Major Finding: Of 58 female patients who were between the ages of 9 and 18 years and were diagnosed with PCOS, 15 (26%) of them were preadolescents aged 9–12 years and 43 (74%) of them were adolescents aged 13–18 years.
Data Source: A cross-sectional retrospective chart study of 58 females aged 9–18 years with PCOS.
Disclosures: No funding sources or financial conflicts of interest were reported.
Polycystic ovary syndrome appears to be manifesting at younger ages than previously thought, a study has shown.
The disorder should be considered and a thorough work-up performed in prepubertal girls who have risk factors suggestive of PCOS, with particular attention given to hyperinsulinemia and early pubarche and thelarche, said Dr. Jason Bronstein and his associates at New York University.
In what they described as the largest pediatric PCOS study to date, the researchers found “a large subgroup of young PCOS girls with characteristic metabolic derangements at a younger age, suggesting a need for early therapeutic interventions.”
Early onset of PCOS does not portend well for future complications such as infertility, metabolic syndrome, and vascular disease.
However, earlier recognition and treatment of PCOS might reduce morbidity in later adolescence and adulthood, they noted.
The investigators performed a retrospective, cross-sectional chart study of 58 patients from diverse ethnic backgrounds who attended two large, urban tertiary care centers and were diagnosed as having PCOS between ages 9 and 18 years. Fifteen (26%) of these subjects were preadolescents aged 9–12 years, and 43 (74%) were adolescents aged 13–18 years.
The severity of PCOS was similar between preadolescents and adolescents. Hyperinsulinemia was present in similar proportions of both groups, indicating that metabolic derangement is already present in the youngest girls with PCOS.
However, preadolescent girls were different in that they had significantly earlier pubarche and thelarche than did adolescent girls with PCOS, and the disorder developed much sooner after thelarche in the younger girls.
Clinicians should look for early pubarche and thelarche in girls predisposed to PCOS, the investigators said (J. Pediatr. Adolesc. Gynecol. 2011;24:15-20).
The two groups also had similar risk factors.
Mothers or other relatives had PCOS in approximately 14% of the study subjects, and there were no significant differences between preadolescents and adolescents in historical risk factors such as gestational age at birth, birth weight, childhood obesity, or family history of obesity, diabetes, or hypertension.
There also were no differences between preadolescents and adolescents in clinical risk factors such as body mass index, acne, hirsutism, alopecia, or hyperandrogenism, and no differences in biochemical risk factors such as serum total testosterone and free testosterone levels, insulin resistance, HDL levels, triglyceride levels, or fasting glucose levels.
These findings show that a high index of suspicion is needed to diagnose PCOS in preadolescents.
'We recommend that pediatricians ascertain risk for PCOS in their patients, including maternal factors, family history, birth weight, metabolic factors, and history of premature pubarche and/or early thelarche,” Dr. Bronstein and his colleagues concluded.