Early Endocrine, Metabolic, and Sonographic Characteristics of Polycystic Ovary Syndrome (PCOS): Comparison between Nonobese and Obese Adolescents

Abstract

Approximately half of all women with polycystic ovary syndrome (PCOS) are overweight or obese, and studies have reported endocrine and metabolic differences between lean and obese women with PCOS. PCOS has not been as extensively investigated in the adolescent population. The objectives of our study were to further characterize early endocrine and metabolic alterations in adolescents with PCOS and to determine whether differences between nonobese and obese women with PCOS are present early in its course. We studied an ethnically heterogeneous group of 48 adolescents: 11 nonobese with PCOS [age, 16.1 +/- 1.9 yr; body mass index (BMI), 22.5 +/- 1.5 kg/m(2)], 22 obese with PCOS (age, 15.5 +/- 1.4 yr; BMI, 35.9 +/- 6.2 kg/m(2)), and 15 obese controls (age, 14.4 +/- 1.5 yr; BMI, 35.8 +/- 7.1 kg/m(2)). Fasting levels of glucose, insulin, proinsulin, hemoglobin A1c, testosterone, SHBG, Delta4-androstenedione (Delta4-A), dehydroepiandrosterone sulfate (DHEAS), LH, FSH, IGF-I, IGF binding protein-1, free IGF-I, and lipids were measured. Six of the 11 nonobese PCOS subjects, 11 of the 22 obese PCOS subjects, and six of the 15 controls underwent standard oral glucose tolerance testing. The insulin response to the oral glucose tolerance test was measured by the insulin area under the curve (I(AUC120)). Measures of insulin sensitivity were calculated as the fasting glucose to insulin ratio, quantitative insulin sensitivity check index, and composite insulin sensitivity index. The nonobese adolescents with PCOS demonstrated higher levels of LH, SHBG, Delta4-A, DHEAS, dihydrotestosterone, free IGF-I, and high-density lipoprotein, and lower low-density lipoprotein, compared with the obese PCOS group. Fasting levels of insulin and proinsulin, I(AUC120), and log I(AUC120) were higher, and the fasting glucose to insulin ratio, quantitative insulin sensitivity check index, and composite insulin sensitivity index were lower in the obese compared with the nonobese PCOS subjects. Greater levels of LH and androgens, including total and free testosterone, Delta4-A, and DHEAS, and lower SHBG levels were found in the obese PCOS group compared with the obese controls. Adolescents with PCOS manifest clinical, metabolic, and endocrine features similar to those of adult women, and differences between nonobese and obese women with PCOS may be detected in adolescence. Our findings indicate a more pronounced alteration in the hypothalamo-pituitary-adrenal axis in nonobese adolescents with PCOS and a more marked dysregulation of insulin levels and impairment of insulin sensitivity in their obese counterparts. Our data also suggest differences in the IGF system between nonobese and obese adolescents with PCOS.

Prenatal androgen excess programs metabolic derangements in pubertal female rats

“…In a study of 22 obese adolescents with PCOS, only one participant (4.5%) had IGT (Bridger et al 2006), whereas other studies of obese adolescents with PCOS have reported IGT rates as high as 33-52% , Palmert et al 2002. By contrast, nonobese adolescents with PCOS have not been reported to have an increased risk of IGT (Silfen et al 2003), suggesting the underlying relationship between IGT and obesity.…”

Is ultrasound useful in the diagnosis of adolescents with polycystic ovary syndrome?

“…Overall, nine studies conducted between 2003 and 2013 were identified, and seven were used in this review (8)(9)(10)(11)(12)(13)(14). Two studies were excluded from our analysis because there was a lack of ultrasonographic quantitative data (15,16).…”

“…The overall mean ovarian volume was 9.29 ± 4.62 cm 3 for PCOS patients and 4.77 ± 2.30 cm 3 for controls (p < 0.001). This was calculated using studies that had both PCOS and control patients (9,11,13). The morphology of ovarian follicles was reported in three of the studies, which showed peripheral and multiple follicles ( > 10) in 83% of cases (10,11,14).…”

Hyperandrogenism in adolescents

“…[23] Yap›lan testlerle hiperandrojenemi tan›s› için total testosteron 55 ng/dl, serbest testosteron 6.3 pg/ml, androstenodion 2.45 ng/ml ve/veya DHEA-S 2480 ng/ml üzerinde olmas› gerekir. [24] Fruzzetti F. ve arkadafllar› ise total testosteron 80 ng/dl üzerinde ve/veya serbest testosteron 3.6 pg/ml üzerinde ve/veya DHEAS 3600 ng/ml üzerinde …”