PCOS and Metabolic Syndrome in Adolescent Girls Enrolled in a Bariatric Surgery Program

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 498-523-Female Reproductive Endocrinology & Case Reports
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-518
Vivian L Chin*1, Marisa Censani1, Shulamit E Lerner1, Rushika Conroy2, Sharon E Oberfield1, Donald J McMahon1 and Ilene Fennoy1
1Columbia University Medical Center, New York, NY, 2Baystate Medical Center, Springfield, MA
Background: Adolescents with morbid obesity have multiple comorbidities. Reports regarding disordered gonadal function and metabolic syndrome among adolescent girls in this population are extremely rare.

Objective: To describe gonadal dysfunction among girls in a morbidly obese adolescent population presenting for bariatric surgery and evaluate its association with metabolic syndrome.

Methods: 169 girls, mean age 16.2 yrs (12-19, SD 1.3), Tanner stage 4-5, mean BMI 47 kg/m2 (36-86, SD 8) were enrolled in the Center for Adolescent Bariatric Surgery Program at Columbia University Medical Center. Under an IRB-approved protocol, height, weight, waist circumference, Tanner stage, reproductive hormone measures, carbohydrate and lipid markers, drug use and menstrual history were obtained in all patients at baseline. Group comparisons by Fisher’s exact or t-tests and logistic regression models were performed using SAS software.

Results: Average menarche was 11.5 yrs (SD 1.6) with a menarchal age of 4.6 yrs (SD 1.9). Excluding girls with menarchal age less than 2 years, complete menstrual data and reproductive hormones were available for 133 girls at initial visit. Girls who were treated with OCPs (n=10), Metformin (n=13) or both (n=5) were also excluded from further analysis. 105 untreated girls were divided into 4 groups: PCOS by NIH criteria, PCOSN (n=15), irregular menses only, IM (n=28), elevated testosterone only, ET (n=7, Testosterone ≥50 ng/dL) and obese controls, OC (n=55).

There was no difference in BMI among all 4 groups. Metabolic syndrome (MeS) by Cook criteria affected 31 girls overall and 13% of PCOSN (2/15), 35% of IM (10/28), 43% of ET (3/7) and 29% of OC (16/55). MeS components (HDL, triglycerides, SBP or DBP, fasting glucose, and waist circumference) when analyzed individually (all p>.05) or as a whole (p>.05) were not predictive of those with PCOS status.

In separate regression analyses, the model most predictive for elevated testosterone included BMI, total cholesterol, triglycerides, HDL and LDL (χ2 = 16.5), while the model most predictive for irregular menses included height, BMI, AST, testosterone and menarchal age (χ2 = 33.9).

Conclusion: PCOSN affected 14% (15/105) and 2 of these 15 (13%) had MeS. Overall 31% (31/105) of all patients had MeS in the morbidly obese adolescent population. Unlike obese adults, MeS and its individual components were not associated with PCOSN in the morbidly obese adolescent population. Further investigation is warranted to clarify the relationship between morbid obesity and gonadal dysfunction in the adolescent girl.

Nothing to Disclose: VLC, MC, SEL, RC, SEO, DJM, IF

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm