Primary amenorrhea as a manifestation of polycystic ovarian syndrome in adolescents: a unique subgroup?

OBJECTIVE

To compare clinical and metabolic features of adolescents having primary amenorrhea (PA) and polycystic ovarian syndrome (PCOS) with those having oligomenorrhea or secondary amenorrhea (OM/SA) and PCOS.

DESIGN

Retrospective case-control study.

SETTING

Endocrine Gynecology Clinic at The Hospital for Sick Children, Toronto, Ontario, Canada.

PATIENTS: Girls and young women aged 14 to 18 years having PA and PCOS (n = 9) seen during a 2(1/2)-year period were compared with control subjects having OM/SA and PCOS (n = 18) randomly selected during the same period.

INTERVENTION: Medical record review was performed to assess clinical, biochemical, and ultrasonographic measures, as well as response to a progesterone challenge.

MAIN OUTCOME MEASURES: Differences in response to the progesterone challenge, hyperandrogenism, and the presence of features of the metabolic syndrome.

RESULTS

Compared with adolescents having OM/SA, adolescents having PA demonstrated older age at pubarche, higher androstenedione levels, greater prevalence of family history of obesity, a tendency toward no withdrawal bleeding in response to the progesterone challenge, and more features associated with the metabolic syndrome (acanthosis nigricans, higher diastolic blood pressure, and lower high-density lipoprotein cholesterol level). No significant correlation was demonstrated between response to the progesterone challenge, metabolic features, and androstenedione levels.

CONCLUSION

Adolescents with PA and PCOS exhibit increased features of the metabolic syndrome and higher androstenedione levels and may represent a more severe spectrum of a common condition.