ESPE Abstracts (2016) 86 P-P1-371

Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool, UK

Background: Diagnostic criteria for polycystic ovarian syndrome (PCOS) are well established in the adult population, but may not be appropriate for adolescent girls. Clinical and/or biochemical hyperandrogenism is one important diagnostic criterion. Screening for hyperandrogenism is often restricted to measurements of testosterone in adult practice. It was our impression that this strategy would under-diagnose PCOS in our adolescent population.

Objective and hypotheses: To describe androgen profiles in adolescent girls presenting with clinical features of PCOS, to identify the most sensitive marker of hyperandrogenism in adolescent PCOS.

Method: A retrospective case review was undertaken of patients with clinical characteristics of PCOS (clinical hyerandrogenism plus oligomenorrhoea/ primary or secondary amenorrhoea, with or without polycystic ovaries on ultrasound) attending a single centre between 2005 and 2015.

Results: Data are reported as median (range). Data were collected from 40 patients, age 15.49 (11.84–18.02) years. BMI-SDS was 2.42 (−1.25–3.91), and 25/40 (62.5%) were overweight/obese (BMI SDS >1.75). Androgen profiles and sex hormone binding globulin levels at presentation are given in Table 1.

Table 1. Androgen and sex hormone binding globulin levels in 40 patients.
Biochemical marker (normal range)Number of patients with abnormal level (%), median level (range)
Testosterone (0–3.5 nmol/l) 2 (5%), 1.7 (<0.7–4.7)
DHEAS (1.6–7.8 umol/l)11 (28%), 5.7 (1.8–14.9)
Androstendione (2–5.4 nmol/l)26 (65%), 6.6 (1.3–18.2)
SHBG (25–145 nmol/l)20 (50%), 24.5 (9–200)
LH: FSH ratio (<2)14 (35%), 1.71 (0.1–5.8)
Free Androgen Index (0.5–6.5)19 (48%), 5.99 (0.72–33.5)

Conclusion: In this population of girls, with clinical feature of PCOS, hyperandrogenism would not have been diagnosed in 60% of patients if only testosterone was measured. No patient, in whom androstenedione was elevated, had normal testosterone levels. These novel data suggest that the most sensitive marker of PCOS in adolescent girls is androstenedione.

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