Cargando…

SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers

Background Primary ovarian insufficiency (POI) is characterized by ovarian dysfunction resulting in premature cessation of menses. Excluding patients with gonadal dysgenesis, it is estimated that only 0.01% of adolescents will experience POI. After thorough evaluation, the underlying cause remains e...

Descripción completa

Detalles Bibliográficos
Autores principales: Hoyos-Martinez, Alfonso, Hoyos, Luis R., Comkornruecha, Metee, Diaz, Alejandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Endocrine Society 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553169/
http://dx.doi.org/10.1210/js.2019-SUN-243
_version_ 1783424756618362880
author Hoyos-Martinez, Alfonso
Hoyos, Luis R.
Comkornruecha, Metee
Diaz, Alejandro
author_facet Hoyos-Martinez, Alfonso
Hoyos, Luis R.
Comkornruecha, Metee
Diaz, Alejandro
author_sort Hoyos-Martinez, Alfonso
collection PubMed
description Background Primary ovarian insufficiency (POI) is characterized by ovarian dysfunction resulting in premature cessation of menses. Excluding patients with gonadal dysgenesis, it is estimated that only 0.01% of adolescents will experience POI. After thorough evaluation, the underlying cause remains elusive in 85-90% of cases. Ovarian function in POI is variable, intermittent, and unpredictable. The lack of well-established criteria and low prevalence in adolescents make the diagnosis and management challenging. Methods Using diagnostic codes we identified all cases of ovarian insufficiency between 2012 and 2018 seen at a children’s hospital in South Florida. We reviewed all cases diagnosed with ovarian insufficiency and chose those meeting current adult diagnostic criteria for POI for further analysis. Patients with missing information, gonadal dysgenesis, eating disorders, gonadal surgeries and/or a history of oncological conditions, or exposure to gonado-toxic treatments, were excluded. We conducted chart reviews, and relevant clinical and diagnostic information was extracted. Results A total of 48 patients diagnosed with ovarian insufficiency were identified; only seven met inclusion criteria. Mean age of diagnosis was 15.5 and 15.2 years respectively for primary and secondary amenorrhea. Patients with POI were evaluated and treated by the pediatrician, endocrinologist, and/or adolescent medicine specialist. Anti-ovarian antibodies were evaluated in all cases, anti-thyroid antibodies in six of the patients, but only two patients were tested for the presence of anti-adrenal antibodies. Karyotype was obtained in all of them, while genetic evaluation of FMR1 gene was performed in two. Finally, only two patients received reproductive counseling or were referred to a fertility specialist. One of them was referred after she had a spontaneous pregnancy and voluntary interruption. Conclusions Anti-ovarian antibodies were always obtained despite their lack of clinical significance in POI. Anti-adrenal antibodies, which are a better diagnostic test, were not evaluated as often as expected. Genetic evaluation was mostly limited to karyotype. Evaluation for FMR-1 premutation may be helpful for the diagnosis and management of the patient, as well as other female relatives. Only two of the seven patients received reproductive counseling or were referred to reproductive medicine. This is a key part of the evaluation and management of POI, since an early and appropriate intervention may improve the chances of fertility preservation as well as promote reproductive health in the adolescent population. Better training in the evaluation and management of patients with POI is needed across pediatric providers that care for these patients.
format Online
Article
Text
id pubmed-6553169
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Endocrine Society
record_format MEDLINE/PubMed
spelling pubmed-65531692019-06-13 SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers Hoyos-Martinez, Alfonso Hoyos, Luis R. Comkornruecha, Metee Diaz, Alejandro J Endocr Soc Pediatric Endocrinology Background Primary ovarian insufficiency (POI) is characterized by ovarian dysfunction resulting in premature cessation of menses. Excluding patients with gonadal dysgenesis, it is estimated that only 0.01% of adolescents will experience POI. After thorough evaluation, the underlying cause remains elusive in 85-90% of cases. Ovarian function in POI is variable, intermittent, and unpredictable. The lack of well-established criteria and low prevalence in adolescents make the diagnosis and management challenging. Methods Using diagnostic codes we identified all cases of ovarian insufficiency between 2012 and 2018 seen at a children’s hospital in South Florida. We reviewed all cases diagnosed with ovarian insufficiency and chose those meeting current adult diagnostic criteria for POI for further analysis. Patients with missing information, gonadal dysgenesis, eating disorders, gonadal surgeries and/or a history of oncological conditions, or exposure to gonado-toxic treatments, were excluded. We conducted chart reviews, and relevant clinical and diagnostic information was extracted. Results A total of 48 patients diagnosed with ovarian insufficiency were identified; only seven met inclusion criteria. Mean age of diagnosis was 15.5 and 15.2 years respectively for primary and secondary amenorrhea. Patients with POI were evaluated and treated by the pediatrician, endocrinologist, and/or adolescent medicine specialist. Anti-ovarian antibodies were evaluated in all cases, anti-thyroid antibodies in six of the patients, but only two patients were tested for the presence of anti-adrenal antibodies. Karyotype was obtained in all of them, while genetic evaluation of FMR1 gene was performed in two. Finally, only two patients received reproductive counseling or were referred to a fertility specialist. One of them was referred after she had a spontaneous pregnancy and voluntary interruption. Conclusions Anti-ovarian antibodies were always obtained despite their lack of clinical significance in POI. Anti-adrenal antibodies, which are a better diagnostic test, were not evaluated as often as expected. Genetic evaluation was mostly limited to karyotype. Evaluation for FMR-1 premutation may be helpful for the diagnosis and management of the patient, as well as other female relatives. Only two of the seven patients received reproductive counseling or were referred to reproductive medicine. This is a key part of the evaluation and management of POI, since an early and appropriate intervention may improve the chances of fertility preservation as well as promote reproductive health in the adolescent population. Better training in the evaluation and management of patients with POI is needed across pediatric providers that care for these patients. Endocrine Society 2019-04-30 /pmc/articles/PMC6553169/ http://dx.doi.org/10.1210/js.2019-SUN-243 Text en Copyright © 2019 Endocrine Society https://creativecommons.org/licenses/by-nc-nd/4.0/ This article has been published under the terms of the Creative Commons Attribution Non-Commercial, No-Derivatives License (CC BY-NC-ND; https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Pediatric Endocrinology
Hoyos-Martinez, Alfonso
Hoyos, Luis R.
Comkornruecha, Metee
Diaz, Alejandro
SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers
title SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers
title_full SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers
title_fullStr SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers
title_full_unstemmed SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers
title_short SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers
title_sort sun-243 evaluation of primary ovarian insufficiency in adolescents is a challenge for pediatric providers
topic Pediatric Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553169/
http://dx.doi.org/10.1210/js.2019-SUN-243
work_keys_str_mv AT hoyosmartinezalfonso sun243evaluationofprimaryovarianinsufficiencyinadolescentsisachallengeforpediatricproviders
AT hoyosluisr sun243evaluationofprimaryovarianinsufficiencyinadolescentsisachallengeforpediatricproviders
AT comkornruechametee sun243evaluationofprimaryovarianinsufficiencyinadolescentsisachallengeforpediatricproviders
AT diazalejandro sun243evaluationofprimaryovarianinsufficiencyinadolescentsisachallengeforpediatricproviders