Body Shape and Size and Insulin Resistance as Early Clinical Predictors of Hyperandrogenic Anovulation in Ethnic Minority Adolescent Girls
Received 29 March 2007; accepted 12 February 2008. published online 20 May 2008.
Refers to article:
Whither PCOS? The Challenges of Establishing Hyperandrogenism in Adolescent Girls
Frank M. Biro, S. Jean Emans
Journal of Adolescent Health
August 2008 (Vol. 43, Issue 2, Pages 103-105) Full Text |
Full-Text PDF (77 KB)
Abstract
Purpose
To determine whether key associated features of hyperandrogenic anovulation (HA) in predominately Caribbean Hispanic (CH) adolescent girls can be combined to improve the early diagnosis of HA.
Methods
Unselected observational sample of females aged 12 to 21 years (mean 17.5 ± 2.4 years), (64% CH, 28% African American). One hundred twenty subjects provided a menstrual history, had a physical examination, and a follicular phase fasting blood drawn for LH, FSH, testosterone, sex hormone binding globulin (SHBG), 17-OH progesterone (17-OHP), androstenedione (Δ4A), glucose, and insulin. We prospectively categorized subjects into four groups: G I (n = 42) had normal menses and normal physical exam; G II (n = 41) had normal menses and abnormal physical exam, that is, signs indicating possible hyperandrogenism and/or insulin resistance, including at least one of obesity, hirsutism, acne, or acanthosis nigricans; G III (n = 15) had abnormal menses and normal physical exam, and G IV (n = 22) had HA with BOTH abnormal menses and abnormal physical exam, that is, girls most likely to develop polycystic ovary syndrome. Hormonal levels and additional clinical and physical characteristics of interest were compared among the four groups.
Results
Group IV subjects had significantly higher waist circumference measurements, independent of overweight status, than all other groups. As hypothesized, Group IV subjects had significantly higher androgen levels and significantly lower SHBG levels than all other groups. FAI, SHBG, and waist circumference had the highest diagnostic accuracy for predicting Group IV status (i.e., HA phenotype).
Conclusions
Markers of insulin resistance and hyperandrogenemia, including waist circumference, FAI, and SHBG, best associate with irregular menstrual cycles and the HA phenotype in ethnic minority adolescent girls.
aDepartment of Pediatrics, Division of Adolescent Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
bDpartment of Obstetrics, Gynecology and Women's Health, Division of Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Bronx, New York
cDepartment of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
dDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York
Address correspondence to: Jessica Rieder, M.D., M.S., Department of Pediatrics, Division of Adolescent Medicine, Children's Hospital at Montefiore, 111 East 210th Street, Bronx, NY, 10467.
Conflict of Interest: J.R., P.M., H.W.C., and S.M.C. have nothing to declare. N.S. consults for Ferring, Wyeth and Pfizer and received lecture fees from Berlex, Wyeth, Serono and Pfizer.
ABSTRACT