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Purpose: Polycystic syndrome (PCOS) is associated with multiple metabolic abnormalities. Studies in the adolescent population are still
limited and the results have been much different. The aim of this study was to investigate the association between PCOS, overweight, and
metabolic syndrome in adolescents.
Methods: 30 PCOS adolescents were randomly selected from a PCOS population with NIH 1990 criteria and 71 adolescents from the normal
adolescents. Anthropometric, hormonal and metabolic parameters were evaluated in four sub-groups including obese and non-obese PCOS
and obese and non-obese normal adolescents.
Results: The prevalence of overweight and metabolic syndrome in adolescents with PCOS was 52% and 33.3% respectively vs 22.4%
(P 5 0.005) and 11.26% in control (normal) adolescents (P 5 0.0001). Among all subjects, including obese and non-obese adolescents with
or without PCOS, the prevalence of insulin resistance, hypercholesterolemia, central obesity, and metabolic syndrome was higher in obese
PCOS with 61.5%, 46.2%, 53.8%, and 69.2%, respectively.
Conclusions: Obesity and IR are important risk factors for metabolic syndrome in PCOS. Considering the long-term health risks, it is
necessary to identify metabolic disorders in adolescents with PCOS as early as possible.
Key Words: Metabolic abnormalities, Polycystic ovary syndrome, Adolescents
group was evaluated by one endocrinologist and after withdrawal bleeding. The polycystic-appearing ovary (PAO)
ruling out other etiologies (e.g., congenital adrenal hyper- was dened according to the presence of increased ovarian
plasia, androgen-secreting tumors, and Cushing syndrome), size and/or at least 12 follicular cysts measuring 2 to 9 mm.
they were enrolled in the PCOS group. After a 10-hour overnight fast, blood samples were taken
In the present study, six months after the rst study, all from adolescents between the rst and fth day of the
the PCOS group members were invited to participate, i.e., menstrual period/withdrawal bleeding in order to measure
from which 40 of them referred to us. In addition, we prolactin (PRL), luteinizing hormone (LH), follicle-stimulating
randomly selected 80 adolescents from the normal hormone (FSH), free testosterone (FT), dehydroepian-
adolescents of the previous study (total of 120 adolescents). drosterone sulfate (DHEAS), 17-hydroxyprogesterone (17-
In the new study, all the population was reevaluated con- OHP), thyroid stimulating hormone (TSH), and lipid prole.
rming the previous diagnosis; all of the normal adoles- The cutoff values for abnormal serum lipid levels were
cents had regular menses (an average length of the cycles based on the National Cholesterol Education Program
between 22 and 41 days; none or a single cycle with Pediatric Panel Report.19 Hypertriglyceridemia, hypercho-
a length of !22 to O41 days during the past year) without lesterolemia, low levels of high-density lipoprotein (HDL-
hirsutism. C), and high levels of low-density lipoprotein (LDL-C) were
All the girls were at least 1 year post menarche at the dened by serum concentrations of triglycerides $150 mg/
time of evaluation. The exclusion criteria were hypothy- dL, total cholesterol $170 mg/dL, HDL-C #35 mg/dL, and
roidism, hyperprolactinemia, use of any medications known LDL-C $110 mg/dL. The homeostasis model analysis insulin
to affect sex hormone, glucose or lipid metabolism for at resistance (HOMA-IR 5 fasting glucose mmol/L fasting
least a month and oral contraceptives for 3 months before insulin mIU/mL/22.5) index was used for estimating insulin
entering of the study. Taking these measures, 10 and 9 action. Cutoff value of 16 mIU/mL was used for hyper-
participants were excluded from the PCOS group and insulinemia based on a study in an independent cohort of
normal group respectively. Based on the previous survey, 748 children and adolescents.20 MS was dened by Inter-
obesity was dened by BMI $85th percentile.13 Then the national Diabetes Federation criteria for MS in children and
study participants were divided into four sub-groups adolescents,21,22 if they had central obesity (waist circum-
including obese and non-obese PCOS and obese and non- ference $ 80 cm) plus two or more of the following four
obese normal adolescent. factors: (1) increased concentration of triglyceride (TG) $
The study protocol was approved by the Institutional 150 mg/dL; (2) reduced concentration of HDL-C ! 35 mg/
Review Board of the Zanjan University of Medical Sciences. dL); (3) raised blood pressure: systolic pressure $ 130 mm
Written informed consent was obtained from all partici- Hg or diastolic pressure $ 85 mm Hg or treatment of
pants and/or their parent or legal care-taker before their previously diagnosed hypertension; and (4) increased
participation in the study. fasting glucose level $ 100 mg/dL.
Study Protocols
Assays
All subjects who were enrolled in the study had a medical
The serum levels of FSH, LH, PRL, TSH, and insulin
history and underwent physical examination, including
(Monobind, Lake Forest, CA) in serum were measured by
height, weight waist and hip circumference, blood pressure,
enzyme-linked immunosorbent assay (ELISA) (Stat Fax
modied Ferriman-Gallwey scores, and acne scores. All
2100, Awareness Technologies, Los Angeles, CA). Serum FT,
measurements were done by observers trained with the
DHEAS, 17-OHP, and androstenedione were measured using
same standard protocols (allowing for comparison with
an ELISA and commercial kits (IBL, Hamburg). Serum
other studies)17,18; waist circumference was measured
glucose, HDL cholesterol, total cholesterol, and TG were
midway between the lowest rib and the iliac crest with the
measured using an enzymatic calorimetric method with an
subject standing at the end of gentle expiration, and hip
autoanalyzer (Mindray BS-Clinical Chemistry Analyzer,
circumference at the greater trochanters. Weight was
Guangzhou Shihai Medical Equipment Co, Guangdong,
measured in kilograms and height was measured to the
China).
nearest 0.5 cm. BMI was calculated. Blood pressure was
measured twice with mercury sphygmomanometer with
subjects seating quietly for at least 5 minutes; the readings Statistical Analysis
were averaged as the nal value. Ferriman-Gallwey scores
were assessed by at least two observers. All data were analyzed using SPSS version 16.0 (SPSS Inc.,
Since our study group consisted of virginal girls, we Chicago, IL). The normality of the distribution of all
could not perform trans-vaginal ultrasound. So trans- continuous variables were assessed using the Kolmogorov-
abdominal ultrasound examination was obtained to eval- Smirnov test. Continuous variables were presented as mean
uate the ovaries using a Toshiba Sonolayer SSA-220A and standard deviation. Means between groups were
(Toshiba, Tokyo, Japan) with a mechanical 6-MHz probe. compared with the t test and medians between them were
Adolescents with regularly menstruation were scanned in compared with the Mann-Whitney U test. The Pearson
the early follicular phase (cycle days 3e5), while those with chi-square test was used to analyze the differences between
oligomenorrhea or amenorrhea were scanned between the groups and obtain an odds ratio. Statistical signicance
days 3 and 5 of spontaneous or progestin-induced was set at P ! 0.05.
210 H. Rahmanpour et al. / J Pediatr Adolesc Gynecol 25 (2012) 208e212
Results Table 2
Metabolic Characteristic of PCOS and Control Adolescents
The participants of this study, i.e., 30 adolescents in PCOS PCOS Normal P value
group and 71 adolescents in the normal group, were adolescent adolescent
(n 5 30) (n 5 71)
comparable in age (17.73 1.01 vs 17.69 1.29, respectively).
Waist circumference (cm) 74.3 7.26 70.31 7.91 0.02*
However, PCOS adolescents had greater BMI (P 5 0.007) and Systolic blood pressure (mm Hg) 108.17 12.06 103.1 12.22 0.059
greater level of FT (P 5 0.001). Table 1 shows the demo- Diastolic blood pressure (mm Hg) 76.67 11.24 70.83 11.43 0.02*
graphic and hormonal features of adolescents with or Fasting HDL (mg/dl) 35.53 12.54 35.38 4.32 0.94
Fasting triglyceride (mg/dl) 108.23 59.88 98.55 40.87 0.045**
without PCOS. Majority of the PCOS adolescents had Fasting cholesterol (mg/dl) 154.43 26.42 142.58 25.53 0.037**
polycystic-appearing ovaries on pelvic sonography in FBS (mg/dl) 96.6 12.32 94.39 8.21 0.565
comparison to those without PCOS (63.3% vs 7%; P 5 0.0001). Fasting insulin (mIU/liter) 10.42 6.45 8.93 5.65 0.222
HOMA - IR 2.56 1.9 2.13 1.5 0.25
Adolescents with PCOS displayed signicantly greater MS 10 (33.3%) 8 (11.26%) 0.038***
waist circumference, TG, and cholesterol levels, but there
Data are presented as mean standard deviation or as percent, and number
were no signicant differences in fasting glucose, HOMA-IR, * t test
and HDL levels between the PCOS and the control groups. ** Mann-Whitney U test
The prevalence of MS in PCOS group was greater than the *** Chi-square test
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