22. Clinical and Biochemical Characteristics of Adolescent Females in the United States at Time of PCOS Diagnosis: Results from the CALICO multi-center database

Background

Adolescents with polycystic ovary syndrome (PCOS) are a heterogeneous population with variable phenotypes. We describe the clinical and biochemical characteristics of a regionally and racially diverse cohort of adolescents, at the time of PCOS diagnosis, in the United States.

Methods

These data derive from the retrospective Clinical Adolescent Polycystic Ovary (CALICO) Database, including data from 15 U.S. sites of adolescents diagnosed with PCOS per 2023 international guidelines. Data from the initial PCOS diagnostic encounter were included. Sample size differs with each variable due to documentation and clinical practice differences across sites. To harmonize differences in hormonal assays, these variables are reported as the percentage of the upper limit of normal (%ULN) for each assay. Data were divided by overweight/obesity status (BMI >85%ile). Continuous variables were compared using linear model ANOVA or t-tests and categorical variables were compared using Pearson's Chi-squared test.

Results

This cohort includes 839 youth from across the U.S. (34.1% from the Southeast, 25.7% from the Midwest, 21% from the West, 16.2% from the Northeast, and 3% from the Southwest) who were of diverse race/ethnicity (65.5% Caucasian, 20.4% Black, 34.5% Hispanic). The median age of menarche was 11.5 years (IQR, 11, 12.5) and median age of PCOS diagnosis was 15.3 years (IQR, 14.2, 16.4). Menstrual patterns included primary amenorrhea in 9.3%, < 21 days between periods in 5.0%, and >45 days between periods in 85.6% of individuals. Hirsutism severity was documented in 48.7% of encounters with 34.4% reporting no hirsutism and 8.3% reporting severe hirsutism. Facial acne severity was documented in 65.4% of encounters with 26.2% reporting mild acne and 6.6% reporting severe acne. Biochemical markers including free and total testosterone, DHEA-S, FSH and LH were assessed in >60% of encounters at time of diagnosis. When stratified by overweight/obese status, those with overweight/obesity had significantly higher free testosterone but lower SHBG, androstenedione and LH. There were no significant differences by weight status in total testosterone, DHEA-S, FSH or AMH (Table 1).

Conclusions

In this study, we characterize the presentation of adolescents at time of PCOS diagnosis in the U.S. with data collected from a geographically, ethnically and racially diverse cohort of individuals. Weight status significantly impacted the levels of some biochemical markers used in the diagnostic evaluation of PCOS.