ESPE Abstracts (2014) 82 P-D-2-1-530

The Vaginal Maturation Index as a Marker of Local Sensitivity to Estrogens in Girls with Congenital Adrenal Hyperplasia During Puberty

Irina Kopylova, Sofya Blokh, Elizaveta Orlova, Irina Yarovaya & Maria Kareva


Endocrinology Research Centre, Department of Pediatric Endocrinology, Moscow, Russia


Background: Introital stenosis is the main complication of vaginoplasty in females with Congenital Adrenal Hyperplasia (CAH) which could result from poor estrogenization of vaginal tissue during puberty.

Objective and hypotheses: To evaluate the maturation of vaginal mucosa depending on the degree of compensation.

Method: 19 adolescent girls with CAH (salt-wasting (SW) – 9, simple virilizing (SV) – 10; 15.9 years (14.4, 16.9), Tanner 4 (3, 5)) were divided into two groups according to the mean serum 17-hydroxyprogesterone (17-OHP), testosterone (Ts) levels and regularity of menstrual cycle during last year: group 1 – satisfactory compensation (n=10, regular/irregular cycle – 6/4); group 2 – inadequate compensation (n=9, regular cycle/primary amenorrhea/secondary amenorrhea=2/3/4). The control group 3 included 12 age-matched healthy adolescent girls with regular menstrual cycle. Cytological examination of vaginal smears with the determination of vaginal maturation index (VMI=(% intermediate cells×0.5)+% superficial cells) and atrophic index (AI, % parabasal cells)) has been performed.

Results: Serum Ts level negatively correlated with VMI (rs=−0.58, P=0.008) and positively correlated with AI (rs=0.51, P=0.024) in total CAH group. No significant correlations were observed between indices and serum estradiol and 17-OHP levels. In group 1 VMI was significantly higher than in group 2 (62.5% (56, 64.5) vs 48.3% (43.2, 53.75), P=0.002). No significant difference of VMI was revealed between group 1 and group 3. Parabasal cells were found in five girls from group 2 (AI =3.5% (0.0, 20.0) vs 0.0% (0.0, 0.0) in group 1). The significant difference of AI was observed in group 2 between SW and SV form (20.25% (10.0, 33.75) vs 0.0% (0.0, 3.5), P=0.04).

Conclusion: The estrogenization of vaginal tissue mainly depends on the compensation of CAH. Epithelium maturation is reduced more in SW in comparison to the SV form.

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