Findings of a new study presented at ENDO 2022, the annual meeting of the Endocrine Society suggest two phenotypes of polycystic ovary syndrome (PCOS) in adolescents.¹

In this study, data of 352 girls, aged 13-18 years, from the PCOS multisite registry was retrospectively examined. Of these 68 girls were lean (average BMI 22.6 kg/m2), while the remaining 284 were obese (average BMI 36.1 kg/m2). In the obese group, the age at diagnosis of PCOS was 15.3, while in the lean group it was 15.8 years. Menarche occurred at 12.1 years of age in lean adolescents, whereas in the obese adolescents, the age at menarche was 11.6 years. There were no significant differences in the composition of the groups by race or ethnicity.

However, there were marked differences in metabolic parameters between the two groups. Glycosylated hemoglobin (A1c), alanine aminotransferase and triglyceride levels were higher, while HDL cholesterol levels were lower in the obese group compared to the lean group. Acanthosis nigricans was more prevalent among the obese girls; it was moderate to severe in some cases. In contrast, acanthosis nigricans was uncommon in the lean group and none had severe acanthosis.

Another point of difference was the abnormal hormone levels in the non-obese group, who had significantly higher levels of total testosterone, androstenedione and luteal hormone and lower free testosterone levels, whereas the obese group had hyperandrogenemia with higher free testosterone and lower sex hormone–binding globulin (SHBG) due to insulin resistance.

A study published last year in PLoS Medicine had characterized reproductive and metabolic subtypes of PCOS in adult women.² The observations of the present study also highlight the differences in clinical presentations of PCOS in adolescent girls.

References

1. Two distinct subtypes of PCOS identified in adolescents - Medscape - Jun 17, 2022.
2. Dapas M, et al. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLoS Med. 2020 Jun 23;17(6):e1003132.