Characteristics and Ethnic Variations of Adolescents with Polycystic Ovarian Syndrome at a Tertiary Care Center

Research Article

J Pediatri Endocrinol. 2017; 2(2): 1019.

Characteristics and Ethnic Variations of Adolescents with Polycystic Ovarian Syndrome at a Tertiary Care Center

Shenep L* and Al-Zubeidi H

Department of Pediatrics, University of Tennessee Health Science Center, USA

*Corresponding author: Shenep L, Department of Pediatrics, Memphis, University of Tennessee Health Science Center, TN, USA

Received: July 09, 2017; Accepted: November 24, 2017; Published: December 01, 2017

Abstract

Objective: Determine the prevalence, characteristics, and ethnic variations in adolescents with Polycystic Ovarian Syndrome (PCOS).

Methods: A retrospective chart review of 250 adolescent girls with a diagnosis of PCOS or related co-morbidities between April 2014 to April 2016 was performed. A total of 92 patients were identified as having either possible PCOS or confirmed PCOS.

Results: The prevalence of confirmed PCOS in our cohort was 0.22%, and the prevalence of confirmed and possible PCOS was 1%. The average age was 15.4 years, and 90% of patients had a BMI>85%. 65% were black and 26% white. Black subjects had a greater prevalence of more severe obesity, defined as a BMI>40 (p=0.014), and a higher prevalence of elevated hemoglobin A1c (p=0.003). White subjects had a higher prevalence of an abnormal lipid profile (p=0.004). In black patients, hemoglobin A1C was positively associated with free testosterone (p=0.016), and BMI z score was negatively associated with sex hormone binding globulin (p=0.001).

Conclusion: Ethnicity influences the metabolic phenotype of PCOS within adolescents. Metabolic characteristics such as BMI and hemoglobin A1c are correlated with hyperandrogenemia.

Keywords: Polycystic ovarian syndrome; Ethnic variation; Adolescents

Introduction

Polycystic Ovarian Syndrome (PCOS) is one of the most common metabolic disorders in women of reproductive age. It is characterized by ovarian hyperandrogenism and chronic anovulation. While the pathogenesis of PCOS is not fully understood, PCOS likely develops from a combination of genetic and environmental factors affecting steroid metabolism [1]. Abnormalities in ovarian steroidogenesis as well as insulin resistance play a role in the development of hyperandrogenism [2-4].

Most studies regarding ethnic variations in patients with PCOS are limited to adult populations [5]. Ethnic variations in insulin resistance, obesity, lipid profiles have been described in women with PCOS [5-10]. In general, higher rates of obesity and insulin resistance are observed in black women with and without PCOS [7,8,10- 12]. Few studies have shown ethnic differences in androgens and gonadotropin [5].

Many features of PCOS overlap with the characteristics of normal pubertal development, including irregular menstrual cycles, acne, and polycystic ovarian morphology, making the diagnosis challenging in this age group [2]. Three international conferences have developed diagnostic criteria for adult women, including the National Institutes of Health (NIH) conference criteria (1990), the Rotterdam consensus criteria (2003), and the Androgen Excess-PCOS Society consensus criteria (2006) [13-15]. In 2003, an Endocrine Society-appointed Task Force suggested that the diagnosis of PCOS in adolescents be made based on the presence of clinical and/or biochemical Hyper- Androgenism, persistent oligomenorrhea, and exclusion of related disorders, which is consistent with the NIH criteria [16].

The objective of this study is to estimate the prevalence of PCOS and baseline characteristics within an adolescent population at a tertiary care center in Memphis, TN. We also aim to evaluate ethnic variations on clinical, hormonal, and metabolic parameters.

Methods

Study design

This was a retrospective chart review, conducted in an academic health center setting, designed to evaluate the prevalence, characteristics, and ethnic variations in adolescents with Polycystic Ovarian Syndrome (PCOS). The institutional review board of Le Bonheur Children’s hospital, Memphis, TN approved this study.

Subjects

A total of 9,205 girls aged 12-19 between April 2014 and April 2016 were seen in the General Pediatrics Clinic, Healthy Lifestyles Clinic, and Pediatric Endocrinology Clinic at Le Bonheur Children’s Hospital, Memphis, TN. We identified 250 subjects who received a diagnosis of PCOS [International Classification of Diseases, Ninth Revision (ICD-9) 256.4 or Tenth Revision (ICD-10) E28.2] or a related disorder, including amenorrhea (626.0 or N91.5), scanty or infrequent menstruation (626.1), irregular menstrual cycle (626.4 or N92.6), hyperandrogenism (256.1), or hirsutism (704.1 or L68.0).

Of the 250 subjects identified by ICD-9 or ICD-10 codes, a total of 92 subjects were included in the study. Those subjects were divided into two groups: confirmed-PCOS and possible- PCOS. The confirmed-PCOS group consisted of 20 adolescents who had biochemical hyperandrogenism, menstrual dysfunction (oligomenorrhea or menorrhagia), and exclusion of related disorders (which required a normal 17-hydroxyprogesterone level). The possible-PCOS group consisted of 72 adolescents who met at least one criterion but may have had an incomplete evaluation. Of those, 24 subjects had biochemical Hyper- Androgenism only, 28 subjects had menstrual dysfunction only, and 20 subjects had menstrual dysfunction and biochemical Hyper-Androgenism but without exclusion of related disorders. The confirmed-PCOS and the possible- PCOS groups were combined for the analysis and named all-PCOS. Characteristics of the study population are shown in (Table 1). The remainder (158 subjects) were excluded. Exclusion criteria included: 1) normal androgen laboratory studies or had another known cause of abnormal androgens, including congenital adrenal hyperplasia; 2) pregnancy or a history of pregnancy; or 3) menstrual irregularity secondary to abnormal thyroid studies, poorly controlled type 1 diabetes, prolactinoma, or the use of certain medications, including Depo-Provera and anti-psychotics. Subjects were not excluded if they were taking oral contraceptive pills or metformin.