The Polycystic Ovary Syndrome a comparison of the presentation in adolescents compared to women aged 35 years and older attending the Gynaecology Endocrine clinic at Groote Schuur Hospital.
Zephne van der Spuy
Introduction: This study was aimed at comparing the presentation, metabolic and endocrine profiles of adolescents aged 10-19 years to women aged 35 years and older, presenting to the Gynaecology Endocrine Clinic for the first time between 1996 until 2013 with a diagnosis of PCOS as defined by the Rotterdam 2003 criteria.
Method: This was a descriptive cohort study. The inclusion criteria were any adolescent aged 10-19 years and women who presented at aged 35 years and older with a diagnosis of PCOS. Clinical data was entered into our database.
Results: There were a total of 1549 patients included in the PCOS database of these 146 patients were 35 years or older and 186 were between the ages of 10 and 19 years old. The mean age of the adolescents was 17 years old and of the adults was 37 years.
The study population were overweight, the mean BMI in the adolescents was 29.4 and of the adult group was 35.7. The waist-hip ratio was increased in both groups. In adults 71.3% and in adolescent group 46.2% had a waist-hip ratio of 0.85.
Menstrual irregularities were reported in 89.7% (n=167) adolescents at recruitment and 72.4% (n=105) of women 35 years and older. Hirsutism was a common problem in both groups and was reported in 79.3% (n=146) of the adolescents and in 76.6% (n=109) of the adults. Acne was seen more commonly in the adolescent group, 57% (n=107) and in 29.8% (n=43) of adults.
In the women 35 years and older 84.2% (n=123) had attempted fertility and of these 54.5% (n=67) struggled to conceive with 25.2% (n=31) reporting primary infertility and 29.2% (n=36) reporting secondary infertility. In the adolescent group only thirteen women had attempted fertility and of these women eight reported primary infertility.
Insulin levels were raised in both groups with 78.8% (n=145) of adolescents and 86% (n=124) adults having insulin levels above 10. Acanthosis nigricans was seen more frequently in adult women 67.8% (n=97) compared to adolescents 55.7% (n=102). There was no significant difference in the HOMA or glucose-insulin ratio between the two groups 78% of the adult women had a HOMA value greater than 2.5 compared with 69.3% of the adolescents.
Serum total cholesterol, LDL cholesterol and triglyceride levels were significantly higher in the adult group than the adolescents. In the adult group 13.6% (n=20) of women had all four lipids with abnormal values compared with 3.2% (n=6) of adolescents. Hypertension was more prevalent in the adult group.
Testosterone levels and free androgen index was similar between the two groups. In the adolescent group 76.7% and in the adult group 82.5% had raised testosterone levels.
Conclusion: The importance of diagnosing PCOS in adolescence lies in primary prevention of endocrinopathy, obesity, infertility, hyperinsulinaemia and cardiovascular disease later in life. This study shows that insulin resistance and hyperandrogenism is a core component of the syndrome and are already raised in the younger age group which may put them at risk of cardiovascular disease and metabolic syndrome later in life but many of the features of PCOS including dyslipidaemia and obesity evolve over time. Early diagnosis and treatment of PCOS in adolescents may still alter the clinical course of this syndrome.