approach for optimal results.

Type 2 diabetes, polycystic ovary syndrome and the insulin resistance syndrome in adolescents: Are they one big iceberg?

Obesity in children may cause overt clinical disease in childhood. The complex endocrine and metabolic changes of obesity and insulin resistance in adolescents result in hyperinsulinemia, dyslipidemia, hypertension, steatohepatitis, glucose intolerance, type 2 diabetes, acanthosis nigricans and ovarian hyperandrogenemia, commonly known as polycystic ovarian syndrome (PCOS). Type 2 diabetes and PCOS in adolescents are new endocrine diseases in this age group that require unique approaches to diagnosis and treatment. The direct correlation between duration of disease and control of the disease, and subsequent long term complications of these two diseases, predict serious morbidity in young adult life for the affected adolescents. Pediatricians have an important role in the prevention, diagnosis and treatment of obesity, insulin resistance syndrome, type 2 diabetes and PCOS.

Polycystic ovary syndrome in adolescents: is there an epidemic?

Polycystic ovary syndrome in adolescents: is there an epidemic?

Menstrual irregularity in the first postmenarchal years: an early clinical sign of polycystic ovary syndrome in adolescence

Menstrual irregularity in the first postmenarchal years: an early clinical sign of polycystic ovary syndrome in adolescence

Menstrual irregularity in the first postmenarchal years: an early clinical sign of polycystic ovary syndrome in adolescence

We determined the hormonal ,metabolic and ultrasonographic pattern of adolescents with menstrual irregularity since menarche but without clinical signs of hyperandrogenism with the aim of evaluating whetherthis condition represents an early stage of polycystic ovary syndrome (PCOS). These adolescents were divided in two groups: 13 adolescents with irregular cycles (IC) within the first 3 postmenarchal years(IC ≤ 3) and 15 adolescents having persistent irregular cycles for more than three postmenarchal years (IC > 3). These adolescents were compared with 15 adolescents with PCOS and 18 normal adolescents.The values of free testosterone ,free androgen index ,luteinizing hormone (LH) and LH/follicle-stimulating hormone (FSH) ratio were similar in IC ≤ 3 ,IC > 3 and PCOS ,and higher than in the normalgroup (p < 0.005). The total testosterone and androstenedione levels were higher and sex hormonebinding globulin (SHBG) lower in PCOS only when compared with the normal group (p < 0.05).The ovarian volume was similar in IC ≤ 3 ,IC > 3 and PCOS ,and higher than in the normal group (p < 0.005). A higher incidence of polycystic structure was found in IC ≤ 3 ,IC > 3 andPCOS ,whereas normal structure was more common in normal adolescents (p < 0.0005). There were no significant differences in glucose and insulin parameters between groups. These results indicatethat menstrual irregularity within the first postmenarchal years can be an early clinical sign of PCOS.

Polycystic ovary syndrome in adolescence and early adulthood

Polycystic ovaries and the associated syndrome are recognized as the most common cause of endocrine disturbances in adult women, but much less research has been performed to examine how polycystic ovary syndrome (PCOS) presents in girls and young women. Polycystic ovaries have been demonstrated in childhood, and there is evidence to show that even very young women may show symptoms and signs of the associated syndrome. Closer examination of younger populations (ˇ- 25 years of age), and in particular, studies of girls during the transition from puberty into early adulthood (adolescence), may provide new insights into the pathogenesis and natural history of polycystic ovaries and PCOS, and may indicate whether polycystic ovaries could potentially be considered as a marker for health screening. Consideration should be given to the management of girls and young women with polycystic ovaries and PCOS as this group may have different needs and health risks compared with older women.

Adolescent polycystic ovary syndrome.

Annals of the New York Academy of SciencesVolume 816, Issue 1 p. 194-208 Adolescent Polycystic Ovary Syndrome V. DRAMUSIC, V. DRAMUSIC Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorU. RAJAN, U. RAJAN Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorP. CHAN, P. CHAN Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorS. S. RATNAM, S. S. RATNAM Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorY. C. WONG, Y. C. WONG Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this author V. DRAMUSIC, V. DRAMUSIC Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorU. RAJAN, U. RAJAN Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorP. CHAN, P. CHAN Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorS. S. RATNAM, S. S. RATNAM Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this authorY. C. WONG, Y. C. WONG Department of Obstetrics and Gynaecology and Psychosocial Medicine National University Hospital and School Health Service Lower Kent Road Singapore 119074Search for more papers by this author First published: 17 December 2006 https://doi.org/10.1111/j.1749-6632.1997.tb52143.xCitations: 24Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume816, Issue1Adolescent Gynecology and Endocrinology: Basic and Clinical AspectsJune 1997Pages 194-208 RelatedInformation