ODP416 Increased Ovarian Volume in Young Girls: A Marker of Impending Hyperandrogenism or Normal Variant?

Ovarian volume increases with age in childhood with reported volumes from 0.6 cm 3 in neonates to approximately 6 cm 3 by 12 years old. There are no precise normal ranges defined based on age or Tanner stage in childhood; therefore, interpretation of ovarian volume can be challenging. The surgical and medical implications of ovarian enlargement are important as it can help predict ovarian torsion. It has been reported that a higher ovarian volume ratio (OVR) (ratio of larger to contralateral ovary) may be a strong predictor of ovarian torsion. A study evaluating premenarchal girls 3-14 years old showed OVR of 7.6 Vs 1.4 in those with and without torsion respectively. There is also an association between current or eventual development of hyperandrogenism and enlarged ovaries in adolescents. Seven girls, five to nine years old presented for care between 2013 and 2021 with at least one ovary large for pubertal status (volume ranging from 6 to 38 mL). Of these, 6 had bilateral enlargement. Presentation was for abdominal pain from ovarian torsion (5/7) or concerns for early puberty (2/7). Family history of PCOS was positive in 4/7. All girls were prepubertal or in early puberty (Tanner stage I-II for breast and pubic hair). All had normal body mass indices (BMI), none had reported hirsutism, acne or stigmata of Mc-Cune Albright syndrome. Pelvic ultrasound revealed large ovaries without discrete ovarian cysts or masses, 2/7 had decreased blood flow with one of these having heterogeneity related to prior torsion. Thyroid function tests, prolactin, gonadotropins, androgen levels and tumor markers were normal when measured. Bone age was checked and normal in five cases. Follow up ranged from 0-8 years, none required pubertal suppression for progressive precocious puberty. One case was diagnosed with PCOS at age 17 years after an initial presentation of ovarian torsion. PCOS is associated with oligo/anovulation and a risk for development of metabolic syndrome. Earlier detection of PCOS, particularly in the early pubertal age group may alter the trajectory of the complications with close monitoring potentially decreasing eventual metabolic risks. Since PCOS is associated with larger ovarian volumes (>10mL in the adolescent population), detection of this enlargement in early puberty may portend later development of PCOS. It is also conceivable that premenarchal girls presenting with ovarian enlargement may signify a specific hyperandrogenic phenotype. While it is possible that larger ovarian volumes are variants of normal, larger retrospective studies and ideally, prospective, long term follow up investigations are required to determine a relationship between them and eventual hyperandrogenic and metabolic phenotypes. Presentation: No date and time listed