PRECOCIOUS SIGNS OF POLYCYSTIC OVARIES IN OBESE GIRLS

As several studies have reported that 35% of patients with polycystic ovary syndrome are obese and that this syndrome seems to originate dur ing the early phase of sexual maturation, we undertook a study of such subjects. We studied ultrasound and hormonal findings in 49 obese gir ls aged from 7.9 to 19.10 years, with a mean excess weight of 44%; 23 premenarcheal girls and 26 postmenarcheal girls with mean gynecologica l age of 2.5 years. As controls, we studied 18 girls in the pubertal p hase and 17 healthy girls with regular menses, matched for age and gyn ecological age. Pelvic ultrasonography was carried out in all girls an d estrone, estradiol, progesterone, prolactin, follicle stimulating ho rmone, luteinizing hormone, sex hormone binding globulin (SHBG), testo sterone, free testosterone, dehydroepiandrosterone (DHEA), dehydroepia ndrosterone sulfate (DHEA-S), androstenedione and 17-hydroxyprogestero ne (17-OHP) were measured by radioimmunoassay in 11 of the 18 postmena rcheal girls. Five girls (10.2%) with excess weight of > 40% presented with mild or severe hirsutism based on Ferriman and Gallway scores; s ix (12.2%) presented with acne and 14 (28.5%) presented with acanthosi s nigricans. Hormonal evaluation showed elevated levels of estrone (p < 0.005) and testosterone (p < 0.01) but lower than normal levels of S HBG (p < 0.05) and estradiol (p < 0.05). On the basis of our results, 23% of the postmenarcheal obese subjects showed clinical, hormonal and ultrasonographic signs of polycystic ovaries, and 23% of postmenarche al obese girls showed multifollicular ovaries. Six of these, at 1 year after menarche, showed a uterine cross-sectional area larger than nor mal for gynecological age (21.92 +/- 5.64 cm2 VS. 16.36 +/- 2.34 cm2). Further serial echographic studies and a careful follow-up will demon strate if both multifollicular ovaries and increased uterine cross-sec tional area in obese girls are precocious signs of polycystic ovaries.