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Adrenal hypoandrogenism in adolescents with premature ovarian insufficiency

  • Meliha Esra Bilici ORCID logo EMAIL logo , Zeynep Şıklar ORCID logo , Semra Çetinkaya ORCID logo , Elif Özsu ORCID logo , Zehra Aycan ORCID logo and Merih Berberoğlu ORCID logo
Published/Copyright: January 10, 2025
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 3

Abstract

Objectives

Premature ovarian insufficiency (POI) affects 1 in 10,000 children, with its molecular causes largely unknown. Adult studies suggest that low androgen levels induce ovarian insufficiency, but data on about this in children is limited. This study aims to assess the prevalence of low androgen levels in childhood POI and its relationship with adrenal insufficiency.

Methods

Idiopathic POI adolescents were categorized into two groups based on DHEAS and total testosterone (TT) measured by chemiluminescence. Low androgen group (LAG) was defined using cut-offs according to Tanner pubarche staging. Demographic, clinical, and laboratory data were compared. Morning cortisol <7 μg/dL and/or ACTH >96 or <5 pg/mL were planned to undergo ACTH stimulation testing, with a peak cortisol response <18 μg/dL considered insufficient.

Results

Forty-three adolescents, mean age 15.5 ± 1.3 years with a 46, XX karyotype, normal FMR1 mutation, FSH levels >40 mIU/mL, and low AMH levels were included. In 14 cases (37.8 %), DHEAS and TT were low. In the LAG, pubarche was absent in seven patients, and initial height SDS was significantly lower. Morning cortisol ranged from 7.9 to 23.5 μg/dL, with an ACTH of 29.4 ± 9.7 pg/mL. No differences in adrenal steroids or correlations between DHEAS and ACTH were observed.

Conclusions

Diminished androgen levels are prevalent in children with idiopathic POI. The potential for this condition to increase the risk of adrenal insufficiency and its impact on secondary ovarian insufficiency remains unclear. This study, the first of its kind in children, underscores the potential role of genetic factors in zona reticularis and ovarian development.

Keywords: hypoandrogenism; low DHEAS; adrenal insufficiency; premature ovarian insufficiency
Corresponding author: Meliha Esra Bilici, MD, Bülent Ecevit University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, 67630 Zonguldak, Türkiye, E-mail:

  1. Research ethics: The local Institutional Review Board deemed the study exempt from review.

  2. Informed consent: Not applicable.

  3. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: Not applicable.

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Received: 2024-08-29
Accepted: 2024-11-14
Published Online: 2025-01-10
Published in Print: 2025-03-26

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2024-0415
Keywords for this article
hypoandrogenism; low DHEAS; adrenal insufficiency; premature ovarian insufficiency

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Thyroid surgery in pediatric age: a 10-year experience at a single center and literature review
  4. Differentiated thyroid cancer in adolescents – does extent of disease at presentation differ with age?
  5. Evaluation of iodine and selenium level and thyroid functions in patients with cystic fibrosis
  6. Interpreting positive celiac serology in children with new-onset type 1 diabetes
  7. Elastographic evaluation for fatty liver disease in north Indian children and adolescents with type 1 diabetes
  8. Diagnostic value of fasting insulin and insulin-like growth factor-1 levels in girls with central precocious puberty
  9. Clinical outcomes of switching to lonapegsomatropin from somatropin for treatment of pediatric growth hormone deficiency
  10. Development of a disease diagnostic model to predict the occurrence of central precocious puberty of female
  11. Adrenal hypoandrogenism in adolescents with premature ovarian insufficiency
  12. The clinical presentation and genetic diagnosis of Tangier disease in the pediatric age group
  13. Clinical and genetic diagnosis of first cohort of differences of sexual development in the Iranian population
  14. Short Communication
  15. Effect of a GnRH injection on kisspeptin levels in girls with suspected precocious puberty: a randomized-controlled pilot study
  16. Case Reports
  17. Coexistence of phenylketonuria and tyrosinemia type 3: challenges in the dietary management
  18. Acrodermatitis dysmetabolica: lessons from two pediatric cases
  19. Dramatic response to Evinacumab in a North Indian girl with homozygous familial hypercholesterolemia
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