Normal Pubertal Development in Daughters of Women With PCOS: A Controlled Study

Abstract

Context: Daughters of women with polycystic ovary syndrome (PCOS) are thought to be at increased risk for developing stigmata of the syndrome, but the ontogeny during puberty is uncertain.

Objective: We phenotyped daughters (n = 76) of mothers with PCOS and daughters (n = 80) from control mothers for reproductive and metabolic parameters characteristic of PCOS.

Design, setting, and participants: We performed a matched case/control study at Penn State Hershey Medical Center that included non-Hispanic, white girls 4 to 17 years old.

Intervention: We obtained birth history, biometric, ovarian ultrasounds, whole-body dual-energy X-ray absorptiometry scan for body composition, 2-hour glucose challenged salivary insulin levels, and two timed urinary collections (12 hours overnight and 3 hours in the morning) for gonadotropins and sex steroids.

Main outcome measures: We measured integrated urinary levels of adrenal (dehydroepiandrosterone sulfate) and ovarian [testosterone (TT)] steroids. Other endpoints included integrated salivary insulin levels and urinary luteinizing hormone levels.

Results: There were no differences in detection rates or mean levels for gonadotropins and sex steroids in timed urinary collections between PCOS daughters and control daughters, nor were there differences in integrated salivary insulin levels. Results showed that 69% of Tanner 4/5 PCOS daughters vs 31% of control daughters had hirsutism defined as a Ferriman-Gallwey score >8 (P = 0.04). There were no differences in body composition as determined by dual-energy X-ray absorptiometry between groups in the three major body contents (i.e., bone, lean body mass, and fat) or in ovarian volume between groups.

Conclusions: Matched for pubertal stage, PCOS daughters have similar levels of urinary androgens and gonadotropins as well as glucose-challenged salivary insulin levels.

Figure 1.

Results from overnight (12-h) and morning (3-h) timed urinary gonadotropin collections by diagnosis (C, daughter of control mother; P, PCOS mother), number of subjects per group (directly under the diagnosis), and percentage of detectable hormone and Tanner stage. No significant differences between groups in median levels (▪) by Tanner stage were noted.

Figure 2.

Results from overnight (12-h) urinary collections for unconjugated sex steroids by diagnosis (C, daughter of control mother; P, PCOS mother), number of subjects per group (directly under the diagnosis), and percentage of detectable hormone and Tanner stage. No significant differences between groups in median levels (▪) by Tanner stage were noted.

Figure 3.

Results from overnight (12-h) urinary collections for conjugated sex steroids by diagnosis (C, daughter of control mother; P, PCOS mother), number of subjects per group (directly under the diagnosis), and percentage of detectable hormone and Tanner stage. No significant differences between groups in median levels (▪) by Tanner stage were noted.

Figure 4.

Results of salivary insulin levels from 2-h oral glucose tolerance test by diagnosis [daughter of PCOS mother (PCOS) or daughter of control mother (Control)] by Tanner stage. There were no significant differences by time point or in area-under-the-curve values between groups for any Tanner stage.