Clinical and metabolic findings in adolescent females with hyperandrogenism

The purpose of this study was to characterize the population of adolescent females with laboratory evidence of hyperandrogenism and to explore clinical and laboratory features that may facilitate the diagnosis and management of this condition. We further investigated these characteristics by race, weight, and type of androgen abnormality.

A 4-year retrospective chart review was undertaken. Female patients were included if they attended Adolescent Medicine Clinic and had at least one abnormal laboratory parameter on a testing panel that included total and free testosterone, calculated percent free testosterone, and sex hormone binding globulin levels.

Our final sample included 154 females, 70% of whom were white, 28% African-American and 2% of other ethnicities. The mean age was 16.1 years (range 11-23). The mean body mass index (BMI) was 30.4, ranging from 16.6 to 45.0, and 78% were obese (BMI>95th percentile for age). Initial reason for visit included irregular menses in 75.3%, acne or hirsutism in 7.1%, and other reason in 17.5%. Non-whites were more likely than whites to present with other reason for visit (28 vs. 13%, P<0.05). Non-white patients had a higher chronologic and gynecologic age at presentation than whites. Total testosterone was elevated in 82.6% of the non-white compared to 62.0% of the white patient group (P<0.05). There was no difference in BMI or obesity between whites and non-whites. The subgroup of adolescents with an isolated elevated testosterone was leaner, had a younger gynecologic age, and was more likely to have an abnormal glucose to insulin ratio than were those girls with other androgen abnormalities. Of those tested for other metabolic abnormalities, 55% had at least one abnormal lipid value, and 68% had an abnormal glucose to insulin ratio.

Adolescent females with hyperandrogenism are at risk for other metabolic abnormalities. The higher gynecologic age and higher testosterone levels in our non-white patient group may reflect a delay in referral. Primary care physicians need to be sensitive to signs and symptoms of hyperandrogenism in the non-white population and in lean adolescents.