{"id":20895,"date":"2021-04-06T10:08:42","date_gmt":"2021-04-06T09:08:42","guid":{"rendered":"https:\/\/touchendocrinology.com\/?p=20895"},"modified":"2022-03-02T11:32:22","modified_gmt":"2022-03-02T11:32:22","slug":"clinical-metabolic-and-hormonal-profiles-of-bangladeshi-adolescents-with-polycystic-ovary-syndrome","status":"publish","type":"post","link":"https:\/\/touchendocrinology.com\/reproductive-endocrinology\/journal-articles\/clinical-metabolic-and-hormonal-profiles-of-bangladeshi-adolescents-with-polycystic-ovary-syndrome\/","title":{"rendered":"Clinical, Metabolic and Hormonal Profiles of Bangladeshi Adolescents with Polycystic Ovary Syndrome"},"content":{"rendered":"

Polycystic ovary syndrome (PCOS) is a heterogeneous androgen-excess disorder that presents with different degrees of reproductive and metabolic dysfunctions; it is also associated with insulin resistance and metabolic syndrome.1<\/span>\u00a0The global prevalence estimates of PCOS in women of reproductive age are highly variable, ranging from 5% to 18%.2<\/span>\u00a0This could be due to the lack of a universal definition of PCOS, as the prevalence rates depend, to a great extent, on the criteria used to define this disorder.1<\/span><\/p>\n

Though PCOS can affect women at any stage of their reproductive age, the manifestations of PCOS may develop in adolescence but may not be diagnosed until well into adulthood.3<\/span>\u00a0There is a lack of well-established diagnostic criteria for adolescent PCOS, as all PCOS diagnostic criteria are designed for adults. Diagnostic criteria include varying combinations of three features: oligo-\/anovulation, clinical and\/or biochemical hyperandrogenism and polycystic ovarian morphology.4\u20136<\/span>\u00a0Normal adolescent physiology, including irregular cycles and acne, may mimic symptoms of PCOS. Besides, multi-follicular ovaries are a feature of normal puberty that subsides with the onset of a regular menstrual cycle and may be difficult to distinguish from PCOS morphology.7<\/span>\u00a0Therefore, the diagnosis of PCOS in adolescent girls is challenging, and the exact prevalence of PCOS in adolescent girls is mostly unknown. The prevalence of PCOS in Indian adolescents, using the Rotterdam criteria, has been reported as 9.13%;3<\/span>\u00a0however, the Rotterdam criteria has been found to be inappropriate for PCOS diagnosis in adolescents. In a recent
\nmeta-analysis, the prevalence of PCOS in adolescents based on the Rotterdam criteria was 11.04% (95% confidence interval [CI]: 6.84\u201316.09%); based on the National Institute of Health criteria, it was 3.39% (95% CI: 0.28\u20139.54%); and based on Androgen Excess and Polycystic Ovary Syndrome Society, it was 8.03% (95% CI: 6.24\u201310.01%).8<\/span>\u00a0Recently, the Endocrine Society has suggested that the diagnosis of PCOS in adolescent girls should be made based on the presence of clinical and\/or biochemical evidence of hyperandrogenism (after exclusion of other pathologies) in the presence of persistent menstrual irregularities.9<\/span><\/p>\n

Identifying and treating adolescents with PCOS is of prime importance, as adult women with PCOS have a 10-fold increased risk of developing type 2 diabetes, and a 2-fold increased risk of metabolic syndrome.3<\/span>\u00a0Additionally, PCOS is associated with worse reproductive outcomes, including subfertility and psychiatric comorbidities.1<\/span>\u00a0Another reason that correct diagnosis is vital is that behavioural modification and lifestyle changes during adolescence play an essential role in the prevention of future complications and morbidity.10<\/span>\u00a0Data relating to the reproductive, metabolic and endocrine features of PCOS in adolescents in Bangladesh is lacking. The purpose of this study was to fill this knowledge gap.<\/p>\n

Materials and methods<\/p>\n

The protocol of the study obtained approval from the institutional review board. Informed consent was obtained from all patients in this study. This cross-sectional study was conducted among newly-diagnosed, consecutive adolescent patients (age 10\u201319 years) with PCOS attending the endocrinology outpatient department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh, from January 2017 to December 2019. Those receiving drug treatment for diabetes, hypertension, dyslipidaemia and obesity, and those with pelvic inflammatory disease, any chronic debilitating illness or any malignancy, were excluded.<\/p>\n

The diagnosis of PCOS in adolescent girls was made based on the presence of clinical and\/or biochemical evidence of hyperandrogenism (after exclusion of other pathologies) in the presence of persistent menstrual irregularities.9<\/span>\u00a0Oligomenorrhea was defined as menstrual cycle >35 days, or less than eight cycles per year after 2 years of menarche; primary amenorrhea as amenorrhea by age 15 years, or >3 years post thelarche; secondary amenorrhea as the cessation of menstruation for at least 6 months in a previously menstruating girl; and polymenorrhea as menstrual cycle <21 days.<\/p>\n

A semi-structured, questionnaire-based interview on a one-to-one basis was conducted to collect detailed information on clinical presentation and family history. Height (to the nearest 0.1 cm) was measured in all the individuals using wall-mounted stadiometers, and body weight (to the nearest 0.1 kg) measured using electronic calibrated scales. Body mass index (BMI) was calculated from height and weight using the formula: height\/weight2<\/span>. Obesity status was determined by BMI categories applicable to Asian Indians.11<\/span> Waist circumference was measured (to the nearest 0.5 cm) at the end of a gentle expiration midway between the lower rib margins and the iliac crests. Blood pressure (BP) was measured twice in each study participant by the auscultatory method using standard validated aneroid sphygmomanometer after at least 5 minutes of rest; two separate readings were taken at an interval of a minimum of 3 minutes, and the average of the two readings was used.<\/p>\n

Hypertension and pre-hypertension were defined according to the Joint National Committee VII criteria.12<\/span>\u00a0Hirsutism was assessed by the modified Ferriman\u2013Gallwey (FG) score; a score of \u22658 was the cutoff point for diagnosis of hirsutism.13<\/span> Oral glucose tolerance test (OGTT) with a 75-g glucose load was carried out in all participants after overnight fasting for at least 8 hours; fasting plasma glucose (FPG) and plasma glucose 2 hours after OGTT (PG 2H-OGTT) were measured by the glucose oxidase method using a fully automatic biochemistry analyser. Prediabetes and diabetes mellitus were diagnosed according to criteria described by the American Diabetes Association.14<\/span><\/p>\n

Lipid profile was measured in all participants in fasting states using a fully automatic biochemistry analyser. Dyslipidaemia was defined according to cutoff points described in the Adult Treatment Panel III guideline.15 <\/span>Metabolic syndrome was diagnosed using the International Diabetes Federation consensus definition of metabolic syndrome in children and adolescents; abdominal obesity plus two or more of:<\/p>\n