24 ADOLESCENT POLYCYSTIC OVARY SYNDROME-OUT-PATIENT DIAGNOSIS

Abstract

We have expanded the endocrine diagnostic criteria for PCOS and have identified it in 8 adolescents. PCOS consists of a spectrum of functional ovarian hyperandrogenic states ranging from cases without histologic ovarian abnormalities through classic Stein-Leventhal ovaries. Diagnostic criteria developed for adults are: elevated plasma free (unbound) testosterone (T) (≥12 pg/ml) which does not fall to ≤ 8 upon adequate adrenal suppression by dexamethasone (dex). In addition, we found bioactive LH (B-LH) to be more often significantly elevated in PCOS than radioimmunoassayable LH (I-LH).

We first established that adult female levels of total and free T and LH are normally achieved prior to the time of menarche.

The 8 PCOS patients were 12.5-17 years old. 5 had menstrual disturbances (4 oligo- or amenorrhea × 1.5-2.5 yrs and 1 menometrorrhagia × 1.5 yrs), 6 had hirsutism, and 5 were obese. I with subclinical problems was detected in a school screening program. A high free T level was found in each (15-25 pg/ml), though total T (51-133 ng/dl) and free T (10.1-25) were intermittently normal in some. Free T fell only to 9-28 pg/ml on dex. B-LH was elevated in 4/6 (>620 ng/ml), while I-LH was only elevated in 2/6 (>91 ng/ml). 1 patient with persistently high I-LH (260-410 ng/ml) underwent laparoscopy which revealed sclerocystic ovaries. Estrogen-progestin (BCP) (n=3) normalized free T (≤8 pg/ml).

PCOS, as the basis of teenage menstrual difficulties or hirsutism--sometimes minor, can be diagnosed from elevated free T levels pre and post dex and elevated B-LH without invasive procedures.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account

Continue with Google

Continue with ORCiD