Challenges in diagnosis of polycystic ovary syndrome in adolescence.

OBJECTIVE: we evaluated clinical features, the hormonal status, and ovarian morphological characteristics using ultrasound (US) in adolescents with polycystic ovary syndrome (PCOS) and an 'increased risk' of PCOS, and compared the data to age-matched controls.

METHODS: the prospective study involved 154 adolescents (≥2 and <8 years post menarche): Group I-adolescents with PCOS ( n  = 60), Group II- adolescents with an 'increased risk' of PCOS ( n  = 48), and Group III- control group ( n  = 46). PCOS patients met all 3 diagnostic criteria of the Rotterdam consensus (2003), an 'increased risk' of PCOS was accepted as 'menstrual irregularities and clinical and/or biochemical hyperandrogenism'.

RESULTS: In adolescents with PCOS and 'increased risk' of PCOS, AMH and SHBG did not differ significantly. In Group I and Group II, the average AMH level was significantly higher, while SHBG was significantly lower than in the controls ( p  < .001). Androgen levels and mFG in Group I and Group II did not differ significantly, but were significantly higher than in controls ( p  < .001). In Group I, index of insulin resistance and the number of antral follicles (AFC) were significantly higher than in the comparison groups ( p  < .05). There was no significant difference in ovarian volume between comparison groups ( p  < .001).

CONCLUSIONS: A combination of AMH, SHBG, clinical and biochemical hyperandrogenism and menstrual irregularities may be considered as diagnostic markers of PCOS in adolescents and for the identification of a 'risk group' for developing PCOS. Ultrasound estimation of AFC are a more specific marker of ovarian morphology in adolescents with PCOS, rather than ovary volume.