Can adolescent PCO regress as she attains full age of adulthood ? The issue of regression or progression of mini-PCOS / nascent PCOS/ hyperpubertal symptoms.

Can adolescent PCO regress as she attains full age of adulthood ? The issue of regression or progression of   mini-PCOS / nascent PCOS/ hyperpubertal symptoms.

Whether the pathogenesis is initiated by hyperandrogeniaemia or hyperinsulinaemia is still controversial but the clinical expressions of such changes were earlier used to be designated as nascent PCOS, hyperpubertal state or physiological mini-PCOS^13,14.  According to present author such a term or clinical note in the case sheet is appropriate as such a note will remind the treating physician to follow her up more scrupulously at a subsequent date. As stated earlier in some girls with such exaggerated physiological changes will not reverse with passage of time. (CR Rudely no 13,Nobles F, Dewailly D. Puberty and polycystic ovary syndrome: The insulin/insulin like growth factor1 hypothesis. Fertil Steril 1992; 58:655-66. which author feels is quite appropriate  12 (Venturoli S, Poreu E, Fabbri R, Magrini O, Paradrisi R, Pallotti G, Gammi I, Flamigni C. Postmenarcheal evolution of endocrine pattern and ovarian aspects in  adolescents with menstrual irregularities. Fertil Steril 1987; 48:78-85).  Fortunately in most girls clinical and hormonal parameters induced by   such temporary hyperandrogenemia and or hyperinsulinaemia will normalize with passage of time but   it is difficult to distinguish biologically and ultrasonically those adolescent at the age group 12-17 years where such normal evolutionary changes will persist and aggravate giving rise to full- fledged PCOS. The author feels the task of researchers now bestow to find out some biological markers to identify such at- risk cases who are destined to develop from mini PCOS to full-fledged PCOS ¹⁴

What are the reasons for medical attention? What are, then the common symptoms of adolescent PCOS?

The phenotypic expression of this syndrome is heterogeneous but in most cases this syndrome commences with ordinary normal pubertal symptom like oligomenorrhea, obesity, persistent acne, hyperseborrhoea and occasionally with hirsutism. Rarely there may be only one finding like central adiposity, acanthosis nigricans, alopecia or even secondary amenorrhoea ¹⁵. The symptoms quoted above are often common accompaniment of normal adolescence and such trivial symptoms are becoming more common as nutritional status of our adolescents is improving in our country too¹⁶.Karla P,   Bansal B, Nag P, Singh JK, Gupta RK, Kumar S et al . Abdominal fat distribution and insulin resistance in Indian women with polycystic ovary syndrome. Steril 2009; 91:1437-40

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Is it possible to predict occurrence of full-blown PCOS in early adolescence?

The problem is that the transition from normal pubertal changes to normal healthy adult or to a full-blown PCOS is an illdefined and slow process .Though in majority adolescents such trivial symptoms disappear within 1-2 years but in some symptoms will worsen giving rise to full- blown PCOS. It is difficult for clinicians to forecast which girls are going to finally develop PCOS by couple of years and also difficult to predict the magnitude of ill effects through associated hyperinsulinaemia and or hyperandrogeniaemia. Many scientists however believe that obesity, and or laboratory evidence of frank insulin resistance predispose to development of full- blown PCOS¹⁷.

 Criteria of adult PCOS are well defined but what are the diagnostic criteria of adolescent PCOS?

The etiology of otherwise normal metabolic-hormonal complexity of adolescent girls is partly understood. But why in some girls such physiological abnormality persists giving rise to full- blown PCOS is not known. As stated, till date there is no international consensus on definition of adolescent PCOS! Even there is lack of unanimously agreed standard screening protocol and tests to confirm PCOS in adolescent girls. Put in such a situation many clinicians wrongly apply diagnostic criteria designed for adult women to adolescent girls.  Adopting such a policy, author is afraid, that many otherwise healthy adolescent girls are being and will continue to be falsely leveled as PCOS.

 However on realizing this some experts and international academic bodies recently have come forward to settle the issue of diagnostic criteria of adolescent PCOS. For instance Prof. Dr. Charles Sultan of Montpellier¹⁸, France, who by profession is a pediatric endocrinologist and his colleague, suggested that to qualify for adolescent PCOS there should be presence of at least four of the following five criteria. These are 1) clinical hyperandrogenism 2) biological hyperandrogenemia, 2) insulin resistance and hyperinsulinaemia, 4) oligomenorrhea persisting for 2 years postmenarche and 5) polycystic ovaries on ultrasound. If we accept the definition proposed above then it is understandable that one has to rely heavily on estimation of different hormones to substantiate the diagnosis of adolescent PCOS which is not a very common practice in our country. Instead, till date more reliance is usually paid on sonography in diagnosing PCOS both in adolescent and adult population.

 Another group of investigators, Carmina et al ¹⁷ have defined adolescent PCOS in some other way. They are of opinion that any adolescent having all the three and not just two features of Rotterdam Criteria (2003) should be primarily leveled as adolescent PCO and thereafter followed up regularly.  Lifestyle modifications and dietary alterations should be instituted immediately because there is a growing bodies of evidence that metabolic syndrome which commonly associated with these conditions can be reversed. de Ferranti SD. Recovery from metabolic syndrome is both possible and beneficial .Clin Chem, 2010, 56(7)1053-55 ^19.