REVISTA DE LASOCIEDAD CHILENA DEOBSTETRICIA Y GINECOLOGIAINFANTIL Y DE LA ADOLESCENCIA
Polycystic Ovary Syndrome In Teenagers: Clinical, Laboratory and Ultrasound Evaluation and Treatment. / Sotomayor Karina y cols.
Polycystic Ovary Syndrome In Teenagers: Clinical, Laboratory and
Ultrasound Evaluation and Treatment. p.024
Sotomayor Karina, Barrera C., Flández J.Centro de Docencia de Atención Clínica Integral Ambulatoria, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
se (body mass index (BMI)> or = 95th percentile,
1) To compare the clinical and laboratory fea-
NCHS/OMS) and at-risk adolescents (BMI 85th to
tures of obese versus eutrophic teenagers with Po-
<95th percentile), and group 2: eutrophic teenagers
(BMI 10th to 84th percentile). MBS was assessed
2) To assess the presence of metabolic syndro-
(Ferranti criteria ATP III). Additionally to the obe-
se teenagers were indicated by healthy diet, regular
3) To evaluate clinically the diet, exercise and
exercise and Metformin (850 mg two times daily)
Metformin treatment in obese teenagers with
if insulin level was altered. They were evaluated by
weight, BMI, hirsutism score (Ferriman Gallwey) and menstrual regularity at 3,6,12 and 18 months.
Descriptive statistical analysis and some parame-
Transversal study of 23 teenagers evaluated in
ters analytic statistic were done. Using STATA 8.0,
Pediatric Gynaecology Unit, with PCOS diagnosed
with p value significative <0.05.
by the 2003 Rotterdam diagnostic criteria. They were evaluated clinically and sonographically and
hormone plasma levels were measured: prolac-
The mean age of 23 adolescents was 15 years
tin, thyroid stimulating hormone (TSH), 17-OH-
old (range: 12-19) and their gynaecological mean
progesterone, dehydroepiandrosterone sulphate
age was 3 years (range: 6 months-8 years). The
(DHEA-S), androstenedione, total testosterone
mean weight was 64.7 kg (range: 42.5-100.5),
(Tt), sexual hormone binding globulin (SHBG) and
mean BMI was 25.2 kg/m2 (range: 18.6-35.2).17
free androgens index (FAI) from Tt and SHBG was
of them (74%) consulted by menstrual irregulari-
calculated. Lipid profile: total cholesterol, high-
ties, 5 (22%) by clinical hyperandrogenism (acne
density lipoprotein (HDL), low-density lipoprotein
or hirsutism) and just 1 consulted by obesity. Ante-
(LDL), triglycerides (TG) and oral glucose tole-
cedents of girl born small for gestational age were
rance test with fasting and post charge glucose 2
present at 3 (13%), premature pubarche at 1 (4%),
hours insulin were measured too. Index of insulin
precocious menarche at 1 (4%) and family history
resistance from glucose and insulin levels: the ho-
of type 2 diabetes mellitus at 14 (61%). 12 (52%)
meostasis model assessment (HOMA) was calcu-
adolescents were obese (group 1) and 11 (48%)
lated. Two groups were compared: group 1: obe-
were eutrophic teenagers (group 2). Clinical featu-
SOGIA Vol. 14 - Nº 3, Año 2007 - AV - Pág. 55
Polycystic Ovary Syndrome In Teenagers: Clinical, Laboratory and Ultrasound Evaluation and Treatment. / Sotomayor Karina y cols.
res as blood pressure, acanthosis nigricans, acne,
12 months and 10 (91%) restored normal men-
Ferriman-Gallwey score and menstrual cycle
strual cycles at 3 months post therapy. Just one
were similar in both groups.14 (61%) ultrasound
adolescent restored normal menses at 12 months
were altered, 10 with polycystic ovaries and 4
post therapy, with the highest insulin levels.
with enlarged ovaries. There wasn`t difference between both groups. Prolactin, TSH, lipid profi-
le, 17-OH-progesterone, DHEA-S, Tt, SHBG le-
1) Approximately 50% of our adolescents with
vels and FAI didn't show significative association
PCOS were obese, coincident with literature.
with nutritional status (p>0,05). Basal and post-
2) We observed a significative association bet-
charge insulin were altered in 50% (group 1) vs
ween insulin levels with nutritional status, sug-
9% (group 2) and 90% (group 1) vs 37% (group
gesting that PCOS and obesity may have a sy-
2) respectively. Statistical significative associa-
nergistic effect on the magnitude of the insulin
tion was found between altered basal (p=0,032)
and postcharge insulin (p=0,013), OR:16.6 (con-
3) MBS was present in 2 patients (9%), both
fidence interval 1,36,204)95 with nutritional sta-
with the highest insulin levels and BMI, sugges-
tus. HOMA index was altered in 100% of obese
ting hyperinsulinemia is a likely common patho-
adolescents (group 1) vs 57% (group 2). MBS
genetic factor for both PCOS and MBS.
was detected in 2 adolescents, both obese, with
4) The most of our adolescents restored nor-
the highest BMI (35.2 and 33.1 kg/m2). 11 obe-
mal menses at 3 months post therapy coincident
se adolescents received diet, regular exercise and
with literature. Just 1 needed 12 months to achie-
Metformin therapy. 7 (64%) presented a descent
ve ovulatory menses. The elevated insulin levels
of weight over 5% at 6 months, the mean Ferri-
in this patient suggest that insulin disorder may
man-Gallwey score descended in three points at
be the mean factor to anovulatory cycles. SOGIA Vol. 14 - Nº 3, Año 2007 - AV - Pág. 56
IL SINDACO Vista la deliberazione n. 341 del 12.5.1999 con la quale la Giunta comunale, nel precisare che durante i quattro giorni di permanenza nella stalla di Contrada e nelle sei prove di Piazza i cavalli del Palio possono avere la necessità di proseguire eventuali terapie in atto o andare incontro ad alterazioni del normale stato fisiologico che, anche se non di rilevante gravità e tali