POLYCYSTIC OVARY SYNDROME IN ADOLESCENCE

  • Diana Baptista Department of Pediatrics of Hospital Senhora da Oliveira, Guimarães
  • Maria João Vieira Department of Pediatrics of Hospital Senhora da Oliveira, Guimarães
  • Carla Meireles Department of Pediatrics of Hospital Senhora da Oliveira, Guimarães
Keywords: adolescence, hyperandrogenism, hirsutism, Polycystic Ovary Syndrome

Abstract

Introduction:Polycystic Ovary Syndrome is recognized as the most common endocrine disorder of reproductive-age women. The syndrome often presents during adolescence, but the diagnosis in this age group is complicated by the overlap between features of the syndrome and physiologic findings observed during the normal progression of puberty.

Objective:To review the diagnosis and treatment of Polycystic Ovary Syndrome in adolescence.

Development:There are no consensual diagnostic criteria or treatment guidelines for Polycystic Ovary Syndrome in pediatric population. Many features of the syndrome, including acne, menstrual irregularities and hyperinsulinemia, are common in normal puberty. Most authors recommend a diagnosis based on clinical and/or biochemical evidence of hyperandrogenism with ovarian dysfunction, not explained by other causes. Measurement of free testosterone level is the more sensitive and reliable method for establishing the existence of androgen excess. Ultrasonographic visualization of polycystic ovary doesn’t set the diagnosis, because it’s a frequent finding in healthy adolescents. Lifestyle changes and treatment of hirsutism and menstrual irregularities are essential hallmarks in the therapeutic approach of Polycystic Ovary Syndrome in adolescents.

Conclusion: Identification of adolescents at risk for Polycystic Ovary Syndrome is critical, not only for an appropriate therapeutic approach, but also to prevent co-morbidities associated with the syndrome, including obesity, insulin resistance, dyslipidemia and infertility.

References

Stein IF. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29: 181.

Al Khalifah RM, Flórez ID, Dennis B, Neupane B, Thabane L, Bassilious E. The effectiveness and safety of treatments used for polycistic ovarian syndrome management in adolescentes: a systematic review and network meta-analysis protocol. Systematic Reviews 2015; 4:125

Agapova SE, Cameo T, Sopher AB, Oberfield, SE. Diagnosis and Challenges of Polycystic Ovary Syndrome in Adolescence. Semin Reprod Med. 2014; 32: 194–201.

Zawadski, JK.; Dunaif, A. Diagnostic criteria for polycystic ovary syndrome; towards a rational approach. In: Dunaif, A.; Givens, JR.; Haseltine, F., editors. Polycystic Ovary Syndrome. Vol. 1992. Boston, MA: Black-well Scientific; p. 377-84.

Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004; 19:1–7.

Azziz R, Carmina E, Dewailly D et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456.

National Institutes of Health. Evidence-Based Methodology Workshop on Polycystic Ovary Syndrome: Executive Summary. Washington: National Institutes of Health; 2012.

Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013; 98:4565.

Legro R. Diagnosis and treatment of polycystic ovary syndrome (PCOS): An interview with Richard Legro. BMC Medicine 2015; 13:64

Rosenfield RL. Definition, clinical features and differential diagnosis of polycystic ovary syndrome in adolescentes. Outubro 2014. (Acedido em 3 fevereiro 2016). Disponível em: http://www.uptodate.com.

Rosenfield L. Pathophysiology and etiology of polycystic ovary syndrome in adolescentes. Outubro 2014. (Acedido em 3 fevereiro 2016). Disponível em: http://www.uptodate.com.

Souto SB, Carvalho Braga D, Medina JL. Síndrome do ovário poliquístico – do diagnóstico ao tratamento. Rev Port Endocrinol Diabetes Metab. 2008;01: 39-50.

Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012; 97(Suppl 1):28.e25–38.e25. [PubMed: 22153789]

Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome – part 1. Endocr Pract 2015;21:1291-8.

Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961; 21:1440.

Rosenfield RL. Clinical review: Adolescent anovulation: maturational mechanisms and implications. J Clin Endocrinol Metab 2013; 98:3572.

Rodrigues P, Castedo JL. Oligomenorreia na adolescência – Avaliação na prática clínica. Rev Port Endocrinol Diabetes e Metabolismo. 2011;1:53-63.

Cink DA, Dilbaz B. What do we know about metabolic syndrome in adolescents with PCOS? J Turk Ger Gynecol Assoc 2014; 15: 49-55.

Nicandri KF, Hoeger K. Diagnosis and treatment of polycystic ovarian syndrome in adolescents. Curr Opin Endocrinol Diabetes Obes. 2012; 19:497–504. [PubMed: 23076041]

Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007; 8: 299-306.

Özsoy S. Psychiatric status and approach in polycystic ovary syn- drome and hirsutism. Turkiye Klinikleri J Endocrin-Special Topics 2009; 2: 126-30.

EscobarMorreale

HF, Sanchón R, SanMillán JL. A prospective study of the prevalence of nonclassical congenital adrenal hyperplasia among women presenting with hyperandrogenic symptoms and signs. J Clin Endocrinol Metab 2008; 93:527.

Rosenfield L. Diagnostic evaluation of polycystic ovary syndrome in adolescents uptodate. Outubro 2014. (Acedido em 4 fevereiro 2016). Disponível em: http://www.uptodate.com.

Martin KA, Chang RJ, Ehrmann DA, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93:1105.

ACOG Committee on Practice BulletinsGynecology.

ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. Obstet Gynecol 2009; 114:936.

Mendelson EB, BohmVelez

M, Joseph N, Neiman HL. Gynecologic imaging: comparison of transabdominal and transvaginal sonography. Radiology 1988; 166:321.

Jonard S, et al. Ultrasound examination of polycystic ovaries: is it worth counting the follicles? Hum Reprod 2003; 18: 598-603.

Dewailly D, Lujan ME, Carmina E, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2014;20:334-52.

Bachanek M, Abdalla N. Value of ultrasonography in the diagnosis of polycystic ovary syndrome – literature review. J Ultrason 2015; 15: 410–22

Lavery GG, Walker EA, Tiganescu A, et al. Steroid biomarkers and genetic studies reveal inactivating mutations in hexose6phosphate

dehydrogenase in patients with cortisone reductase deficiency. J Clin Endocrinol Metab 2008; 93:3827.

Lawson AJ, Walker EA, Lavery GG, et al. Cortisonereductase

deficiency associated with heterozygous mutations in 11betahydroxysteroid

dehydrogenase type 1. Proc Natl Acad Sci U S A 2011; 108:4111.

Rosenfield RL, Cohen RM, Talerman A. Lipid cell tumor of the ovary in reference to adultonset

congenital adrenal hyperplasia and polycystic ovary syndrome. A case report. J Reprod Med 1987; 32:363.

Bidet M, BellannéChantelot

C, GalandPortier

MB, et al. Clinical and molecular characterization of a cohort of 161 unrelated women with nonclassical congenital adrenal hyperplasia due to 21hydroxylase

deficiency and 330 family members. J Clin Endocrinol Metab 2009; 94:1570.

EscobarMorreale

HF, Sanchón R, San Millán JL. A prospective study of the prevalence of nonclassical congenital adrenal hyperplasia among women presenting with hyperandrogenic symptoms and signs. J Clin Endocrinol Metab 2008; 93:527.

Glickman SP, Rosenfield RL, Bergenstal RM, Helke J. Multiple androgenic abnormalities, including elevated free testosterone, in hyperprolactinemic women. J Clin Endocrinol Metab 1982; 55:251.

Quaresma L, Oliveira S, Leite AL, Teles A, Marques JS, Campos RA. Hiperprolactinémia – que diagnóstico? Rev Port Endocrinol Diabetes Metab. 2015;10:160-5.

Grupo de Estudo da Insulino-Resistência da Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Manual sobre Insulinorresistência. 3ª Edição. Helena Cardoso. 2013. p. 11-4.

Bouzas I. Síndrome dos ovários policisticos na adolescência. Adolescência e Saúde. 2007; 4: 43-7.

Rosenfield L. Treatment of polycystic ovary syndrome in adolescentes. Outubro 2014. (Acedido em 5 fevereiro 2016). Disponível em: http://www.uptodate.com.

Reunião de Consenso Nacional sobre Contracepção. Sociedade Portuguesa de Ginecologia, Contracepção, e Medicina da Reprodução. Consenso sobre Contracepção 2011. Edições Frist News. 2011. p. 9-23, 25-31.

Lord JM, Flight IH, Norman RJ. Insulinsensitising

drugs (metformin, troglitazone, rosiglitazone, pioglitazone, Dchiroinositol)

for polycystic ovary syndrome. Cochrane Database Syst Rev 2003; CD003053.

Randall VA, et al. New dimensions in Hirsutism. Lasers Med Sci 2006; 21: 126-33.

Published
2017-02-03
How to Cite
Baptista, D., Vieira, M., & Meireles, C. (2017). POLYCYSTIC OVARY SYNDROME IN ADOLESCENCE. NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 25(4), 227-235. https://doi.org/10.25753/BirthGrowthMJ.v25.i4.10800
Section
Review Articles