Endocrine Abstracts

Background and Aims: Polycystic ovary syndrome (PCOS) usually develop symptoms during adolescence. However, diagnosis in adolescents is challenging because physiologic development overlap typical manifestation of PCOS. Recently, an international evidence-based PCOS guideline development group recommended that ultrasound should not be used for the diagnosis of PCOS in those with a gynecological age of < 8 years. Thus, girls with irregular menstruation (IM)/PCO or hyperandrogenism (HA)/PCO cannot be diagnosed as PCOS if they do not pass 8 years since menarche. This study aimed to investigate the characteristics of these excluded girls.

Methods: We included subjects who were between 2- 8 years since menarche. Adolescent PCOS (n=315) was diagnosed according to the 2003 Rotterdam criteria like adults. A total of 428 girls served as controls.

Results: In 315 girls with PCOS, numbers of the IM/HA/PCO, IM/HA, HA/PCO and IM/PCO phenotypes were 206 (65.4%), 30 (9.5%), 12 (3.8%) and 67 (21.3%), respectively. According to the 2018 guideline, 79 girls (25.1%) with HA/PCO (15.2%) or IM/PCO (84.8%) phenotypes are not diagnosed as PCOS. These girls who had changes in diagnostic status were designated as “increased risk” group. As expected, PCOS group showed the worst metabolic profiles (degree of generalized and central obesity and frequency of IR, prediabetes or diabetes and metabolic syndrome) and a higher hirsutism score than those of the other two groups. About 90% of the “increased risk” group were lean, which was similar to the controls. However, they showed worse metabolic profiles (mean BP, TG, fasting insulin and HOMA-IR levels) than did the controls, but showed similarly elevated profiles with those of PCOS. The “increased risk” group showed similarly elevated serum LH levels and LH/FSH with those of the PCOS.

Conclusions: One-fourth of the adolescent girls who were diagnosed as PCOS based on the original Rotterdam criteria were excluded from the diagnosis of PCOS using the 2018 guideline. Although these ‘increased risk’ girls do not fulfil the diagnostic criteria of PCOS, they visited hospital due to menstrual abnormality or hyperandrogenic symptoms, and showed significantly worse metabolic and androgenic profiles than did controls. And they shared considerable metabolic and hormonal features with PCOS. About 90% of ‘increased risk’ girls were lean, but they were not metabolically reassuring group. A practical approach to them would involve controlling symptoms and regularly evaluating them regarding newly-developed or worsening PCOS-related symptoms or metabolic abnormalities.