Hirsutism and oligomenorrhea are appropriate screening criteria for polycystic ovary syndrome in adolescents

Abstract

We evaluated the association of hirsutism and oligomenorrhea (persistent menstrual cycles > 45 days) as screening criteria for the detection of biochemical hyperandrogenism (BH) and polycystic ovaries (PCOM) during adolescence and determined which androgens, granulosa cell hormone, ultrasonographic parameters have the best association with polycystic ovary syndrome (PCOS). Hirsute girls with oligomenorrhea (N = 26 Hirs/Oligo group) and non-hirsute girls with regular cycles (N = 63, C group) were studied. Prevalence of BH and PCOM, diagnostic performance of androgens and ultrasound parameters for PCOS diagnosis were analyzed. BH and PCOM prevalence were higher in the Hirs/Oligo girls than in the C girls (76.9% versus 25.5%; 92.3% versus 33.3%, respectively; p < 0.0001). A complete PCOS phenotype (Hirs/Oligo with BH and PCOM) was observed in 73.1% of the Hirs/Oligo group. The presence of both BH and PCOM was observed in 7.9% of the C group. The parameters with the best diagnostic performance were free androgen index ≥6.1, testosterone ≥2.4 nmol/L, follicle number ≥12 and ovarian volume ≥10 ml anti-Müllerian hormone (AMH) exhibited a low diagnostic accuracy. Hirsutism and persistent menstrual cycle over 45 days are highly associated with BH and PCOM suggesting that the presences of both criteria are necessary for the diagnosis of PCOS during adolescence.

High Prevalence of Polycystic Ovary Syndrome in Type 1 Diabetes Mellitus Adolescents: Is There a Difference Depending on the NIH and Rotterdam Criteria?

“…Among the patients without PCOS, regardless of Rotterdam or NIH criteria, none had a clinical association of oligomenorrhea and hirsutism. This is in accordance with the recent publication of Villarroel et al [33] that highlights the clinical phenotype of PCOS in adolescents. In contrast, 23.3% of our NIH-PCOS-negative patients had laboratory criteria of PCOS (biochemical hyperandrogenism and PCOM).…”

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

“…Calculated free testosterone, free androgen index or bioavailable testosterone should be used to assess biochemical hyperandrogenism in the diagnosis of PCOS. This was the only strong evidence-based recommendation of low GRADE quality for biochemical testing for hyperandrogenism, including one study in adolescents [35]. This recommendation was determined after examination of the literature showing that androgen levels in adolescents reach adult levels around the time of menarche.…”

“…This recommendation was determined after examination of the literature showing that androgen levels in adolescents reach adult levels around the time of menarche. Seven studies evaluated the most effective measure to diagnose PCOS-related hyperandrogenism (biochemical) [35][36][37][38][39][40][41], with only one of these studies performed in adolescents, including 89 subjects (26 with girls with PCOS and 63 controls) [35] (see Section 1.2 in the Technical Report).…”

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

“…Elevated AMH levels have been a consistent hormone finding in women with PCOS [186, 187]. However, in adolescents, AMH should not be used as a criterion of PCOS since there is a weaker association of AMH levels with the disorder [188, 189]. This divergence may be due to the presence of higher AMH serum levels in healthy adolescents compared to adult women, with a wide normal range [178, 180, 190, 191].…”