New Diagnostic Criteria of Polycystic Ovarian Morphology for Adolescents: Impact on Prevalence and Hormonal Profile

Abstract

Background: The ultrasonographic criteria used to identify polycystic ovarian morphology (PCOM) during adolescence have changed over time. Recently, a Worldwide Pediatric Consensus (PedC) defined PCOM using stricter criteria than the previous recommendations of the Rotterdam Consensus (RC) and Androgen Excess-Polycystic Ovarian Syndrome Society (AES/PCOS) criteria. The aim of this study was to determine the prevalence of PCOM in healthy adolescents according to the 3 reported diagnostic criteria and compare the hormonal profile in females with and without PCOM based on the PedC criteria. Methods: Nonobese adolescents (n = 102) with regular menstrual cycles were studied. Transabdominal ultrasound and hormonal profiles were assessed during the follicular phase. PCOM was defined on the basis of the 3 published criteria. Results: On the basis of the PedC, RC, and AES/PCOS criteria, PCOM was diagnosed in 13, 34, and 24% of adolescents, respectively. Adolescents with and without PCOM according to the PedC criteria had similar androgen levels. Serum anti-Müllerian hormone (AMH) levels were elevated in adolescents with PCOM, irrespective of the criteria used. Conclusions: Use of the new PedC diagnostic criteria for PCOM results in a lower prevalence of this ultrasonographic pattern in adolescents, but this condition is not associated with hyperandrogenism. Elevated AMH is associated with PCOM in adolescents regardless of the criteria used to determine the ultrasonographic pattern.

The Relevant Hormonal Levels and Diagnostic Features of Polycystic Ovary Syndrome in Adolescents

“…In 2015, the World Pediatric Consensus (PedC) suggested the possibility of using the AMH level as a non-invasive screening test for PCOS diagnosis [11]. Yetim et al calculated cut-off for the AMH for 15-20 years old youth with PCOS and showed that AMH value > 6.10 ng/mL had 92.3% sensitivity and 81.1% specificity in the diagnosis [2].…”

“…Yetim et al calculated cut-off for the AMH for 15-20 years old youth with PCOS and showed that AMH value > 6.10 ng/mL had 92.3% sensitivity and 81.1% specificity in the diagnosis [2]. The research based on examining of 102 adolescents with PCOS, conducted by Merino et al, recommended the threshold for AMH > 7.03 ng/mL with 50.0% sensitivity and 70.8% specificity [11]. Though such investigations in adolescence are rare, according to our results, the use of AMH levels > 7.20 ng/mL with high sensitivity and specificity (75.0% and 89.0%) could be one of the perspective diagnostics tests of PCOS in girls at the age of 15-17 years.…”

“…Its direct radiometric or enzyme-linked assays are more specific and sensitive compared with those for testosterone [9,10]. However, HA determination in adolescents is often difficult, since hormonal levels in girls with PCOS are frequently within the standard values for adults [4,11,12].…”

“…It was proposed to use the anti-Mullerian hormone (AMH) level as a non-invasive screening test for the diagnosis of PCOS and in addition to the ultrasound parameter, though it has not been validated for girls [4,10]. However, according to the 2016 analysis, the use of AMH level ≥ 7.03 ng/mL gives only 50.0% and 70.8% specificity and sensitivity, respectively, in the diagnosis of PCOS in young patients [11].…”

The association between anti-Müllerian hormone and vitamin 25(OH)D serum levels and polycystic ovarian syndrome in adolescent females

“…Additionally, there is disagreement about the definition of polycystic-appearing ovaries in the adolescent population. The Rotterdam criteria use ovarian volume greater than 10 mL or more than 12 follicles on an ovary using a vaginal transducer, however, adolescents have been noted to have greater ovarian volumes and follicular counts than adult women, and it is not recommended to perform vaginal ultrasound on this population [ 6 , 10 , 11 ]. In a retrospective study, only 38% of adolescents who met Rotterdam criteria for PCOS had ovarian volumes ≥10 mL, while 7% of a comparison non-PCOS population had ovarian volumes ≥10mL [ 12 ].…”