The relationship between ovarian structure and hyperandrogenism in premature pubarche

The aim of this study was to describe the ovarian structure (OS) and its re lationship with hyperandrogenism in girls with premature pubarche (PP). A p elvic ultrasound was carried out in 23 girls with PP and in 57 prepubertal age-matched controls (C), and the OS was subdivided into five classes (c): 1-homogeneous; 2-microcystic, 3-multicystic, 4-polycystic and 5-follicular. In the girls with PP, an ACTH test was performed, and the presence of horm onal levels >3 SD of postpubertal normal levels and not compatible with lat e-onset congenital adrenal hyperplasia were considered an exaggerated respo nse. The fasting levels of glucose (G) and insulin (I) were measured and th e fasting I to G ratio (FIGR) was calculated. FIGR >22 was suggestive of I resistance (IR). The microcystic structure (c2) was more frequently found i n the PP than in the C group (63% vs 35%, p=0.03). In the PP group, we obse rved the following OS: cl (n=6), c2 (n=15), c3 (n=1) and c4 (n=1). 11-Deoxy cortisol - both basal and after ACTH was greater in the PPc2 group than in PPc1 (p=0.04, p=0.0008, respectively). We also observed an exaggerated resp onse to ACTH in 87% of the girls with PP, greater in the PPc2 group than in PPc1 (p=0.04). The FIGR showed IR in 44% of girls with PP, but I levels an d FIGR were similar between PPc1 and PPc2. These findings suggest generaliz ed adrenocortical hyperresponsiveness in girls with PP, which is more accen tuated in PPc2. Long-term follow-up of girls with PP into adulthood is warr anted to ascertain whether microcystic ovarian structure precedes functiona l ovarian hyperandrogenism.