ESPE Abstracts (2018) 89 FC10.6

Primary Ovarian Insufficiency Incidence Rate and ETIOLOGY AMONG ISRAELI ADOLESCENTS between the Years 2000-2016 - A Multi-Center Study

Noah Grubera,b, Shir Kuglera, Liat de Vriesb,c, Avivit Brenerb,c, Amnon Zungd,e, Ori Eyalb,f, Marianna Rachmielb,g, Ilana Korenh, Yardena Tenenbaum-Rakoveri,j, Eli Hershkovitzk, Zohar Landaub,l, Meirav Orenm, Alon Eliakimb,n, David Zangene,o, Alina Germanp, Hussein Majdoubh, Kineret Mazor-Aronovitchl, Dalit Modan-Mosesa,b, Yonatan Yeshayahua,b, Larisa Naugolnig, Yael Levy-Shragaa,b, Michal Ben-Amia,b, Gherta Brillq, Floris Levy-Khademie,r, Carmit Avnon-Zive,r, Dov Tiosanoj,m, Shira Harels, Einat Kedeml, Anat Segev-Beckerf, Yehuda Shoenfeldb,t & Orit Pinhas-Hamiela,b


aPediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel; bSackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; cThe Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel; dPediatric Endocrinology Unit, Kaplan Medical Center, Rehovot, Israel; eThe School of Medicine in the Hebrew University, Jerusalem, Israel; fPediatric Endocrinology and Diabetes Unit, Dana-Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; gPediatric Endocrinology Unit, Division of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel; hPediatric Endocrinology Clinic, Armon Child Center, Clalit Health Services, Haifa, Israel; iPediatric Endocrine Unit, Ha’Emek Medical Center, Affula, Israel; jThe Rappaport Faculty of Medicine, Technion, Haifa, Israel; kPediatric Endocrinology and Metabolic Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; lPediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel; mPaediatric Endocrine Unit, Rambam Health Care Campus, Haifa, Israel; nMeir Medical Center, Kfar Saba, Israel; oDivision of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel; pPediatric Department, Bnei Zion Medical Center, Haifa, Israel; qMigdale Ha’Meha, Clalit Health Services, Central District, Tel Aviv, Israel; rDivision of Pediatric Endocrinology, Shaare Zedek Medical Center, Jerusalem, Israel; sMaccabi Health Services, Central District, Rishon Lezion, Israel; tZabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel


Introduction: Primary ovarian Insufficiency (POI) occurring in youth is a devastating condition. POI is characterized by at least 4 months of disordered menses in association with menopausal follicle stimulating hormone (FSH) levels. The most common causes of POI in adolescence are iatrogenic and chromosomal abnormalities. Data are scarce regarding the incidence of POI in adolescents.

Objectives: We aimed to estimate the incidence and the distribution of etiologies of POI in a multi-center study in Israel.

Methods: Data regarding girls under age 22 years presenting with POI during the years 2000–2016 were collected from 14 medical centers. Iatrogenic cases were excluded. The incidence rate of new POI diagnosis was calculated based on birthrate information from the Israeli Central Bureau of Statistics (CBS).

Results: One hundred and fourteen girls met the criteria of POI, presented at a mean age of 13.6±3.8 years, 68 (60%) with primary amenorrhea. Their mean FSH level was 77.3±39.9 mUI/ml. The distribution of etiologies was: Turner syndrome/mosaicism in 50/114 (44%), idiopathic in 36/114 (32%) and other (genetic, autoimmune, etc.) in 28/114 (24%). The incidence rate of new POI diagnoses per 100,000 births doubled between the years 2009–2016 compared to the years 2000–2008 (incidence rates 3.8 and 1.8, respectively, P-value=0.0007). Moreover, the incidence rates of both idiopathic and other etiologies tripled comparing these two time periods (P-value=0.004 and P-value=0.01 respectively), contrasting with Turner syndrome, whose incidence rate remained static (P-value=0.6).

Conclusions: Over the last decade a significant increase in the rate of POI was observed among adolescents, especially among non-Turner cases. We believe the findings reflect a true increase in the risk of developing POI and not a change in awareness and identification patterns. The possible involvement of environmental and epigenetic factors in this remarkable increase should be investigated.

Article tools

My recent searches

No recent searches.