Jussi Tennilä1, Jarmo Jääskeläinen1, Pauliina Utriainen2,3, Raimo Voutilainen1, Merja Häkkinen4, Seppo Auriola4, Laure Morin-Papunen5,6, Jani Liimatta1. 1. Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland. 2. Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland. 3. Pediatric Research Center, Children's Hospital, Helsinki University Hospital, Helsinki, Finland. 4. School of Pharmacy, University of Eastern Finland, Kuopio, Finland. 5. Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland. 6. Medical Research Center and PEDEGO Research Unit, University of Oulu, Oulu, Finland.
Abstract
CONTEXT: Premature adrenarche (PA) may increase the risk for polycystic ovary syndrome (PCOS). OBJECTIVE: To study features of PCOS in young adult women with a history of PA. DESIGN AND PARTICIPANTS: Thirty PA and forty-two control females were followed from prepuberty to young adulthood (median age 18.1 years). MAIN OUTCOME MEASURES: Ovarian function, the use of contraceptives, and clinical and biochemical indicators of hyperandrogenism. RESULTS: We found no differences in the use of hormonal contraceptives (50 vs 50%, PA vs controls, respectively; P > .999), indication for using contraceptives (P = .193), or in the history of oligo- (17 vs 26%, P = .392) and amenorrhea (0 vs 0%, P > .999). Among women not using hormonal contraceptives, those with a history of PA had a higher prevalence of hirsutism (27 vs 0%, P = .023) but not acne (87 vs 67%, P = .252). Steroid profiles were broadly comparable between the groups, but PA women had lower sex hormone-binding globulin (SHBG) concentrations (30.1 vs 62.4 nmol/l, P < .001) resulting in higher free androgen index (3.94 vs 2.14, P < .001). The difference in SHBG levels persisted through BMI adjustment. SHBG correlated negatively with HOMA-IR (r -0.498, P = .003). Anti-Mullerian hormone concentrations were comparable between the groups (39.3 vs. 32.1 pmol/l, P = .619). CONCLUSIONS: PA was not associated with evident ovarian dysfunction in young adult women. However, women with a history of PA had decreased SHBG levels and thus, increased bioavailability of circulating androgens.
CONTEXT: Premature adrenarche (PA) may increase the risk for polycystic ovary syndrome (PCOS). OBJECTIVE: To study features of PCOS in young adult women with a history of PA. DESIGN AND PARTICIPANTS: Thirty PA and forty-two control females were followed from prepuberty to young adulthood (median age 18.1 years). MAIN OUTCOME MEASURES: Ovarian function, the use of contraceptives, and clinical and biochemical indicators of hyperandrogenism. RESULTS: We found no differences in the use of hormonal contraceptives (50 vs 50%, PA vs controls, respectively; P > .999), indication for using contraceptives (P = .193), or in the history of oligo- (17 vs 26%, P = .392) and amenorrhea (0 vs 0%, P > .999). Among women not using hormonal contraceptives, those with a history of PA had a higher prevalence of hirsutism (27 vs 0%, P = .023) but not acne (87 vs 67%, P = .252). Steroid profiles were broadly comparable between the groups, but PAwomen had lower sex hormone-binding globulin (SHBG) concentrations (30.1 vs 62.4 nmol/l, P < .001) resulting in higher free androgen index (3.94 vs 2.14, P < .001). The difference in SHBG levels persisted through BMI adjustment. SHBG correlated negatively with HOMA-IR (r -0.498, P = .003). Anti-Mullerian hormone concentrations were comparable between the groups (39.3 vs. 32.1 pmol/l, P = .619). CONCLUSIONS:PA was not associated with evident ovarian dysfunction in young adult women. However, women with a history of PA had decreased SHBG levels and thus, increased bioavailability of circulating androgens.