Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disease among women of reproductive age with a prevalence of about 8% according to the Androgen Excess Society (AES) criteria. The pathophysiology of PCOS is not well understood and it is associated with a high prevalence of metabolic disorders. During puberty, irregular menses and acne are common, thus making the diagnosis of PCOS in adolescence challenging.
Objective and hypotheses: To study the prevalence of PCOS among obese teenage girls referred to the Obesity Unit at CHUV Hospital and characterize the clinical, endocrine and metabolic profiles of these obese teens.
Method: 1-year prospective observational study of obese girls (BMI>+2 SDS) from menarche or after age 15 in cases of primary amenorrhea. Exclusion criteria were hyperprolactinemia, hypothyroidism, pregnancy and every other cause of hyperandrogenemia. Endocrine and metabolic profiling and pelvic ultrasound were performed.
Results: In total, 21 patients (1117 years old) were included none of whom had been previously diagnosed with PCOS. According to AES criteria (hyperandrogenism, oligomenorhea, PCO morphology on pelvic US) the 43% of this cohort presented with PCOS. By definition, total testosterone and androstenedione were significantly higher in the PCOS group. This group exhibited higher LH, (10.6 vs 5.3 mUI/l, P=0.029), inhibin B (108.3 vs 57.5 pg/ml, P=0.023) and AMH (35.16 vs 16.6 pM, P=0.05), and had higher total cholesterol levels (4.1 vs 3.6 mM, P=0.05). Yet no other differences in metabolic parameters. Interestingly, lumbar bone mineral density was significantly lower in PCOS teens.
Conclusion: PCOS among obese adolescent is extremely frequent. Moreover, this prevalence is probably underestimated given the poor sensitivity of trans-abdominal ultrasound to detect PCO morphology in these teens. No significant differences were observed in terms of prediabetes/diabetes among these obese teens potentially due to the limited sample size. Further imaging using pelvic MRI is ongoing and will enable a more precise diagnosis of PCO morphology.
10 Sep 2016 - 12 Sep 2016