Polycystic Ovary Syndrome In Adolescent Girls Research Articles

Prevalence and diagnosis of polycystic ovary syndrome (PCOS) in adolescents - what's new in 2023? Systematic review.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting approximately 5 to 18% of women of reproductive age and 3 to 11% of teenagers. The diagnostic criteria used in adult patients are not suitable for the diagnosis of adolescent patients, because some of the features may be physiological for puberty, so research is still ongoing to improve the criteria for diagnosing PCOS in teenagers. Polycystic ovary syndrome is associated with hormonal and metabolic changes and may predispose to the occurrence of many other diseases, such as obesity, metabolic syndrome, hypertension, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). Due to the high prevalence of PCOS and the various health problems it brings, it is necessary to select adolescent girls from the risk group, make an efficient diagnosis, start appropriate treatment, and lead the patient through a lifestyle change as soon as possible. Researchers' attention is increasingly focused on patients presenting with PCOS already in their teenage years. In our work, we want to look at the latest reports regarding the prevalence, pathophysiology and diagnosis of PCOS in adolescent girls.

005 New insights into polycystic ovary syndrome (PCOS) in adolescents

Polycystic ovary syndrome (PCOS) is a complex heterogenous disorder characterized by hyperandrogenism and chronic anovulation. Six (6%) to 20% of reproductive aged women are affected based on the diagnostic criteria used. Symptoms of PCOS arise during the early pubertal years. Although the Rotterdam criteria are mainly accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated.

Quality Improvement in the Evaluation and Diagnosis of Polycystic Ovary Syndrome in Adolescent Girls.

Polycystic ovary syndrome (PCOS) can be challenging to diagnose in adolescents because the diagnostic criteria for adult women overlap with normal features of pubertal development. Previous studies have highlighted inconsistencies in diagnostic criteria used by health care providers. International consensus groups have introduced recommendations to aid diagnosis of this disorder among adolescents. In this study we explored diagnostic inconsistencies and provided education for providers regarding these consensus recommendations. Quality improvement. Teaching hospital-affiliated adolescent medicine clinic. Adolescent medicine providers (n = 14) participated in the intervention. Educational intervention on the basis of the 2015 international consensus recommendations was implemented to address provider inconsistencies. Use of laboratory assessment and documentation for diagnosis of girls evaluated for possible PCOS. Preintervention, providers used diverse diagnostic criteria including obesity, insulin resistance, mild acne, and minimal hirsutism with no reference to published criteria. Laboratory studies to exclude other disorders were obtained in 24/87 (28%) preintervention patients. Postintervention, the percentage of laboratory studies increased to 40/65 (62%). Oral glucose tolerance tests performed to assess for glycemic comorbidities increased from 6/87 (7%) to 16/65 (25%). After this intervention, providers included more documentation of features associated with PCOS yet did not use "at risk for PCOS" terminology. After our educational intervention, providers showed greater awareness of diagnostic criteria for PCOS in adolescent girls. Medical record documentation and use of "at risk for PCOS" terminology needs improvement. Integration of specific PCOS templates in the electronic medical record might improve medical record documentation and appropriate diagnosis.

Adolescent Polycystic Ovary Syndrome: An Update

Menstrual irregularities and cutaneous signs of androgen excess are commonly encountered when caring for adolescent girls. Polycystic ovary syndrome (PCOS) is the most common cause of these symptoms in adult women, and it can be diagnosed in adolescents as well. Diagnostic criteria used to diagnose adult women are not applicable in adolescents, as some diagnostic criteria overlap with the normal physiology of a maturing reproductive system. Thus, application of adult criteria will overdiagnose adolescents with PCOS. Two recent guidelines on the diagnosis and treatment of PCOS in adolescence were created to provide clarity in the diagnosis of PCOS in adolescent girls and to guide best practices in treatment. This review summarizes the recommendations and gives practical advice on the application of these recommendations to everyday pediatric practice. [Pediatr Ann. 2019;48(8):e304-e310.].

Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected. Symptoms of PCOS arise during the early pubertal years. Both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne. Owing to the complicated interwoven pathophysiology, discerning the inciting causes is challenging. Most available clinical data communicate findings and outcomes in adult women. Whereas the Rotterdam criteria are accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated. Diagnostic features for adolescent girls are menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls. Even before definitive diagnosis of PCOS, adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being “at risk for PCOS.” Management of both those at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms. Interventions can include metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne. In addition to ascertaining for associated comorbidities, management should also include regular follow-up visits and planned transition to adult care providers. Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS. Timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life.

Reduced Prenatal Weight Gain and/or Augmented Postnatal Weight Gain Precedes Polycystic Ovary Syndrome in Adolescent Girls.

Hepato-visceral fat excess is a feature of polycystic ovary syndrome (PCOS). Risk factors for such excess include low prenatal weight gain and high postnatal weight gain. This study examined whether adolescent PCOS was preceded by a relatively low birth weight and/or a relatively high BMI at diagnosis. Study participants included 467 girls with PCOS (298 without obesity and 169 with obesity), diagnosed, respectively, in Spain and Germany; 87 healthy girls were controls. Z scores for weight at birth and BMI at PCOS diagnosis were derived, and their differences were calculated. Spanish girls with PCOS and without obesity and German girls with PCOS and obesity had mean birth weight z scores of -0.7 and 0.0, respectively, and mean BMI z scores of + 0.4 and +2.7, respectively, so that mean z score increments amounted to +1.1 and +2.6 (P < 0.001 vs. controls). PCOS in adolescent girls was preceded by marked z score increments between weight at birth and BMI at PCOS diagnosis, thus corroborating the notion that PCOS development is driven by a mismatch between prenatal weight gain and postnatal weight gain.

High Prevalence of Polycystic Ovary Syndrome in Type 1 Diabetes Mellitus Adolescents: Is There a Difference Depending on the NIH and Rotterdam Criteria?

Background: Polycystic ovary syndrome (PCOS) is more frequently observed in type 1 diabetes mellitus (T1DM) adult women than in nondiabetic women. No such prevalence has yet been studied in adolescent girls with T1DM. Aim: The aim of this study was to evaluate the prevalence of PCOS in adolescent girls with T1DM and to determine the clinical and hormonal features associated with the disorder. Methods: A cross-sectional study of 53 adolescent girls (gynecological age >2 years) referred for routine evaluation for T1DM was conducted. We diagnosed PCOS using the National Institutes of Health (NIH) and Rotterdam criteria. Results: 26.4 and 47.9% of adolescents had PCOS according to NIH (NIH-PCOS) and Rotterdam (Rotterdam-PCOS) criteria. 66.7% of NIH-PCOS adolescents had a complete phenotype associated with hyperandrogenism, oligomenorrhea, and polycystic ovarian morphology, unlike only 33.3% of the Rotterdam-PCOS adolescents. A family history of type 2 diabetes mellitus (T2DM) was more frequent in PCOS than in non-PCOS girls, whichever criteria were used. Late pubertal development and a T1DM diagnosis close to puberty were factors associated with NIH-PCOS. Conclusion: Adolescents with T1DM had a high prevalence of PCOS. More differences between PCOS and non-PCOS patients were found using the NIH criteria, suggesting that clinical characteristics might be more accurate for diagnosing PCOS in girls with T1DM. A family history of T2DM is associated with a high risk of PCOS.

Polycystic ovary syndrome in adolescent girls.

Polycystic ovary syndrome (PCOS) is a common heterogeneous disorder that appears to have its origins during the peripubertal years. The diagnostic conundrum is that the typical clinical features, irregular menses and acne, occur during normal female puberty. Understanding the physiologic origins and molecular basis of the dysregulated hypothalamic-pituitary-gonadal axis in PCOS is fundamental to interrupting the distinctive vicious cycle of hyperandrogenism and chronic anovulation. Newer ultrasound technology with better spatial resolution has generated controversy regarding the optimal imaging criteria to define polycystic ovary morphology. Using such equipment, the Androgen Excess PCOS Society Task Force Report recommends a threshold of at least 25 follicles per ovary as the definition of polycystic ovary morphology. The implementation and results of genome-wide association studies has opened a new window into the pathogenesis of PCOS. Recent genome-wide association studies have identified several loci near genes involved in gonadotropin secretion, ovarian function, and metabolism. Despite the impediments posed by phenotypic and genetic heterogeneity among women with PCOS, investigation into one locus, the DENND1A gene, is providing insight into the ovarian steroidogenesis. Anti-Mullerian hormone (AMH) has long been recognized to play a major role in the ovarian dysfunction. Recent animal data implicate AMH in the neuroendocrine dysregulation by demonstrating AMH-stimulated increased gonadotropin releasing hormone and luteinizing hormone secretion. PCOS is a common complex multifaceted disorder associated with genetic and environmental influences affecting steroidogenesis, steroid metabolism, neuroendocrine function, insulin sensitivity, pancreatic β cell function, and alternative adaptations to energy excess. Current research into the genetics and pathophysiology is reviewed. The difficulties inherent in diagnosing PCOS in adolescent girls are discussed.

Diagnosing polycystic ovary syndrome in adolescent girls

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies and it manifests itself in about 4-12% women of reproductive age. The Rotterdam, AES and NIH criteria can be used to diagnose PCOS in adults but there are no specific criteria to diagnose PCOS in adolescent girls. Most authors agree that applying criteria for adult to teenagers leads to overdiagnosis because of similarity in physiological changes during puberty and common PCOS symptoms. Tightening of the current criteria and including new, not widely accepted yet, was proposed. Currently it seems justifiable to diagnose PCOS in adolescent girls using the Rotterdam criteria, on condition that all three symptoms are present, hyperandrogenism is established in laboratory tests and pelvic ultrasound reveals an increased ovarian volume (> 10 ml). Nevertheless, the necessity of more research and establishing specific criteria for adolescent girls is emphasized.

Diagnosing PCOS in adolescent girls

Polycystic ovary syndrome (PCOS) is a common endocrinologic problem in women. Irregular menses, an important component of PCOS, is more common at the onset of menses in adolescence. This has made the diagnosis of PCOS more difficult in adolescence and has led some to suggest that the diagnosis of PCOS be delayed until adulthood. This delay may be problematic, because PCOS is known to be associated with a metabolic phenotype that puts women at increased risk of cardiovascular disease.In this issue of The Journal, Roe et al explore the utility of the Androgen Excess (AE)-PCOS Society guidelines to diagnose PCOS in adolescent females. In this retrospective chart review, the authors found that adolescents diagnosed with PCOS using AE-PCOS Society criteria are at significantly increased risk of obesity, hypertension, and low high-density lipoprotein cholesterol compared with those who did not meet the criteria. The most common presenting symptoms of PCOS were menstrual irregularity, acne, hirsutism, and weight gain. Pediatricians should be aware of the diagnosis of PCOS in adolescent girls and not delay the diagnosis until adulthood.Article page 937▶ Polycystic ovary syndrome (PCOS) is a common endocrinologic problem in women. Irregular menses, an important component of PCOS, is more common at the onset of menses in adolescence. This has made the diagnosis of PCOS more difficult in adolescence and has led some to suggest that the diagnosis of PCOS be delayed until adulthood. This delay may be problematic, because PCOS is known to be associated with a metabolic phenotype that puts women at increased risk of cardiovascular disease. In this issue of The Journal, Roe et al explore the utility of the Androgen Excess (AE)-PCOS Society guidelines to diagnose PCOS in adolescent females. In this retrospective chart review, the authors found that adolescents diagnosed with PCOS using AE-PCOS Society criteria are at significantly increased risk of obesity, hypertension, and low high-density lipoprotein cholesterol compared with those who did not meet the criteria. The most common presenting symptoms of PCOS were menstrual irregularity, acne, hirsutism, and weight gain. Pediatricians should be aware of the diagnosis of PCOS in adolescent girls and not delay the diagnosis until adulthood. Article page 937▶ Using the Androgen Excess–PCOS Society Criteria to Diagnose Polycystic Ovary Syndrome and the Risk of Metabolic Syndrome in AdolescentsThe Journal of PediatricsVol. 162Issue 5PreviewTo use the Androgen Excess–PCOS Society (AE-PCOS) criteria in adolescents to diagnose polycystic ovary syndrome (PCOS) and identify the prevalence of metabolic risk factors. Full-Text PDF

Reproductive endocrinology of adolescent polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women, and it typically presents during adolescence. The objective of this review is to describe the clinical manifestations of PCOS in adolescent girls and the underlying basis for the altered reproductive physiology. Recognising adolescents at risk for PCOS and taking the appropriate steps to reduce circulating androgen levels is critical in reducing the clinical symptomatology of this disorder, and the development of adulthood infertility, diabetes, and metabolic syndrome in patients with PCOS.

Syndrome des ovaires polykystiques en période péripubertaire : polymorphisme clinique, biologique, métabolique et génétique

Polycystic ovary syndrome (PCOS) is a common cause of hyperandrogenism in adolescent girls. In its complete post menarchal expression, the syndrome is characterized by the association of typical clinical, biological, and ultrasonographic findings. Many factors have contributed to our knowledge of different clinical forms of PCOS in adolescent girls. They are helpful for clarifying misleading situations in a period of life when diagnosis of PCOS implies a treatment for many years and may interfere with gynecological outcome. During the last 3 years, we had the opportunity to follow-up in our unit 45 adolescent girls with ovarian hyperandrogenism: 32 of them had PCOS and the other 13 functional ovarian hyperandrogenism defined by clinical and biological hyperandrogenism without ultrasonographic abnormality. In this review, we report, from our personal experience as well as from recent literature data, the various clinical expressions of PCOS in the pubertal period: the classical post menarchal form, the exceptional pre menarchal form, the post precocious pubarche and the post precocious puberty forms, the familial expression as well as the dominant metabolic expression.

Le syndrome des ovaires polykystiques en période péri-pubertaire : polymorphisme clinique, biologique, métabolique et génétique

Polycystic ovary syndrome (PCOS) is a common cause of hyperandrogenism in adolescent girls. In its complete post menarchal expression, the syndrome is characterized by the association of typical clinical, biological, and ultrasonographic findings. Many factors have contributed to our knowledge of different clinical forms of PCOS in adolescent girls. They are helpful for clarifying misleading situations in a period of life when diagnosis of PCOS implies a treatment for many years and may interfere with gynecological outcome. During the last 3 years, we had the opportunity to manage in our unit 45 adolescent girls with ovarian hyperandrogenism: 32 of them had PCOS and the other 13 functional ovarian hyperandrogenism defined by clinical and biological hyperandrogenism without ultrasonographic abnormality. In this review, we report, from our personal experience as well as from recent literature data, the different clinical expressions of PCOS in the pubertal period: the classical post menarchal form, the exceptional pre menarchal form, the post precocious pubarche and the post precocious puberty forms, the familial expression as well as the dominant metabolic expression.