title: Primary ovarian insufficiency in adolescents: a case series.
abstract: BACKGROUND
  Primary ovarian insufficiency (POI) is characterized by 4 to 6 months of amenorrhea and elevated serum FSH and LH in females less than 40 years. Ovarian insufficiency is uncommon in pediatrics and typically results from a chromosomal abnormality or treatment for malignancy. Idiopathic POI in which no apparent precipitant is identified is even rarer. After encountering three teens with idiopathic POI in recent months, we utilized an informatics-enabled search of the electronic medical records from our hospital to identify all cases of idiopathic POI presenting from 1998-2013.
  
  
  METHODS
  15 girls (ages 14.4 to 17.9 years) met criteria for idiopathic POI. At diagnosis, breast development ranged from Tanner stage 1 to 5; 6 of 15 patients had secondary amenorrhea. All patients presented in the past 11 years and 13 of 15 in the past 5 years.
  
  
  CONCLUSIONS
  In this first case series of POI from the United States, we observed a clustering at our institution in recent years. If an increased incidence of idiopathic POI is identified at other institutions, further investigation into potential environmental and genetic precipitants is warranted.
authors.affiliation: Stanford University School of Medicine, Room H314, 300 Pasteur Drive, Stanford, CA USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Pederson
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA.
authors.forename: Rajiv B
authors.initials: RB
authors.lastname: Kumar
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA USA.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Adams Hillard
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Bachrach
keywords: Amenorrhea; Delayed puberty; Ovarian failure; Ovarian insufficiency