Prevalence of Cardiometabolic Abnormalities in a Clinical Sample of Young Women With Polycystic Ovary Syndrome

Polycystic ovarian syndrome (PCOS) affects 6-8% of reproductive-aged women and is associated with significant cardiometabolic morbidity in adulthood, including dyslipidemia, hypertension, and diabetes. Optimal methods of identification and treatment of adolescent PCOS and its associated comorbidities are still debated, and thus are highly amenable to quality improvement via a Standardized Clinical Assessment and Management Plan (SCAMP). Using a PCOS SCAMP. we sought to elucidate which testing for metabolic abnormalities should be performed during adolescence. From June 2012 to June 2016, we screened 249 females ages 11-25 years who presented to an outpatient adolescent and young adult practice with irregular menses, hirsutism, or hyperandrogenism for SCAMP participation. Clinicians collected data on medical history, physical exam findings, and laboratory results. Diagnostic tests were ordered based upon evidence-based or consensus-based algorithms developed for the SCAMP; providers noted where they deviated from SCAMP recommendations due to clinical judgment or patient preference. Forty-four patients (18%) were overweight and 96 (39%) were obese. Sixty-two percent had acne. 56% had hirsuitism, and 27% had acanthosis nigricans. Laboratory data were available for 183 patients (74% of those screened). Ten percent (n = 24) had impaired glucose tolerance (IGT). defined as a fasting plasma glucose level > 100 mg/dL, a 2-hour plasma glucose level >140 mg/ dl on an oral glucose tolerance test (OGTT). or a HbA1c >5.7%. Seventy-five percent (18 of 24) of those diagnosed with IGT met criteria due to an abnormal HbA1c, while 42% (10 of 24) met criteria due to an abnormality noted on OGTT. Nine (2%) patients were diagnosed with diabetes; the diagnosis for each patient was based on HbA1c >6.5%. Elevated fasting insulin concentrations (>12 U/mL) were present in 86% of those patients screened (83 of 96). Abnormalities on lipid panels were common, with 82% patients having low HDL-cholesterol (150mg/dL). Neither the presence of acanthosis nigricans on physical examination nor obesity was differentially associated with abnormal lipid results. Lipid abnormalities (especially low HDL cholesterol) are incredibly common in young women with PCOS, are not restricted to those with acanthosis nigricans or obesity, and likely reflect the insulin resistance common in this endocrine disorder. Impaired glucose tolerance is also prevalent even among adolescents with PCOS, and all cases a