Polycystic ovarian morphology in adolescents with regular menstrual cycles is associated with elevated anti-Mullerian hormone

Villarroel, Claudio; Merino, Paulina M.; López, Patricia; Eyzaguirre, Francisca; Velzën, A. Van; Íñiguez, Germán; Codner, Ethel

doi:10.1093/humrep/der223

Cited by 86 publications

(68 citation statements)

References 47 publications

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“…AMH concentrations reflect the number of antral follicles and are often elevated in adult women with PCOS. Available data are inconsistent regarding the usefulness of AMH in the diagnosis of PCOS among adolescent girls [92][93][94][95][96] . (2) Further, a multifollicular pattern, which is defined by the presence of large follicles distributed throughout the ovary, does not have a relationship with hyperandrogenism, is more common in adolescents, and should not be considered a pathological finding (Level C).…”

Section: What Hormonal Findings Are Associated With Polycystic Ovaries?mentioning

confidence: 99%

The Diagnosis of Polycystic Ovary Syndrome during Adolescence

et al. 2015

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dress a series of questions regarding the diagnosis of PCOS during adolescence including the following: clinical and biochemical evidence of hyperandrogenism, criteria for oligoanovulation and polycystic ovary morphology, diagnostic criteria to exclude other causes of hyperandrogenism and amenorrhea, role of insulin resistance, and intervention. Results and Conclusion: Features of PCOS overlap normal pubertal development. Hence, caution should be taken before diagnosing PCOS without longitudinal evaluation. However, treatment may be indicated even in the absence of a definitive diagnosis. While obesity, insulin resistance, and hyperinsulinemia are common findings in adolescents with hyperandrogenism, these features should not be used to diagnose PCOS among adolescent girls. © 2015 S. Karger AG, Basel Key WordsHyperandrogenism · Ovarian hyperandrogenism · Ovary · Polycystic ovary syndrome · Puberty Abstract Background/Aims: The diagnostic criteria for polycystic ovary syndrome (PCOS) in adolescence are controversial, primarily because the diagnostic pathological features used in adult women may be normal pubertal physiological events. Hence, international pediatric and adolescent specialty societies have defined criteria that have sufficient evidence to be used for the diagnosis of PCOS in adolescents. Methods: The literature has been reviewed and evidence graded to ad-

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Section: What Hormonal Findings Are Associated With Polycystic Ovaries?mentioning

confidence: 99%

The Diagnosis of Polycystic Ovary Syndrome during Adolescence

et al. 2015

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“…Villarroel and cols. (40), from our group, reported that girls with PCOM have higher AMH levels than girls without PCOM (72.5 ± 6.1 vs. 33.4 ± 2.6 pmol/L; P < 0.0001), and lower FSH levels (5.4 ± 0.3; 6.2 ± 0.2 mUI/ml; P < 0.036). AMH levels positively correlated with the 2-5 mm follicle number, and AMH levels above 60.15 pmol/L had a sensitivity and specificity of 64.0 and 89.8%, respectively, to diagnose PCOM by the Rotterdam criteria (AUC = 0.873).…”

Section: Polycystic Ovarian Morphologymentioning

confidence: 67%

“…The hormonal profile associated with the presence of PCOM has shown that this condition, when observed in healthy girls with regular menstrual cycles, is not associated with insulin resistance or hyperandrogenism (40,43,44). However, Mortensen and cols.…”

Section: Polycystic Ovarian Morphologymentioning

confidence: 99%

“…A high prevalence of PCOM in healthy adolescents, with regular menstrual cycles and with no evidence of clinical hyperandrogenism, has been reported in the 30%-35% range (40)(41)(42), which is similar to the prevalence of 38% and 37% observed in adolescents with hyperandrogenism and or PCOS, respectively, but is lower compared to the prevalence of PCOM 90%-100% in adult women with PCOS (17). Thus, these findings suggest that PCOM during adolescence is not increased in hyperandrogenic adolescents compared to healthy girls, and is less prevalent in the former group compared to adult women with PCOS.…”

Section: Polycystic Ovarian Morphologymentioning

confidence: 99%

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A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence

Merino

Codner

Cassorla

2011

Arq Bras Endocrinol Metab

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SUMMARYPolycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These findings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence creates confusion and may be misleading. Arq Bras Endocrinol Metab. 2011;55(8):590-8 Keywords Hyperandrogenism; hirsutism; polycystic ovarian syndrome; adolescence; diagnosis; puberty; polycystic ovarian morphology; menstrual irregularities; anti-Müllerian hormone SUMáRio A síndrome dos ovários policísticos (SOP) é uma desordem que afeta pacientes por toda a vida e é caracterizada por hiperandrogenismo e disfunção ovariana, com um amplo leque de sintomas e sinais clínicos. Três diferentes conjuntos de critérios diagnósticos foram estabelecidos para definir essa doença em mulheres adultas, mas existem controvérsias relacionadas ao uso desses critérios na adolescência. Durante a puberdade, o critério de disfunção ovariana usado em adultos não parece aplicável, porque um padrão menstrual irregular e uma menor taxa de ovulação são eventos fisiológicos nesse período da vida. Além disso, uma maior prevalência de morfologia ovariana policística (MOP) pode ser observada nesse período, de forma que a MOP não é um critério útil para se definir a SOP em mulheres jovens. Esses achados sugerem que o hiperandrogenismo é um fator-chave para o diagnóstico da SOP na adolescência. Além disso, como a MOP não está claramente associada com o hiperandrogenismo durante esse período da vida, o termo "síndrome dos ovários policísticos" durante a adolescência cria confusão e pode ser errôneo. Arq Bras Endocrinol Metab. 2011;55(8):590-8 Descritores

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“…Many adolescents exhibit physiologic menstrual irregularity and signs of androgen excess (e.g., acne) in the peripubertal period (13). In addition, normative testosterone levels are ill defined in this age group (14), and normal adolescent ovarian morphology overlaps with that of women with PCOS (15,16).…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

Kamboj

Bonny

2017

Transl. Pediatr

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Controversy continues about the underlying etiopathogenesis, diagnostic criteria, and recommendations for polycystic ovary syndrome (PCOS) in adolescents. Recent literature has recognized these deficiencies and evidence based expert recommendations have become more available. The purpose of this chapter is to offer primary care providers a practical understanding and approach to the diagnosis and treatment of PCOS in adolescents. Although the presence of polycystic ovary morphology (PCOM) is included as a key diagnostic criterion of PCOS in adults, it is currently not recommended for the diagnosis in adolescents. As such, the diagnosis of PCOS in adolescents currently hinges on evidence of ovulatory dysfunction and androgen excess. Recommended evidence of ovulatory dysfunction includes: consecutive menstrual intervals >90 days even in the first year after menstrual onset; menstrual intervals persistently <21 or >45 days 2 or more years after menarche; and lack of menses by 15 years or 2-3 years after breast budding. Recommended evidence of androgen excess include: moderate to severe hirsutism; persistent acne unresponsive to topical therapy; and persistent elevation of serum total and/or free testosterone level. Importantly, a definitive diagnosis of PCOS is not needed to initiate treatment. Treatment may decrease risk of future comorbidity even in the absence of a definitive diagnosis. Deferring diagnosis, while providing symptom treatment and regular/ frequent follow-up of symptomology, is a recommended option.The treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. Goals of treatment are to improve quality of life and long-term health outcomes. Lifestyle modifications remain first-line management of overweight and obese adolescents with PCOS. Combined oral contraceptives (COC) are first line pharmacotherapy for management of menstrual irregularity and acne, and metformin is superior to COCs for weight reduction and improved dysglycemia. COCs and metformin have similar effects on hirsutism, but often need to be paired with other treatment modalities to achieve further improvement of cutaneous symptoms. Clinicians should be cognizant that PCOS is associated with significant metabolic and psychological comorbidity and screen for these issues appropriately.

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Polycystic ovarian morphology in adolescents with regular menstrual cycles is associated with elevated anti-Mullerian hormone

Cited by 86 publications

References 47 publications

The Diagnosis of Polycystic Ovary Syndrome during Adolescence

The Diagnosis of Polycystic Ovary Syndrome during Adolescence

A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

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