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2006, Number 1

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Rev Endocrinol Nutr 2006; 14 (1)

Polycystic ovary syndrome in the adolescence. Position of Sociedad Mexicana de Nutrición y Endocrinología

Gómez DRA, Torres TM, Barrón UC, Nishimura ME, Pérez PLE, Cárdenas THM, Calzada LR, Garibay NN, Dorantes ÁLM

Language: Spanish
References: 103
Page: 13-19
PDF size: 124.45 Kb.


ABSTRACT

The Mexican Society of Nutrition and Endocrinology has developed this document to present current recommendations on the diagnosis and treatment of the Polycystic Ovary Syndrome (PCOS) in the adolescents. The most important recommendations are: 1) Early recognition of PCOS in adolescents, 2) Intentional search for metabolic syndrome components (obesity, glucose intolerance, hypertension and lipid abnormalities), 3) Detection of co-morbidities and pharmacological therapy as necessary, 4) Lifestyle modifications in all the adolescents with PCOS, 5) Pharmacological therapy with metformin and antiandrogen agents, and, 6) Long term follow up to assure PCOS and metabolic syndrome treatments. In conclusion, the early recognition and prompt treatment of adolescents with PCOS is one of the main goals for the prevention program of the metabolic syndrome in the adult life; encouragement and motivation to obtain healthy lifestyle must be offered to all the adolescents with PCOS.


REFERENCES

  1. Vicino M, Loizzi V, Scardigno D, Selvaggi L. Polycystic ovary syndrome: from physiopathology to therapy. Minerva Ginecol 2006; 58: 55-67.

  2. Ehrman DA, Barnes RB, Rosenfield RL. Polycystic ovary syndrome as a form of functional ovarian hyperandrogenism due to dysregulation of androgen secretion. Endocr Rev 1995; 16: 322-353.

  3. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18: 774-800.

  4. Ibañez L, Potau N, Carrascosa A. Possible genesis of polycystic ovary syndrome in the periadolescent girl. Curr Opin Endocrinol Diabetes 1998; 5: 19-26.

  5. Szilagyi A, Szabo I. Endocrine characteristics of polycystic ovary syndrome (PCOS). Indian J Exp Biol 2003; 41: 694-700.

  6. Ibañez L, Potau N, Zampolli M, Rique S, Saenger P, Carrascosa A. Hyperinsulinemia and decreased insulin-like growth factor-binding protein-1 are common features in prepubertal and pubertal girls with a history of premature pubarche. J Clin Endocrinol Metab 1997; 82: 2283-2288.

  7. Sharpless JL. Polycystic ovary syndrome and the metabolic syndrome. Clinical Diabetes 2003; 21: 154-161.

  8. Williams CL, Hayman LL, Daniels SR et al. Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002; 106: 143-160.

  9. Arslanian SA, Lewy VD, Danadian K. Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and β-cell dysfunction and risk of cardiovascular disease. J Clin Endocrinol Metab 2001; 86: 66-71.

  10. Ibañez L, Jaramillo AM, Ferrer A, Zegher F. High neutrophil count in girls and women with hyperinsulinaemic hyperandrogenism: normalization with metformin and flutamide overcomes the aggravation by oral contraception. Hum Reprod 2005; 20(9): 2457-2462.

  11. Burke J, Hale D, Hazuda H, Ster M. A quantitative scale of Acantosis nigricans. Diabetes Care 1999; 22: 1655-1659.

  12. Fraser IS, Kovacs G. Current recommendations for the diagnostic evaluation and follow-up of patients presenting with symptomatic polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004; 18(5): 813-823.

  13. Revised 2003 consensus on diagnosis criteria and longterm health risk related to polycystic ovary syndrome (PCOS). Human Reprod 2004; 19(1): 45-47.

  14. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25.

  15. Ibañez L, de Zegher F, Potau N. Anovulation after precocious pubarche: early markers and time course in adolescence. J Clin Endocrinol Metab 1999; 84: 2691-2695.

  16. Avvad CK, Holeuwerger R, Silva VC. Menstrual irregularity in the first postmenarchal years: an early clinical sign of polycystic ovary syndrome in adolescence. Gynecol Endocrinol 2001; 15: 170-177.

  17. Oppenheimer E, Linder B, DiMartino-Nardi J. Decreased insulin sensitivity in prepubertal girls with premature adrenarche and Acantosis nigricans. J Clin Endocrinol Metab 1995; 80: 614-618.

  18. Bauman EE, Rosenfield RI. Polycystic ovary syndrome in adolescence. The Endocrinologist 2000; 12: 333-348.

  19. Lewy VD, Danadian K, Witchel SF, Arslanian S. Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome. J Pediatr 2001; 138: 38-44.

  20. Cook S, Meitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents. Arch Pediatr Adolesc Med 2003; 157: 821-827.

  21. Rosenfield RL. Current concepts of polycystic ovary syndrome. Bailliers Clin Obstet Gynaecol 1997; 11: 307-333.

  22. Legro SR, Rhonda BL, Driscoil D, Wang SG, Dunaif A. Insulin resistance in the sisters of women with polycystic ovary syndrome: association with hyperandrogenemia rather than menstrual irregularity. The Journal of Clinical Endocrinology & Metabolism 2002; 87: 2128-2133.

  23. Benítez MR, Peterman ST, Palomino AA y cols. Prevalencia familiar de patologías metabólicas en pacientes con síndrome de ovarios poliquísticos. Rev Med Chile 2001; 129:

  24. 707-712.

  25. Silfen ME, Denburg MR, Manibo AM et al. Early endocrine, metabolic and sonographic characteristics of polycystic ovary syndrome: comparison between nonobese and obese adolescents. J Clin Endocrinol Metab 2003; 88: 4682-4688.

  26. Sharpless JL. Polycystic ovary syndrome and the metabolic syndrome. Clinical Diabetes 2004; 21: 154-161.

  27. Hooff V, Voorhorst F, Kaptein M, Hirasing R, Koppenaal C, Schoemaker J. Predictive value menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligo-amenorrhoea at age 18 years. Human Reproduction 2004; 19: 383-392.

  28. Ibañez L, Potau N, Chacon P, Pascual C, Carrascosa A. Hyperinsulinaemia, dyslipaemia and cardiovascular risk in girls with a history of premature pubarche. Diabetologia 1998; 41: 1057-1063.

  29. Legro RS, Blanche P, Kraus RM, Lobo RA. Alterations in low-density lipoprotein and high-density lipoprotein subclasses among Hispanic women with polycystic ovary syndrome:

  30. influence of insulin and genetic factors. Fertil Steril 1999; 72: 990-995.

  31. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: A prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999; 84: 165-169.

  32. National Center for Health Statistics National Health and Nutrition examination survey. CDC Growth Charts: Body Mass index for Age. United States 2000.

  33. Gómez DR. Síndrome metabólico en niños y adolescentes. Síndrome de resistencia a la insulina (Síndrome Metabólico). En: Cuauhtémoc Vázquez Chávez Ed. 2004: 141-181.

  34. Diabetes in Children Adolescents Work Group of the National Diabetes Education Program. An update on type 2 diabetes in youth from the National Diabetes Education program. Pediatrics 2004; 114: 259-263.

  35. Expert Panel on Blood Cholesterol levels in children and adolescents. National Cholesterol Education Program report. Pediatrics 1992: 89(suppl): 525-584.

  36. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure

  37. Education Program. Pediatrics 1996; 98(4 Pt 1): 649-658.

  38. Moghetti P, Castello R, Negri C. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivy in polycystic ovary syndrome: a randomized, double-blind placebo-controlled 6-month trial, followed by open, long term clinical evaluation. J Clin Endocrinol Metab 2000; 85: 139-146.

  39. Flemmer M, Scott J. Mechanism of action of thiazolidinediones. Curr Opin Investig Drugs 2001; 11: 1564-1567.

  40. Weiss A, Dziura J, Burgert T, Tamborlane WV, Taksali SE, Yeckel C, Allen K, Lopes M, Savoye M, Morrison J, Sherwin R, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362-2374.

  41. Palmert M, Gordon C, Kartashov A, Legro R, Emans S, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab 2002; 87: 1017-1023.

  42. Falsetti L, Gambera A, Tisi G. Efficacy of the combination ethinyl or estradiol and cyproterone acetate on endocrine, clinical, ultrasonographic profile in polycystic ovarian syndrome. Hum Reprod 2001; 16: 36-42.

  43. Guido M, Romualdi D, Giuliani M. Drospirenone for the treatment of polycystic ovary syndrome: A clinical, endocrinological, metabolic pilot study. J Clin Endocrinol Metab 2004; 89: 2817-2823.

  44. Krattenmacher R. Drospirenone: pharmacology and pharmacokinetics of a unique progestagen. Contraception 2000; 62: 29.

  45. Ibañez L, Zegher F. Flutamide-metformin plus ethinylestradiol-drospirenone for lipolysis and antiatherogenesis in young women with ovarian hyperandrogenism: The key role of metformin at the start and after more than one year of therapy. J Clin Endocrinol Metab 2005; 90(1): 39-43.

  46. Ibañez L, de Zegher F. Ethinylestradiol-drospirenone, flutamide- metformin, or both for adolescents and women with hyperinsulinemic hyperandrogenism: Opposite effects on adipocytokines and body adiposity. J Clin Endocrinol Metab 2004; 89: 1592-1597.

  47. Ibañez L, Valls C, de Zegher F. Flutamide-metformin plus ethinilestradiol drospirenone for lipolysis and antiatherogenesis in young women with ovarian hyperandrogenism: the key role of early, low-dose flutamide. J Clin Endocrinol Metab 2004; 89: 4716-4720.

  48. Cavill N, Biddle S, Sallis JF. Health enhancing physical activity for young people: statement of the United Kingdom expert consensus conference. Pediatr Exerc Sci 2001; 13: 12-25.

  49. Attia GR, Rainey WE, Carr BB. Metformin directly inhibit androgen production in human theca cells. Fertil Steril 2001; 76: 517-524.

  50. Arslanian SA, Lewy V, Danadian K, Saad R. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab 2002; 87: 1555.

  51. Costello MF, Eden JA. A systematic review of the reproductive system effects of metformin in patients with polycystic ovary syndrome. Fertil Steril 2003; 79: 1-13.

  52. De Leo V, La Marca A, Petraglia F. Insulin-lowering agents in the management of polycystic ovary syndrome. Endocr Rev 2003; 24: 633-667.

  53. Glueck CJ, Wang P, Fontaine R. Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome. J Adolesc Health 2001; 29: 160-161.

  54. Vicino M, Loizzi V, Scardigno D, Selvaggi L. Polycystic ovary syndrome: from physiopathology to therapy. Minerva Ginecol 2006; 58: 55-67.

  55. Ehrman DA, Barnes RB, Rosenfield RL. Polycystic ovary syndrome as a form of functional ovarian hyperandrogenism due to dysregulation of androgen secretion. Endocr Rev 1995; 16: 322-353.

  56. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18: 774-800.

  57. Ibañez L, Potau N, Carrascosa A. Possible genesis of polycystic ovary syndrome in the periadolescent girl. Curr Opin Endocrinol Diabetes 1998; 5: 19-26.

  58. Szilagyi A, Szabo I. Endocrine characteristics of polycystic ovary syndrome (PCOS). Indian J Exp Biol 2003; 41: 694-700.

  59. Ibañez L, Potau N, Zampolli M, Rique S, Saenger P, Carrascosa A. Hyperinsulinemia and decreased insulin-like growth factor-binding protein-1 are common features in prepubertal and pubertal girls with a history of premature pubarche. J Clin Endocrinol Metab 1997; 82: 2283-2288.

  60. Sharpless JL. Polycystic ovary syndrome and the metabolic syndrome. Clinical Diabetes 2003; 21: 154-161.

  61. Williams CL, Hayman LL, Daniels SR et al. Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002; 106: 143-160.

  62. Arslanian SA, Lewy VD, Danadian K. Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and β-cell dysfunction and risk of cardiovascular disease. J Clin Endocrinol Metab 2001; 86: 66-71.

  63. Ibañez L, Jaramillo AM, Ferrer A, Zegher F. High neutrophil count in girls and women with hyperinsulinaemic hyperandrogenism: normalization with metformin and flutamide overcomes the aggravation by oral contraception. Hum Reprod 2005; 20(9): 2457-2462.

  64. Burke J, Hale D, Hazuda H, Ster M. A quantitative scale of Acantosis nigricans. Diabetes Care 1999; 22: 1655-1659.

  65. Fraser IS, Kovacs G. Current recommendations for the diagnostic evaluation and follow-up of patients presenting with symptomatic polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004; 18(5): 813-823.

  66. Revised 2003 consensus on diagnosis criteria and longterm health risk related to polycystic ovary syndrome (PCOS). Human Reprod 2004; 19(1): 45-47.

  67. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25.

  68. Ibañez L, de Zegher F, Potau N. Anovulation after precocious pubarche: early markers and time course in adolescence. J Clin Endocrinol Metab 1999; 84: 2691-2695.

  69. Avvad CK, Holeuwerger R, Silva VC. Menstrual irregularity in the first postmenarchal years: an early clinical sign of polycystic ovary syndrome in adolescence. Gynecol Endocrinol 2001; 15: 170-177.

  70. Oppenheimer E, Linder B, DiMartino-Nardi J. Decreased insulin sensitivity in prepubertal girls with premature adrenarche and Acantosis nigricans. J Clin Endocrinol Metab 1995; 80: 614-618.

  71. Bauman EE, Rosenfield RI. Polycystic ovary syndrome in adolescence. The Endocrinologist 2000; 12: 333-348.

  72. Lewy VD, Danadian K, Witchel SF, Arslanian S. Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome. J Pediatr 2001; 138: 38-44.

  73. Cook S, Meitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents. Arch Pediatr Adolesc Med 2003; 157: 821-827.

  74. Rosenfield RL. Current concepts of polycystic ovary syndrome. Bailliers Clin Obstet Gynaecol 1997; 11: 307-333.

  75. Legro SR, Rhonda BL, Driscoil D, Wang SG, Dunaif A. Insulin resistance in the sisters of women with polycystic ovary syndrome: association with hyperandrogenemia rather than menstrual irregularity. The Journal of Clinical Endocrinology & Metabolism 2002; 87: 2128-2133.

  76. Benítez MR, Peterman ST, Palomino AA y cols. Prevalencia familiar de patologías metabólicas en pacientes con síndrome de ovarios poliquísticos. Rev Med Chile 2001; 129: 707-712.

  77. Silfen ME, Denburg MR, Manibo AM et al. Early endocrine, metabolic and sonographic characteristics of polycystic ovary syndrome: comparison between nonobese and obese adolescents. J Clin Endocrinol Metab 2003; 88: 4682-4688.

  78. Sharpless JL. Polycystic ovary syndrome and the metabolic syndrome. Clinical Diabetes 2004; 21: 154-161.

  79. Hooff V, Voorhorst F, Kaptein M, Hirasing R, Koppenaal C, Schoemaker J. Predictive value menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligo-amenorrhoea at age 18 years. Human Reproduction 2004; 19: 383-392.

  80. Ibañez L, Potau N, Chacon P, Pascual C, Carrascosa A. Hyperinsulinaemia, dyslipaemia and cardiovascular risk in girls with a history of premature pubarche. Diabetologia 1998; 41: 1057-1063.

  81. Legro RS, Blanche P, Kraus RM, Lobo RA. Alterations in low-density lipoprotein and high-density lipoprotein subclasses among Hispanic women with polycystic ovary syndrome: influence of insulin and genetic factors. Fertil Steril 1999; 72: 990-995.

  82. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: A prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999; 84: 165-169.

  83. National Center for Health Statistics National Health and Nutrition examination survey. CDC Growth Charts: Body Mass index for Age. United States 2000.

  84. Gómez DR. Síndrome metabólico en niños y adolescentes. Síndrome de resistencia a la insulina (Síndrome Metabólico). En: Cuauhtémoc Vázquez Chávez Ed. 2004: 141-181.

  85. Diabetes in Children Adolescents Work Group of the National Diabetes Education Program. An update on type 2 diabetes in youth from the National Diabetes Education program. Pediatrics 2004; 114: 259-263.

  86. Expert Panel on Blood Cholesterol levels in children and adolescents. National Cholesterol Education Program report. Pediatrics 1992: 89(suppl): 525-584.

  87. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 1996; 98(4 Pt 1): 649-658.

  88. Moghetti P, Castello R, Negri C. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivy in polycystic ovary syndrome: a randomized, double-blind placebo-controlled 6-month trial, followed by open, long term clinical evaluation. J Clin Endocrinol Metab 2000; 85: 139-146.

  89. Flemmer M, Scott J. Mechanism of action of thiazolidinediones. Curr Opin Investig Drugs 2001; 11: 1564-1567.

  90. Weiss A, Dziura J, Burgert T, Tamborlane WV, Taksali SE, Yeckel C, Allen K, Lopes M, Savoye M, Morrison J, Sherwin R, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362-2374.

  91. Palmert M, Gordon C, Kartashov A, Legro R, Emans S, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab 2002; 87: 1017-1023.

  92. Falsetti L, Gambera A, Tisi G. Efficacy of the combination ethinyl or estradiol and cyproterone acetate on endocrine, clinical, ultrasonographic profile in polycystic ovarian syndrome. Hum Reprod 2001; 16: 36-42.

  93. Guido M, Romualdi D, Giuliani M. Drospirenone for the treatment of polycystic ovary syndrome: A clinical, endocrinological, metabolic pilot study. J Clin Endocrinol Metab 2004; 89: 2817-2823.

  94. Krattenmacher R. Drospirenone: pharmacology and pharmacokinetics of a unique progestagen. Contraception 2000; 62: 29.

  95. Ibañez L, Zegher F. Flutamide-metformin plus ethinylestradiol-drospirenone for lipolysis and antiatherogenesis in young women with ovarian hyperandrogenism: The key role of metformin at the start and after more than one year of therapy. J Clin Endocrinol Metab 2005; 90(1): 39-43.

  96. Ibañez L, de Zegher F. Ethinylestradiol-drospirenone, flutamide-metformin, or both for adolescents and women with hyperinsulinemic hyperandrogenism: Opposite effects on adipocytokines and body adiposity. J Clin Endocrinol Metab 2004; 89: 1592-1597.

  97. Ibañez L, Valls C, de Zegher F. Flutamide-metformin plus ethinilestradiol drospirenone for lipolysis and antiatherogenesis in young women with ovarian hyperandrogenism: the key role of early, low-dose flutamide. J Clin Endocrinol Metab 2004; 89: 4716-4720.

  98. Cavill N, Biddle S, Sallis JF. Health enhancing physical activity for young people: statement of the United Kingdom expert consensus conference. Pediatr Exerc Sci 2001; 13: 12-25.

  99. Attia GR, Rainey WE, Carr BB. Metformin directly inhibit androgen production in human theca cells. Fertil Steril 2001; 76: 517-524.

  100. Arslanian SA, Lewy V, Danadian K, Saad R. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab 2002; 87: 1555.

  101. Costello MF, Eden JA. A systematic review of the reproductive system effects of metformin in patients with polycystic ovary syndrome. Fertil Steril 2003; 79: 1-13.

  102. De Leo V, La Marca A, Petraglia F. Insulin-lowering agents in the management of polycystic ovary syndrome. Endocr Rev 2003; 24: 633-667.

  103. Glueck CJ, Wang P, Fontaine R. Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome. J Adolesc Health 2001; 29: 160-161.




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