Abstract
We have expanded the endocrine diagnostic criteria for PCOS and have identified it in 8 adolescents. PCOS consists of a spectrum of functional ovarian hyperandrogenic states ranging from cases without histologic ovarian abnormalities through classic Stein-Leventhal ovaries. Diagnostic criteria developed for adults are: elevated plasma free (unbound) testosterone (T) (≥12 pg/ml) which does not fall to ≤ 8 upon adequate adrenal suppression by dexamethasone (dex). In addition, we found bioactive LH (B-LH) to be more often significantly elevated in PCOS than radioimmunoassayable LH (I-LH).
We first established that adult female levels of total and free T and LH are normally achieved prior to the time of menarche.
The 8 PCOS patients were 12.5-17 years old. 5 had menstrual disturbances (4 oligo- or amenorrhea × 1.5-2.5 yrs and 1 menometrorrhagia × 1.5 yrs), 6 had hirsutism, and 5 were obese. I with subclinical problems was detected in a school screening program. A high free T level was found in each (15-25 pg/ml), though total T (51-133 ng/dl) and free T (10.1-25) were intermittently normal in some. Free T fell only to 9-28 pg/ml on dex. B-LH was elevated in 4/6 (>620 ng/ml), while I-LH was only elevated in 2/6 (>91 ng/ml). 1 patient with persistently high I-LH (260-410 ng/ml) underwent laparoscopy which revealed sclerocystic ovaries. Estrogen-progestin (BCP) (n=3) normalized free T (≤8 pg/ml).
PCOS, as the basis of teenage menstrual difficulties or hirsutism--sometimes minor, can be diagnosed from elevated free T levels pre and post dex and elevated B-LH without invasive procedures.
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Moll, G., Rosenfield, R. & Rich, B. 24 ADOLESCENT POLYCYSTIC OVARY SYNDROME-OUT-PATIENT DIAGNOSIS. Pediatr Res 15 (Suppl 4), 443 (1981). https://doi.org/10.1203/00006450-198104001-00033
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DOI: https://doi.org/10.1203/00006450-198104001-00033