Primary amenorrhea as a manifestation of polycystic ovarian syndrome in adolescents: a unique subgroup?
OBJECTIVE
To compare clinical and metabolic features of adolescents having primary amenorrhea (PA) and polycystic ovarian syndrome (PCOS) with those having oligomenorrhea or secondary amenorrhea (OM/SA) and PCOS.


METHODS
Retrospective case-control study.


METHODS
Endocrine Gynecology Clinic at The Hospital for Sick Children, Toronto, Ontario, Canada.


METHODS
Girls and young women aged 14 to 18 years having PA and PCOS (n = 9) seen during a 2(1/2)-year period were compared with control subjects having OM/SA and PCOS (n = 18) randomly selected during the same period.


METHODS
Medical record review was performed to assess clinical, biochemical, and ultrasonographic measures, as well as response to a progesterone challenge.


METHODS
Differences in response to the progesterone challenge, hyperandrogenism, and the presence of features of the metabolic syndrome.


RESULTS
Compared with adolescents having OM/SA, adolescents having PA demonstrated older age at pubarche, higher androstenedione levels, greater prevalence of family history of obesity, a tendency toward no withdrawal bleeding in response to the progesterone challenge, and more features associated with the metabolic syndrome (acanthosis nigricans, higher diastolic blood pressure, and lower high-density lipoprotein cholesterol level). No significant correlation was demonstrated between response to the progesterone challenge, metabolic features, and androstenedione levels.


CONCLUSIONS
Adolescents with PA and PCOS exhibit increased features of the metabolic syndrome and higher androstenedione levels and may represent a more severe spectrum of a common condition.
Rachmiel
Marianna
M
Division of Pediatrics, Assaf Harofeh Medical Center, Tel Aviv University, Zerifin, Israel 70300. rmarianna@gmail.com
Kives
Sari
S
Atenafu
Eshetu
E
Hamilton
Jill
J
D000293:Adolescent; D000367:Age Factors; D000568:Amenorrhea / Q000209:etiology* / Q000503:physiopathology; D000735:Androstenedione / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D017588:Hyperandrogenism / Q000453:epidemiology* / Q000503:physiopathology; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D009864:Ontario / Q000453:epidemiology; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000503:physiopathology; D011374:Progesterone; D012189:Retrospective Studies; D012307:Risk Factors
D000735:Androstenedione; D011374:Progesterone