Adölesan Dönemde Polikistik Over Sendromu: Fiziksel, Metabolik ve Hormonal Özellikler

Year 2022, , 221 - 226, 30.12.2022

Mustafa Harı , Ramazan Gen , Mahmut Bakır Koyuncu , Hüseyin Durukan , Mehmet Burak Çimen

https://doi.org/10.18678/dtfd.1089043

Abstract

Amaç: Polikistik over sendromu (PKOS) tanısı için Rotterdam kriterleri kullanılmaktadır. Bununla birlikte, adolesanlarda adet düzensizlikleri ve sivilceler daha sık görüldüğünden teorik olarak Rotterdam kriterlerini kullanmak zordur. Bu çalışmanın amacı ergenlik çağındaki PKOS tanısı için Rotterdam kriterlerinin yeterli olup olmadığını incelemektir.
Gereç ve Yöntemler: Çalışmaya 16 ve 18 yaş arası 30 hasta ve 30 sağlıklı birey dahil edildi. Çalışmaya dahil edilenlerin antropometrik ölçümleri, Ferriman Gallwey skoru (FGS), ultrasonografik over hacimleri, androjenler ve diğer hormon seviyeleri kaydedildi.
Bulgular: Hasta grubunda insülin direncinin homeostatik model değerlendirmesi (HOMA-IR) ile bel çevresi/kalça çevresi oranı arasında istatistiksel olarak anlamlı pozitif bir korelasyon vardı (r=0,656; p<0,001). Hasta grubunun ortalama luteinizing hormone (LH) düzeyleri kontrol grubuna göre istatistiksel olarak anlamlı derecede daha yüksek olarak bulundu (p=0,048). Hasta grubunda medyan FGS kontrol grubundan istatistiksel olarak anlamlı derecede daha yüksekti (p<0,001). Polikistik overi olan adolesan kızların serum total testosteron düzeyleri polikistik overi olmayanlara göre istatistiksel olarak anlamlı derecede daha yüksekti (p=0,001). Ultrasonografide polikistik over görünümü olanların ortanca FGS'si polikistik over görünümü olmayanlara göre istatistiksel olarak anlamlı derecede daha yüksek olarak bulundu (p=0,034).
Sonuç: Rotterdam tanı kriterlerinden oligoanovulasyon, akne ve ultrasonografide polikistik over görünümü, PKOS olmayan sağlıklı adolesanlarda da görülebilir. Bu çalışmada PKOS tanısını en çok destekleyen bulgu, orta derecede hirsutizme eşlik eden polikistik over görünümü idi.

Keywords

Polikistik Over Sendromu, adölesan kızlar, serbest androjen indeksi, HOMA-IR

Supporting Institution

Mersin Üniversitesi Bilimsel Araştırma Projeleri Birimi

Project Number

2017-1-TP3-2263

Polycystic Ovary Syndrome in Adolescent Period: Physical, Metabolic, and Hormonal Features

Abstract

Aim: The Rotterdam criteria are used in the diagnosis of polycystic ovary syndrome (PCOS). However, since menstrual irregularities and acne are seen more frequently in adolescents, it is theoretically difficult to use the Rotterdam criteria. The aim of this study was to investigate whether the Rotterdam criteria are sufficient for the diagnosis of PCOS in adolescence.
Material and Methods: Thirty patients and thirty healthy individuals between the ages of 16 and 18 years were included in the study. Anthropometric measurements, Ferriman Gallwey score (FGS), ultrasonographic ovarian volumes, androgens, and other hormone levels of the participants were recorded.
Results: There was a statistically significant positive correlation between the homeostatic model assessment of insulin resistance (HOMA-IR) and waist circumference/hip circumference ratio in the patient group (r=0.656, p<0.001). The mean luteinizing hormone (LH) levels of the patient group were found to be statistically significantly higher than the control group (p=0.048). The median FGS of the patient group was statistically significantly higher than the control group (p<0.001). Serum total testosterone levels of adolescent girls who have polycystic ovaries were statistically significantly higher than the ones who have not (p=0.001). The median FGS of those with polycystic ovarian appearance on ultrasonography was found to be statistically significantly higher than those without (p=0.034).
Conclusion: Among the Rotterdam diagnostic criteria, oligoanovulation, acne, and polycystic ovarian appearance on ultrasonography can be seen in healthy adolescents without PCOS. In this study, the most supportive finding for the diagnosis of PCOS was the appearance of polycystic ovaries accompanying moderate hirsutism.

Keywords

Polycystic Ovary Syndrome, adolescent girls, free androgen index, HOMA-IR

Project Number

2017-1-TP3-2263

References

• Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007;370(9588):685-97.
• Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223-36.
• Gardner J. Adolescent menstrual characteristics as predictors of gynaecological health. Ann Hum Biol. 1983;10(1):31-40.
• Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries--a common finding in normal women. Lancet. 1988;1(8590):870-2.
• Clayton RN, Ogden V, Hodgkinson J, Worswick L, Rodin DA, Dyer S, et al. How common are polycystic ovaries in normal women and what is their significance for the fertility of the population? Clin Endocrinol (Oxf). 1992;37(2):127-34.
• Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J. 1979;1(6171):1109-10.
• Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study. J Pediatr. 1997;130(1):30-9.
• Ibáñez L, Oberfield SE, Witchel S, Auchus RJ, Chang RJ, Codner E, et al. An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Horm Res Paediatr. 2017;88(6):371-95.
• Pfeifer SM, Kives S. Polycystic ovary syndrome in the adolescent. Obstet Gynecol Clin North Am. 2009;36(1):129-52.
• Venturoli S, Porcu E, Fabbri R, Pluchinotta V, Ruggeri S, Macrelli S, et al. Longitudinal change of sonographic ovarian aspects and endocrine parameters in irregular cycles of adolescence. Pediatr Res. 1995;38(6):974-80.
• Swanson M, Sauerbrei EE, Cooperberg PL. Medical implications of ultrasonically detected polycystic ovaries. J Clin Ultrasound. 1981;9(5):219-22.
• Hann LE, Hall DA, McArdle CR, Seibel M. Polycystic ovarian disease: sonographic spectrum. Radiology. 1984;150(2):531-4.
• Saxton DW, Farquhar CM, Rae T, Beard RW, Anderson MC, Wadsworth J. Accuracy of ultrasound measurements of female pelvic organs. Br J Obstet Gynaecol. 1990;97(8):695-9.
• Pache TD, Wladimiroff JW, Hop WC, Fauser BC. How to discriminate between normal and polycystic ovaries: transvaginal US study. Radiology. 1992;183(2):421-3.
• Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update. 2008;14(4):367-78.
• Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003;9(6):505-14.
• Kaewnin J, Vallibhakara O, Arj-Ong Vallibhakara S, Wattanakrai P, Butsripoom B, Somsook E, et al. Prevalence of polycystic ovary syndrome in Thai university adolescents. Gynecol Endocrinol. 2018;34(6):476-80.
• van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J. Predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligo-amenorrhoea at age 18 years. Hum Reprod. 2004;19(2):383-92.
• Zeng X, Xie YJ, Liu YT, Long SL, Mo ZC. Polycystic ovarian syndrome: Correlation between hyperandrogenism, insulin resistance and obesity. Clin Chim Acta. 2020; 502:214-21.
• Reid SP, Kao CN, Pasch L, Shinkai K, Cedars MI, Huddleston HG. Ovarian morphology is associated with insulin resistance in women with polycystic ovary syndrome: a cross sectional study. Fertil Res Pract. 2017;3:8.
• Qu X, Donnelly R. Sex hormone-binding globulin (SHBG) as an early biomarker and therapeutic target in polycystic ovary syndrome. Int J Mol Sci. 2020;21(21):8191.
• Kumar A, Woods K, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf). 2005;62(6):644-9.
• Hernandez MI, López P, Gaete X, Villarroel C, Cavada G, Avila A, et al. Hyperandrogenism in adolescent girls: relationship with the somatotrophic axis. J Pediatr Endocrinol Metab. 2017;30(5):561-8.
• Rosenfield RL. The polycystic ovary morphology-polycystic ovary syndrome spectrum. J Pediatr Adolesc Gynecol. 2015;28(6):412-9.
• Ybarra M, Franco RR, Cominato L, Sampaio RB, Sucena da Rocha SM, Damiani D. Polycystic ovary syndrome among obese adolescents. Gynecol Endocrinol. 2018;34(1):45-8.