Home Medicine Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome
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Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome

  • Markella Nezi , Panagiotis Christopoulos , George Paltoglou ORCID logo , Alexandros Gryparis , Vassilios Bakoulas , Efthimios Deligeoroglou , George Creatsas and George Mastorakos EMAIL logo
Published/Copyright: April 18, 2016
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 29 Issue 6

Abstract

Background: Primary amenorrhea, oligomenorrhea and secondary amenorrhea are diagnosed commonly during adolescence. Weight aberrations are associated with menstrual disorders. Autoimmune thyroiditis is frequent during adolescence. In this study, the commonest clinical and hormonal characteristics of amenorrhea or oligomenorrhea during adolescence were investigated.

Methods: In this cross-sectional study, one hundred and thirty-eight consecutive young patients presenting with amenorrhea or oligomenorrhea referred to an adolescent endocrinology and gynecology university clinic were studied. Clinical examination and an abdominal ultrasound were performed. Testosterone, free-testosterone, estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, sex hormone binding globulin (SHBG), Δ4-androstenedione (Δ4A), free androgen index (FAI), insulin, glucose, thyroid stimulating hormone (TSH), total thyroxine (T4) (TT4), free T4 (FT4), total triiodothyronine (T3) (TT3) and free T3 (FT3). Concentrations were measured in blood samples.

Results: Patients with primary and secondary amenorrhea presented more often with body mass index (BMI) <18.5 and BMI >25 kg/m2, respectively. BMI values correlated positively with insulin (r=0.742) and glucose (r=0.552) concentrations and negatively with glucose/insulin ratio values (r=–0.54); BMI values and insulin concentrations correlated positively with FAI values (r=0.629 and r=0.399, respectively). In all patients, BMI values correlated positively and negatively with free testosterone (r=0.249) and SHBG (r=–0.24) concentrations, respectively. In patients with secondary amenorrhea insulin concentrations correlated negatively with SHBG concentrations (r=–0.75). In patients with oligomenorrhea BMI values correlated positively with insulin (r=0.490) and TSH (r=0.325) concentrations, and negatively with SHBG (r=–0.33) concentrations. Seventy-two percent, 21% and 7% of patients presented with TSH concentrations <2.5 μIU/mL, between 2.5 μIU/mL, 4.5 μIU/mL and >4.5 μIU/mL (subclinical hypothyroidism), respectively. Following the definition of polycystic ovary syndrome (PCOS) according to either the National Institutes of Health (NIH) criteria or those proposed in the literature by Carmina and his team, patients presented mainly with oligomenorrhea or secondary amenorrhea. There was good agreement between patients with amenorrhea or oligomenorrhea fulfilling both of the PCOS definition criteria employed.

Conclusions: Among adolescent patients presenting with amenorrhea or oligomenorrhea for the first time those with low and high BMI present more often with primary and secondary amenorrhea, respectively. Obesity is involved in the development of hyperandrogenemia and hyperinsulinemia, particularly in PCOS patients. In these patients, subclinical hypothyroidism may be concealed and it should be investigated. These patients should be treated for abnormally increased or decreased BMI and be investigated for autoimmune thyroiditis.

Keywords: adolescence; amenorrhea; BMI; hypothyroidism; oligomenorrhea; polycystic ovary syndrome

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Received: 2015-8-5
Accepted: 2016-2-9
Published Online: 2016-4-18
Published in Print: 2016-6-1

©2016 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Medullary thyroid carcinoma: a review on ethical considerations in treatment of children
  4. Original Articles
  5. Monocyte chemoattractant protein 1 and macrophage migration inhibitory factor in children with type 1 diabetes
  6. Organ-specific autoimmunity in relation to clinical characteristics in children with long-lasting type 1 diabetes
  7. Seasonality of diagnosis of type 1 diabetes mellitus in the Netherlands (Young Dudes-2)
  8. Health-related quality of life in children and adolescents with type 1 diabetes mellitus from Montenegro: relationship to metabolic control
  9. Relation of fetuin A levels with cardiac, subcutaneous lipid accumulation and insulin resistance parameters in Turkish obese children
  10. Prooxidant-antioxidant balance in patients with phenylketonuria and its correlation to biochemical and hematological parameters
  11. Serum vaspin concentrations in girls with anorexia nervosa
  12. Effect of intramuscular cholecalciferol megadose in children with nutritional rickets
  13. Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome
  14. Absence of a relationship between thyroid hormones and vitamin D levels
  15. Parathyroid hormone-ionized calcium dynamics over the first year of life
  16. Biochemical markers of bone turnover in children with clinical bone fragility
  17. Adipocytokines and bone metabolism markers in relation to bone mineral values in early pubertal boys with different physical activity
  18. Bone mineral density in young Chilean patients with type 1 diabetes mellitus
  19. Case Reports
  20. A case of mature teratoma with a falsely high serum estradiol value measured with an immunoassay
  21. Leigh syndrome associated with a novel mutation in the COX15 gene
  22. More than one way to skin a thyroid. Managing pediatric hypothyroidism with weekly intramuscular levothyroxine
  23. First case report of rare congenital adrenal insufficiency caused by mutations in the CYP11A1 gene in the Czech Republic
  24. Arg924X homozygous mutation in insulin receptor gene in a Tunisian patient with Donohue syndrome
  25. Corrigendum
  26. Corrigendum to: Exposure to sunshine early in life prevented development of type 1 diabetes in Danish boys
https://doi.org/10.1515/jpem-2015-0312
Keywords for this article
adolescence; amenorrhea; BMI; hypothyroidism; oligomenorrhea; polycystic ovary syndrome

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Medullary thyroid carcinoma: a review on ethical considerations in treatment of children
  4. Original Articles
  5. Monocyte chemoattractant protein 1 and macrophage migration inhibitory factor in children with type 1 diabetes
  6. Organ-specific autoimmunity in relation to clinical characteristics in children with long-lasting type 1 diabetes
  7. Seasonality of diagnosis of type 1 diabetes mellitus in the Netherlands (Young Dudes-2)
  8. Health-related quality of life in children and adolescents with type 1 diabetes mellitus from Montenegro: relationship to metabolic control
  9. Relation of fetuin A levels with cardiac, subcutaneous lipid accumulation and insulin resistance parameters in Turkish obese children
  10. Prooxidant-antioxidant balance in patients with phenylketonuria and its correlation to biochemical and hematological parameters
  11. Serum vaspin concentrations in girls with anorexia nervosa
  12. Effect of intramuscular cholecalciferol megadose in children with nutritional rickets
  13. Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome
  14. Absence of a relationship between thyroid hormones and vitamin D levels
  15. Parathyroid hormone-ionized calcium dynamics over the first year of life
  16. Biochemical markers of bone turnover in children with clinical bone fragility
  17. Adipocytokines and bone metabolism markers in relation to bone mineral values in early pubertal boys with different physical activity
  18. Bone mineral density in young Chilean patients with type 1 diabetes mellitus
  19. Case Reports
  20. A case of mature teratoma with a falsely high serum estradiol value measured with an immunoassay
  21. Leigh syndrome associated with a novel mutation in the COX15 gene
  22. More than one way to skin a thyroid. Managing pediatric hypothyroidism with weekly intramuscular levothyroxine
  23. First case report of rare congenital adrenal insufficiency caused by mutations in the CYP11A1 gene in the Czech Republic
  24. Arg924X homozygous mutation in insulin receptor gene in a Tunisian patient with Donohue syndrome
  25. Corrigendum
  26. Corrigendum to: Exposure to sunshine early in life prevented development of type 1 diabetes in Danish boys
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