Ibáñez L, de Zegher F, Potau N
Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain.
J Clin Endocrinol Metab. 1999 Aug;84(8):2691-5. doi: 10.1210/jcem.84.8.5883.
Adolescent girls with a history of precocious pubarche (PP) are known to be at increased risk for ovarian hyperandrogenism, an endocrinopathy related to reduced fetal growth, but the characteristics of their ovulatory function have not been fully documented. We assessed ovulatory function by weekly urinary LH and salivary progesterone measurements over 3 consecutive months in 85 adolescent girls with known weight and gestational age at birth: 49 girls had no history of PP (age, 14.7+/-1.7 yr), and 36 had a history of PP (age, 14.4+/-2.0 yr); 55 girls were in the early postmenarcheal phase (0-3 yr after menarche), and 30 were in the late postmenarcheal phase (> 3 yr after menarche). In girls with PP, the 17-hydroxyprogesterone (17-OHP) response to ACTH was determined at prepubertal diagnosis of PP, and serum androgen and gonadotropin concentrations were measured in adolescence together with insulin responses to an oral glucose load. Early postmenarche, the fraction of girls with ovulations was similar in the non-PP and PP subgroups (61% vs. 62%), as was the fraction of ovulatory cycles (25% vs. 22%). Late postmenarche, however, the fractions of ovulating girls and ovulatory cycles were strikingly higher (P < or = 0.001) in the non-PP than in the PP subgroup (91% vs. 20% and 47% vs. 12%). Within the PP subgroup, anovulatory girls were found to have a lower weight SD score at birth (mean+/-SEM) than ovulatory girls (-1.22+/-0.3 vs. -0.36+/-0.3; P = 0.03), a higher 17-OHP response to ACTH before puberty (333.1+/-31 vs. 203.8+/-26 ng/dL; P < 0.002), and, in adolescence, lower serum sex hormone-binding globulin levels and higher circulating LH, free androgen indexes, and insulin responses. In conclusion, these findings indicate that girls with PP are at increased risk for anovulation from late (not early) adolescence onward, particularly those girls with a low weight at birth and/or a high 17-OHP response to ACTH at prepubertal diagnosis of PP.
已知有青春期阴毛早现（PP）病史的青春期女孩患卵巢高雄激素血症的风险增加，这是一种与胎儿生长受限相关的内分泌病，但其排卵功能特征尚未得到充分记录。我们对85名已知出生体重和胎龄的青春期女孩连续3个月每周测量尿促黄体生成素（LH）和唾液孕酮，以评估排卵功能：49名女孩无PP病史（年龄14.7±1.7岁），36名有PP病史（年龄14.4±2.0岁）；55名女孩处于初潮后早期（初潮后0 - 3年），30名处于初潮后晚期（初潮后>3年）。在有PP病史的女孩中，在青春期前诊断PP时测定促肾上腺皮质激素（ACTH）刺激后的17 - 羟孕酮（17 - OHP）反应，并在青春期测量血清雄激素、促性腺激素浓度以及口服葡萄糖负荷后的胰岛素反应。初潮后早期，无PP和有PP亚组中排卵女孩的比例相似（61%对62%），排卵周期的比例也相似（25%对22%）。然而，初潮后晚期，无PP亚组中排卵女孩和排卵周期的比例显著高于有PP亚组（P≤0.001）（91%对20%以及47%对12%）。在有PP病史的亚组中，无排卵女孩出生时的体重标准差评分低于有排卵女孩（平均值±标准误，-1.22±0.3对-0.36±0.3；P = 0.03），青春期前对ACTH刺激的17 - OHP反应更高（333.1±31对203.8±26 ng/dL；P<0.002），且在青春期血清性激素结合球蛋白水平更低，循环LH、游离雄激素指数及胰岛素反应更高。总之，这些发现表明，有PP病史的女孩从青春期晚期（而非早期）开始无排卵风险增加，尤其是那些出生体重低和/或青春期前诊断PP时对ACTH刺激的17 - OHP反应高的女孩。
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