Metabolic and reproductive features before and during puberty in daughters of women with polycystic ovary syndrome

Teresa Sir-Petermann, Ethel Codner, Virginia Pérez, Bárbara Echiburú, Manuel Maliqueo, Amanda Ladrón de Guevara, Jessica Preisler, Nicolás Crisosto, Fernando Sánchez, Fernando Cassorla, Shalender Bhasin, Teresa Sir-Petermann, Ethel Codner, Virginia Pérez, Bárbara Echiburú, Manuel Maliqueo, Amanda Ladrón de Guevara, Jessica Preisler, Nicolás Crisosto, Fernando Sánchez, Fernando Cassorla, Shalender Bhasin

Abstract

Context: A significant proportion of the first-degree female relatives of women with polycystic ovary syndrome (PCOS) may be at risk for developing PCOS. However, it is not known at which stage of pubertal development the hormonal and metabolic abnormalities ensue in PCOS.

Objective: The aim of the study was to assess the reproductive and metabolic profiles of daughters of women with PCOS (PCOSd) during the peripubertal period, a stage during which the gonadal axis is activated and PCOS may become clinically manifest.

Design: Ninety-nine PCOSd [30 prepubertal and 69 pubertal (Tanner II-V)] and 84 daughters of control women (Cd) (20 prepubertal and 64 pubertal) were studied. An oral glucose tolerance test, a GnRH agonist test (leuprolide acetate, 10 microg/kg sc), and a transabdominal ultrasound were performed. Gonadotropins, sex steroids, SHBG, glucose, insulin, and lipids were determined.

Results: Both groups had similar chronological ages and body mass index sd scores according to Tanner stage distribution. Ovarian volume and 2-h insulin were significantly higher in PCOSd compared to Cd at all Tanner stages. In Tanner stages IV and V, basal testosterone and poststimulated LH, testosterone, and 17-hydroxyprogesterone concentrations were significantly higher in PCOSd compared to Cd.

Conclusions: Hyperinsulinemia and an increased ovarian volume are present in PCOSd before the onset of puberty and persist during pubertal development. The biochemical abnormalities of PCOS appear during late puberty. Considering the early onset and the nature of the alterations, PCOSd constitute a high-risk group for metabolic and reproductive derangements.

Figures

Figure 1
Figure 1
Correlation between basal testosterone serum concentrations measured by RIA and LC-MS/MS.
Figure 2
Figure 2
LH, 17-OHP, and testosterone (LC-MS/MS) levels after stimulation with leuprolide acetate and the insulin levels after the glucose load (2-h) in PCOSd and Cd. Values are expressed as mean ± sem. *, P < 0.05.
Figure 3
Figure 3
Individual concentrations of stimulated LH, 17-OHP, testosterone (LC-MS/MS) and insulin (2-h) in PCOSd during Tanner I-III, IV and V. The Cd group is shown as the shaded area.

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