Early polycystic ovary-like syndrome in girls with central precocious puberty and exaggerated adrenal response

Institute of Pediatric and Adolescent Endocrinology, Children's Medical Center of Israel, Petah Tiqva, Israel.

Exaggerated adrenal response (ExAR), i.e. hypersecretion of both 17-hydroxypregnenolone (170HPreg) and 17-hydroxyprogesterone(17OHP) in response to adrenocorticotropic hormone (ACTH) stimulation, is frequently found in women with polycystic ovary (PCO) syndrome who had precocious adrenarche. In an earlier study we found an abnormal adrenal response in girls with idiopathic true central precocious puberty (CPP) at early stages of puberty. On follow-up it was noted that a significant number of girls with CPP develop PCO-like syndrome at a relatively young age. The aim of the present study was to determine if there is an association between ExAR and early PCO in girls with a history of CPP. Included were 49 girls with a history of CPP, 34 of whom were treated with gonadotropin-releasing hormone (GnRH) analog. All 49 were evaluated at full maturity, at ages 12.5-14 years, 0.5-4 years after menarche or resumption of menses. Of the 49 girls, 20 had at least 3/4 clinical signs of PCO (irregular menses, hirsutism, acne and obesity) and were defined as PCO-like+, whereas 29 did not fulfil the criteria and were considered PCO-like-. Girls with a definite enzyme deficiency were excluded from the study. All participants underwent a combined iv ACTH-GnRH test at early follicular phase. The PCO-like+ girls all revealed ExAR, i.e. an elevated stimulated 17OHPreg of 63.4 +/- 9.6 nmol/l (normal 28.6 +/- 9.2 nmol/l) and a normal stimulated 17OHPreg/17OHP ratio of 7.1 +/- 1.8 (normal 6.2 +/- 2.7), whereas all the PCO-like- had a normal adrenal response (30.0 +/- 8.7 and 5.3 +/- 2.0 nmol/l, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				R. L. Rosenfield Identifying Children at Risk for Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 787 - 796. [Abstract] [Full Text] [PDF]

				M. Guido, D. Romualdi, R. Suriano, M. Giuliani, B. Costantini, R. Apa, and A. Lanzone Effect of pioglitazone treatment on the adrenal androgen response to corticotrophin in obese patients with polycystic ovary syndrome Hum. Reprod., March 1, 2004; 19(3): 534 - 539. [Abstract] [Full Text] [PDF]

				M. S. Sothern and S. T. Gordon Prevention of Obesity in Young Children: A Critical Challenge for Medical Professionals Clinical Pediatrics, March 1, 2003; 42(2): 101 - 111. [PDF]

				R. Azziz, V. Y. Black, E. S. Knochenhauer, G. A. Hines, and L. R. Boots Ovulation After Glucocorticoid Suppression of Adrenal Androgens in the Polycystic Ovary Syndrome Is Not Predicted by the Basal Dehydroepiandrosterone Sulfate Level J. Clin. Endocrinol. Metab., March 1, 1999; 84(3): 946 - 950. [Abstract] [Full Text]

				P. P. Feuillan, J. V. Jones, K. Barnes, K. Oerter-Klein, and G. B. Cutler Jr. Reproductive Axis after Discontinuation of Gonadotropin-Releasing Hormone Analog Treatment of Girls with Precocious Puberty: Long Term Follow-Up Comparing Girls with Hypothalamic Hamartoma to Those with Idiopathic Precocious Puberty J. Clin. Endocrinol. Metab., January 1, 1999; 84(1): 44 - 49. [Abstract] [Full Text]

				G. Gennarelli, J. Holte, M. Stridsberg, U. Lundqvist, M. Massobrio, T. Bäckström, and C. Berne Response of the Pituitary-Adrenal Axis to Hypoglycemic Stress in Women with the Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., January 1, 1999; 84(1): 76 - 81. [Abstract] [Full Text]