NASPAG 26th Annual Clinical Research Meeting, Issues and Answers in
Pediatric and Adolescent Gynecology, April 19-21, 2012, Miami, Florida
Poster Abstracts
1. Clinical Approaches to PCOS: A Survey of the NASPAG
Membership
Andrea E. Bonny MD 1, Heather Appelbaum MD 2,
Ellen Lancon Connor MD 3, Barbara Cromer MD 4,
Amy DiVasta MD, MMSc 5, Veronica Gomez-Lobo MD 6,
Ze'ev Harel MD 7, Jill Huppert MD, MPH 8, Gina Sucato MD, MPH 9
1
Nationwide Children's Hospital, Columbus, OH
2
Hofstra Northshore-LIJ School of Medicine, Hempstead, NY
3
University of Wisconsin, Madison, WI
4
Case Western Reserve University, Cleveland, OH
5
Harvard Medical School, Boston, MA
6
Georgetown University, Washington, DC
7
Warren Alpert Medical School of Brown University, Providence, RI
8
Cincinnati Children's Hospital Medical Center, Cincinnati, OH
9
University of Pittsburgh School of Medicine, Pittsburgh, PA
Background: Given the short and long-term morbidity associated with
polycystic ovary syndrome (PCOS), consensus regarding diagnostic criteria is
important. However, as with many syndromes, PCOS is composed of
a constellation of clinical, biochemical, and radiologic ndings. Thus, no single
criterion is sufcient for clinical diagnosis. Furthermore, the applicability of the
various existing diagnostic criteria to the adolescent population is unclear,
making the diagnosis during adolescence potentially complex and difcult.
The objective of this study was to evaluate methods of initial diagnosis and
management of PCOS among members of NASPAG in order to assess the
degree of practice heterogeneity among specialist providers of adolescent care.
Methods: An internet-based, anonymous, 10-question survey was
circulated by email to the NASPAG membership. Three separate emails
were sent two weeks apart. Three questions pertained to the number and
types of patients seen by each provider. Three questions pertained to the
tests and treatments used by the provider to initially diagnose and treat
PCOS, and the remaining 4 questions sought demographic respondent data
such as area of expertise or place of practice. Frequency counts for
responses to each question were calculated.
Results: Of the 329 NASPAG members, 127 (39%) responded, 15% of whom
practiced outside of the US. Fifty-ve percent identied expertise in Gyne-
cology, 34% Adolescent Medicine, 10% Reproductive Endocrinology, 6%
General Pediatrics, 4% Endocrinology, and 1% Family Medicine. The
percentage of respondents who incorporated specic tests at initial diagnosis
was as follows: 87% TSH, 78% prolactin, 76% FSH, 76% total testosterone, 74%
DHEAS, 71% 17-hydroxyprogesterone, 61% lipid panel, 60% glucose, 57% free
testosterone, 57% LH, 41% insulin, 31% T4, 25% estradiol, 25% hemoglobin A1C,
25% liver function tests, 24% androstenedione, and 17% sex hormone binding
globulin. Only 36% included ultrasound in their initial diagnosis. One-third
(37%) reported they would make the diagnosis of PCOS within the rst 2 years
following menarche. Oral contraceptives and diet modication/exercise were
the most common therapies recommended by 98% and 90% of respondents,
respectively. Metformin (29%), spironolactone (19%), and referral to cosmetic
surgery (17%) were prescribed initially by a minority of providers.
Conclusions: Considerable practice heterogeneity was present among
the members of NASPAG with regards to diagnostic testing during initial
evaluation for suspected PCOS. Recommendations for rst-line therapy
after diagnosis were more consistent. Future studies should clarify the
clinical utility of specic diagnostic tests for adolescents with PCOS, such
that selection of diagnostic testing is evidence driven.
1083-3188/$ - see front matter 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
doi:10.1016/j.jpag.2011.12.018
2. Androgen Levels Do Not Predict PCOS Phenotypes in
Adolescents and Young Adults
Maude Veilleux-Lemieux MD, FRCPC 1, Courtney E. Walls MPH 2,
Amy Desrochers DiVasta MD, MMSc 1,3
1
Division of Adolescent and Young Adult Medicine
2
Clinical Research Program
3
Division of Pediatric and Adolescent Gynecology, Children's Hospital
Boston, Boston, Massachusetts
Background: Polycystic ovary syndrome (PCOS) is a heterogeneous
disorder and the diagnosis can be challenging during adolescence. This
study explores the relationships between serum androgen levels and PCOS
phenotypes among adolescents.
Methods: Females aged 10 to 22 years old with a diagnosis of PCOS using
the 1990 NIH criteria and with serum androgen concentrations measured
around the time of their initial visit were eligible. Subjects using medi-
cations that could affect study outcomes were excluded. Subjects were
classied into two groups: subjects with elevated androgen levels and
subjects with normal androgen levels. Mean and standard deviation were
calculated for descriptive data. Sample t-tests were used to analyze
differences in the continuous variables between groups; chi-squared tests
were used for categorical variables. Logistic regression models were used
to assess for predictors of elevated androgen levels.
Results: One hundred and fty-six subjects were included in the present
study. Of those, 85.9% (n134) had at least one elevated androgen
concentration. Most subjects reported oligomenorrhea (71.4% vs. 72.7%) in
elevated versus normal groups respectively and hirsutism (59.0% vs. 81.8%)
in elevated versus normal groups respectively. Acne was seen in 44.8%
(n60) of the subjects with elevated androgen levels, and in 40.9% (n9) of
subjects with normal androgen levels. Overall, only 7 subjects (4.5%) had
clitoromegaly, and only 2 (1.3%) had androgenic alopecia. Menstrual
pattern did not correlate with androgen elevation. No signicant rela-
tionships between androgen elevation and age at presentation, acne,
acanthosis nigricans, androgenic alopecia or clitoromegaly were seen.
Subjects with elevated androgen levels were less likely to have hirsutism
(p0.04), but the association was not signicant after adjusting for BMI
(p0.08). Logistic regression models showed that only BMI was a signi-
cant predictor of elevated androgen levels (p0.04).
Conclusions: Our study showed that BMI was the only predictor of elevated
androgen concentration, and that hyperandrogenemia was not associated
with a specic PCOS phenotype among adolescents and young adults.
3. Screening for Abnormal Glucose Metabolism in
Adolescents with Polycystic Ovary Syndrome (PCOS)
M. Tracy Bekx MD, Judith Nir MD, Ellen Connor MD
University of Wisconsin School of Medicine and Public Health, American
Family Children's Hospital, Madison, Wisconsin
Background: Polycystic ovary syndrome (PCOS) affects 5-10% of women
and is increasingly recognized in the adolescent population. Type 2 dia-
betes mellitus (DM2) is found in 10% of young adult women with PCOS,
while prediabetes has been reported in 35%. The few studies evaluating
prevalence of DM2 in adolescents with PCOS report rates of 11-33% for