| Section 1Objective To investigate the menstruation state,the level of follicle stimulating hormone(FSH),luteininzinghormone(LH),chotisol(C) and dehydro-epiandrosterone sulfate(DHEA-S) in the adolescent girls,and determine the physiological ceiling value of LH,LH/FSH ratio and DHEA-S. Methods We performed a study of 325 adolescent middle school girls with normal menstruation.We knew the menstruation state according to a questionnaire.Then tested the measurement of serum levels of C,FSH,LH, DHEA-S and calculated LH/FSH ratio.We analyzed how the parameters changed along with the age and conputed the physiological ceiling value of LH,LH/FSH ratio and DHEA-S as the 95th percentile of the normal adolescent girls. Results It would take 2 years for almost 95%of the normal adolescent girls to establish a regular menstruation after menarche,while 100%of the normal girls have their regular menstruation within 5 years after menarche.The physiological ceiling value of the main parameters(aged 15-18 years):LH is 16.1IU/L;LH/FSH ratio is 1.54;DHEA-S is 407μg/dl.Conclusion It is suitable for adolescent girls using the limit of 2 years to screen the menstruation states.The diagnosis for disturbance of reproductive endocrinology should be according to the physiological ceiling values of the main parameters.Section 2Objective To investigate and analyze the clinical presentation,hormonal profile,and metabolic abnormalities of adolescent girls with polycystic ovary syndrome(PCOS).Methods The data of the anthropometric measurements,clinical manifestations of hyperandrogenism,serum levels of luteininzing hormone(LH),follicle stimulating hormone(FSH), testosterone(T),prolactin(PRL),dehydro-epiandrosterone sulfate (DHEA-S),sex-hormone-binding globulin(SHBG),17-oxyhydroprogesterone (17-OHP),fasting plasma glucose(FPG) and fasting insulin(FINS) detected after oral glucose tolerance test(OGTT),serum lipid levels, including total cholesterol(Chol),triglycerides(TG),high-density lipoprotein(HDL),and low-density lipoprotein(LDL),fasting plasma insulin(FINS) and homeostasis model assessment(HOMA) so as to assess the insulin resistance(IR),serum testosterone(T) and free androgen index(FAI) to estimate the extent of hyperandrogenism,were collected from 167 adolescent women with PCOS,aged 17±2,that were divided into 2 groups according to the body mass index(BMI) and waist-to-hip ratio(WHR):Group OBPCOS(n=90) with the BMI≥25 kg·m-2 or the WHR≥0.85 and Group NOBPCOS (n=77) with the BMI＜25 kg·m-2 and the WHR＜0.85,and 395 age-matched women with regular menstruation served as controls that were divided into 2 groups as well:Group OBCON(n=18) with the BMI≥25 kg·m-2 or the WHR≥0.85;and Group NOBCON(n=307) with the BMI＜25 kg·m-2 and the WHR＜0.85,and underwent a cross-sectional study.Results(1) Clinical phenotype:Adolescent girls with PCOS had precocious menarche compaired with the controls.84.85%of them could not establish a regular menstruation within 2 years after menarche.The presence of obesity was 53.89%(90/167) of which 57.78%(52/90) was central obesity,showed increased frequency of obesity compared with the controls(5.54%,18/325).The incidence of acanthosis nigricans was 26.95%(45/167),44.44%in Group OBPCOS and 6.49% in Group NOBPCOS(P＜0.001).Group OBPCOS showed increased frequency of acanthosis nigricans compared with Group NOBPCOS.(2) Hormonal profile:The LH/FSHratio of the patients was 1.89±0.99,significantly higher than that of the controls(0.70±0.64)(P＜0.01).The LH/FSH ratio of Group NOBPCOS (2.11±1.09) was significantly higher than that of Group OBPCOS(1.69±0.85)(P＜0.01).T and DHEA-S level were higher in Group OBPCOS and Group NOBPCOS than in Group OBCON and Group NOBCON(both P＜0.01).SHBG was lower in Group A and Group C compared with Group B and Group D(both P＜0.01). FAI level was 8.20±8.24 in Group OBPCOS,significantly higher than those of Groups NOBPCOS(5.27±5.96),OBCON(4.02±4.63),and NOBCON(1.63±1.31)(all P＜0.05).(3) Metabolic profile:The prevalence of pathological IR was 29.94%(50/167),significantly higher than that of the controls(6.77%,22/325,P＜0.001),with a higher prevalence rate in Group OBPCOS(45.56%,41/90) compared with Group NOBPCOS(11.69%,9/77)(P＜0.001).The FINS and HOMA-IR of the patients were significantly higher than those of the controls,and those of Groups OBPCOS and OBCON were both significantly higher than those of Groups NOBPCOS and NOBCON(all P＜0.01). The TG of Group OBPCOS was significantly higher than that of Group NOBPCOS (P＜0.01).(4) The family histories of obesity,a]opecia seborrheica, diabetes mellitus and hypertension were associated with adolescent PCOS(all P≤0.001).BMI was an independent risk factor of both hyperandrogenism and insulin resistance.Conclusion Adolescent PCOS is featured by premature menophania,failure to establish regular menstruation with 2 years after menarche,increased prevalence of obesity,hyperandrogenism,pathological insulin resistence.Obese girls with PCOS have more severe hyperandrogenism and IR than normal-weight PCOS girls,which may have some health implications later in life.Section 3Objective To evaluate the effects of metformin treatment in the adolescent girls with PCOS,and the role of insulin on metformin's efficacy.Methods This was a retrospective study.The patient population was 42 adolesecnt girls with PCOS undertaking metformin for 1 year.They were divide into Group IR(n=29) and Group NIR(n=13) according to pathological IR. Menstrual disturbance,insulin metabolism,and reproductive endocrinic parameters were assessed before and at the end of a treatment period of 1 year.Results All the patients were suffering from anovulation before treatment.The ovulation failure was successfully improved in 76.19% (32/42) of the patients after 1 year's metformin,significantly higher than that before treatment,and there were no difference of ovulation rate between Group IR and Group NIR(P＞0.05).The body weight,body mass index, fasting insulin,HOMA-IR,area under the insulin-time curve,total testosterone,LH in both groups and free androgen index,LH/FSH ratio in Group IR were also improved(all P＜0.001).The retrieve of ovulation was negative correlated with fasting insulin and HOMA-IR(both P＜0.05).The free androgen index was negative correlated with fasting insulin(P＜0.05). Conclusion Metformin treatment improves ovulatory function,reproductive endocrinology and metabolic disorder in adolescent girls with PCOS.The recovery of ovulating is associated with the role of decreasing serum level of insulin.
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