Uçar Ahmet, Erol Oğuz Bulent, Yekeler Ensar, Yildiz Ismail, Bozlak Serdar, Saka Nurçin, Baş Firdevs, Poyrazoğlu Şükran, Bundak Rüveyde, Kubat Uzum Ayse, Gul Nurdan, Darendeliler Feyza
Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Clin Endocrinol (Oxf). 2014 May;80(5):699-705. doi: 10.1111/cen.12355. Epub 2013 Nov 18.
Precocious adrenarche (PA) refers to the clinical onset of excess androgen in girls before the age of 8. It is associated with an increased risk of functional ovarian hyperandrogenism after puberty. PA may be associated with polycystic ovary syndrome (PCOS). We compared pelvic ultrasound (US) findings of girls with PA born appropriate for gestational age (AGA) to healthy body mass index (BMI)-matched peers to determine whether US findings in AGA-born PA girls are associated with PCOS antecedents.
We conducted a cross-sectional study on 56 AGA-born girls with PA (6·9 ± 0·6 years) and 33 BMI-matched prepubertal AGA-born peers (7·1 ± 1·0 years). Hormonal data, homeostasis model assessment of insulin resistance (HOMA-IR), insulin sensitivity index (ISIcomp ) and pelvic US findings were compared. Associations of pelvic US findings with clinical and metabolic data were investigated.
Precocious adrenarche girls had greater height and bone age-adjusted uterine length (UL; P = 0·01) and UL standard deviation score (SDS) (P = 0·02) than BMI-matched peers. Mean ovarian volume (MOV), MOV SDS, uterine volume, uterine cross-sectional area and ovarian morphology were similar between the groups (P > 0·05). MOV and MOV SDS correlated with ISIcomp (r = -0·683, P < 0·001; r = -0·760, P < 0·001; respectively). Correlations of pelvic US findings with other biochemical data did not reach significance (P > 0·05). Multivariate regression analysis revealed that in girls with PA, ISIcomp had the most significant effect on MOV SDS (R(2) = 0·731, β = -4·784, P = 0·001).
Appropriate for gestational age-born PA girls have greater UL measurements than AGA-born BMI-matched peers. In AGA-born girls with PA, decreasing insulin sensitivity is strongly and independently associated with an increase in MOV. Longitudinal follow-up of our cohort after menarche will allow us to establish how many AGA-born girls with PA will ultimately develop PCOS.
性早熟型肾上腺初现（PA）是指8岁前女童出现雄激素过多的临床症状。它与青春期后功能性卵巢雄激素过多风险增加有关。PA可能与多囊卵巢综合征（PCOS）相关。我们比较了适于胎龄（AGA）出生的PA女童与健康的、体重指数（BMI）匹配的同龄女童的盆腔超声（US）检查结果，以确定AGA出生的PA女童的US检查结果是否与PCOS前期表现相关。
我们对56名AGA出生的PA女童（6.9±0.6岁）和33名BMI匹配的青春期前AGA出生的同龄女童（7.1±1.0岁）进行了一项横断面研究。比较了激素数据、胰岛素抵抗的稳态模型评估（HOMA-IR）、胰岛素敏感指数（ISIcomp）和盆腔US检查结果。研究了盆腔US检查结果与临床和代谢数据之间的关联。
性早熟型肾上腺初现女童的身高以及骨龄校正后的子宫长度（UL；P = 0.01）和UL标准差评分（SDS）（P = 0.02）均高于BMI匹配的同龄女童。两组之间的平均卵巢体积（MOV）、MOV SDS、子宫体积、子宫横截面积和卵巢形态相似（P > 0.05）。MOV和MOV SDS与ISIcomp相关（r = -0.683，P < 0.001；r = -0.760，P < 0.001）。盆腔US检查结果与其他生化数据之间的相关性未达到显著水平（P > 0.05）。多变量回归分析显示，在PA女童中，ISIcomp对MOV SDS的影响最为显著（R(2) = 0.731，β = -4.784，P = 0.001）。
适于胎龄出生的PA女童的UL测量值高于AGA出生的BMI匹配的同龄女童。在AGA出生的PA女童中，胰岛素敏感性降低与MOV增加密切且独立相关。对我们队列中月经初潮后的纵向随访将使我们能够确定有多少AGA出生的PA女童最终会发展为PCOS。
