title: The relationship between ovarian structure and hyperandrogenism in premature pubarche.
abstract: The aim of this study was to describe the ovarian structure (OS) and its relationship with hyperandrogenism in girls with premature pubarche (PP). A pelvic ultrasound was carried out in 23 girls with PP and in 57 prepubertal age-matched controls (C), and the OS was subdivided into five classes (c): 1-homogeneous; 2-microcystic, 3-multicystic, 4-polycystic and 5-follicular. In the girls with PP, an ACTH test was performed, and the presence of hormonal levels >3 SD of postpubertal normal levels and not compatible with late-onset congenital adrenal hyperplasia were considered an exaggerated response. The fasting levels of glucose (G) and insulin (I) were measured and the fasting I to G ratio (FIGR) was calculated. FIGR >22 was suggestive of I resistance (IR). The microcystic structure (c2) was more frequently found in the PP than in the C group (63% vs 35%, p=0.03). In the PP group, we observed the following OS: cl (n=6), c2 (n=15), c3 (n=1) and c4 (n=1). 11-Deoxycortisol--both basal and after ACTH--was greater in the PPc2 group than in PPc1 (p=0.04, p=0.0008, respectively). We also observed an exaggerated response to ACTH in 87% of the girls with PP, greater in the PPc2 group than in PPc1 (p=0.04). The FIGR showed IR in 44% of girls with PP, but I levels and FIGR were similar between PPc1 and PPc2. These findings suggest generalized adrenocortical hyperresponsiveness in girls with PP, which is more accentuated in PPc2. Long-term follow-up of girls with PP into adulthood is warranted to ascertain whether microcystic ovarian structure precedes functional ovarian hyperandrogenism.
authors: Department of Endocrinology, Hospital Universitario Pedro Ernesto, State University and Federal University of Rio de Janeiro, Brazil. rosijt@fst.com.br
authors: R J
authors: RJ
authors: Teixeira
authors: V C
authors: VC
authors: Silva
authors: J R
authors: JR
authors: Freitas
authors: T
authors: T
authors: Dimetz
authors: S B
authors: SB
authors: Cunha
authors: M M
authors: MM
authors: Guimarães
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000728:Androgens / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000503:physiopathology*; D010048:Ovarian Cysts / Q000145:classification; D010053:Ovary / Q000033:anatomy & histology* / Q000473:pathology; D011629:Puberty, Precocious
chemical_list: D000728:Androgens; D000324:Adrenocorticotropic Hormone