PCOS IN ADOLESCENTS: EARLY DETECTION AND INTERVENTION

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Chloe Snow
5 years ago
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1 PCOS IN ADOLESCENTS: EARLY DETECTION AND INTERVENTION R A C H A N A S H A H, M D M S T R A S S I S TA N T P R O F E S S O R O F P E D I AT R I C S D I V I S I O N O F E N D O C R I N O L O G Y A N D D I A B E T E S C H I L D R E N S H O S P I TA L O F P H I L A D E L P H I A P E R E L M A N S C H O O L O F M E D I C I N E AT T H E U N I V E R S I T Y O F P E N N S Y LVA N I A

2 PCOS IN ADOLESCENTS 6-10% of all REPRODUCTIVE AGE women (includes teens) Under diagnosed in teens Symptoms may mimic normal puberty Weight gain Insulin resistance Irregular periods Acne Disease is often EVOLVING and girl may not meet diagnostic criteria YET or may have features of PCOS that resolve with time

3 DIAGNOSTIC CHALLENGES Laboratory references for ADULT women Must rule out other conditions (adrenal disorders, tumors) May never have period Ultrasound findings not helpful PCOS-like ovaries seen in other diseases (ED, CAH, prolactin) Criteria based on transvaginal ultrasounds (not done in teens) Ovarian size/shape/cysts are different in teens Larger ovaries with more cysts may be NORMAL Need to establish age-based criteria

4 DIAGNOSTIC CHALLENGES Symptoms of PCOS are evolving and may not be readily apparent in adolescents Because the diagnosis has significant lifelong implications--- including testing, treatments, and related anxiety, diagnosis is made with caution When diagnosis unclear, recommend: Education Treatment of specific symptoms if needed Follow up

more severe, different pattern, worse with

insulin resistance) Scalp hair thinning in

5 DERMATOLOGIC ISSUES Hirsutism ter,minal hair in MALE pattern Does NOT correlate with androgen levels but with IR Racial/ethnic differences important Acne more severe, different pattern, worse with periods Acanthosis nigricans (marker of insulin resistance) Scalp hair thinning in male pattern Cause of embarrassment, poor self-esteem in girls

6 HIRSUTISM SCORING (MODIFIED FERRIMAN GALLWEY

7 GYNECOLOGIC ISSUES Anovulation: can have regular periods, increased frequency, heavy bleeding Oligomenorrhea (infrequent periods): >34 day cycles or <10 cycles/year Amenorrhea (NO periods) primary or secondary Degree of menstrual dysfunction also correlates with IR Infertility treatments available CAN have spontaneous pregnancy

8 METABOLIC RISK PCOS increases risk compared to same weight/age If overweight, even HIGHER Insulin resistance worsens symptoms/high androgens worsen insulin resistance Risks: Type 2 diabetes, cholesterol problems, fatty liver, high blood pressure, sleep apnea, heart disease Screen for these at diagnosis and every year

9 PSYCHIATRIC RISKS Increased depression and anxiety Poor body image due to: weight, hirsutism, acne, and fertility concerns Eating disorder risk

10 TREATMENT CHALLENGES Oral contraceptives (birth control pills): growth suppression, social stigma (parents/child), side effects Metformin: side effects (diarrhea, bloating, nausea) Spironolactone: birth defects if pregnancy Lifestyle interventions (diet/exercise): need family support, financial, social barriers, MOTIVATION

11 GOALS OF THERAPY TO TREAT/PREVENT: Dermatologic: acne, hirsutism, hair loss Menstrual dysfunction: dysfunctional bleeding, endometrial hyperplasia/cancer Metabolic disease: insulin resistance/diabetes, hypertension, cholesterol Infertility (future) Usually requires combination of treatments

12 Find the CAUSE Genetics/epigenetics Microbiome Metabolomics Early diagnosis Premature adrenarche SGA Treatment/prevention Diet Medications Others? RESEARCH

13 CHOP ADOLESCENT PCOS CLINIC Multidisciplinary, all pediatric providers Endocrinologist Dermatologist Gynecologist Nutritionist Clinical research team Patients/families meet with multiple providers at one clinic visit to have all their needs met Focus on education about the condition for patients/family

14 To make an appointment, call Endocrinology at or ASK FOR THE PCOS CLINIC

Clinical Problems in the Diagnosis and Treatment of PCOS During Adolescence

Clinical Problems in the Diagnosis and Treatment of PCOS During Adolescence R a c h a n a S h a h, M D M S T A s s i s t a n t P r o f e s s o r o f P e d i a t r i c s D i v i s i o n o f E n d o c r