Hiperandrogenemia is highly frequent in adolescent girls who are obese
Authors: Lopez‐Alarcon Mardia , Inda‐Icaza Patricia , Márquez Concepcion , Armenta‐Alvarez Andrea , Bram‐Falcon Maria Teresa 
Published: November 2023

Aim

Polycystic ovary syndrome (PCOS) is associated with metabolic alterations that increase the risk for chronic diseases and other conditions like infertility and endometrial cancer. In adolescents, the prevalence of PCOS is 2.5%, but it augments to 5.8% in obese girls. Recent recommendations suggest that the search for PCOS must be included as routine evaluation in obese adolescents. However, diagnosis criteria in adolescence are unclear. It has been suggested that likely hiperandrogenemia (HA) is present despite the absence of other clinical manifestations but this has not been demonstrated. Our aim was to evaluate the frequency of HA and PCOS in a sample of obese girls.

Material and methods

In a cross‐sectional design, clinical, anthropometric and biochemical parameters were analyzed in a group of 180 obese girls. Blood pressure and anthropometry were measured by standardized field workers. Abdominal ultrasound (US) was obtained in 45 girls who accepted the procedure. Fasting blood samples were obtained between 8:00–10:00 AM. Serum was stored in separate vials at −80 °C until analyses. Glucose, triglycerides, HDL‐C, AST and ALT, were determined by colorimetric methods. Insulin was measured with radio immunoassay and total testosterone (TT) and the sex hormone binding globulin (SHBG) by chemoluminiscence using commercial kits. Free (FT) and bioavailable testosterone (BT) were calculated. Data were analyzed with non‐parametric statistics.

Results

A sample of 12–18 y old girls, with BMI between 1.45 and 4.63 z‐score, and Tanner classification between 2 to 5 was studied. The prevalence of metabolic alterations was as follows: 93.3% exhibited insulin resistance, 27.2% met the criteria for metabolic syndrome and 20.6% were classified as with non‐alcoholic fatty liver (NAFL). Although the median concentration of TT and SHBG were between normal ranges, 5% of girls presented high TT, 32.2% low SHBG, 38.8% high FT and 15.7% high BT, using the proposed cutoff points by age and Tanner classification. As expected, insulin concentration was positively correlated with glucose (rho = 0.156, p = 0.037), TAG (rho = 0.151, p = 0.044) and ALT (0.174, p = 0.020). In addition, insulin correlated directly with FT (rho = 0.202, p = 0.007) and BT (rho = 0.203, p = 0.007), but negatively with SHBG (rho = −0.191, p = 0.009). Regarding the criteria for PCOS, 38.8% of girls presented HA and 25.8% declared menstrual irregularities. None of the girls presented hirsutism or acne, but 13 exhibited at least one ovary >10 cc in the US. In the complete sample, only 9% met the criteria for PCOS.

Conclusion

we concluded that the frequency of PCOS in this sample is comparable to that reported in the literature for obese adolescents. However, the frequency of HA was very much higher than that of PCOS. In fact, it was greater than the frequency of MS and NAFL supporting the recommendation of looking for HA in obese adolescent girls.

Support or Funding Information

The study was supported with a grant from the Mexican Institute of Social Security.

Grant #: FIS/IMSS/PROT/PRIO/11/014