To study evidence of polycystic ovary syndrome (PCOS) in premenarcheal adolescents
with unexplained ovarian torsion.
Retrospective observational case series.
Tertiary university clinical center
Six premenarcheal adolescents and six adults with acute ovarian torsion
A chart review.
Main Outcome Measures
Contralateral ovarian size, operative findings, ovarian pathology, hormone testing
Five of the six premenarcheal cases had no pathologic explanation for their ovarian
torsion. In four of the cases, size measurements of the contralateral ovary were noted
to be larger than the criterion of their respective age group. Three of the four cases
had either an ovarian volume (28.5 cm3) or an area (16.0 cm2 and 57.6 cm2) that was above the size criterion for a polycystic ovary (volume >10 cm3 or area>5.5 cm2). Pathology of a wedge biopsy of one of the contralateral ovaries suggested evidence
of polycystic ovary. Finally, hormone testing available in three of the cases revealed
elevated testosterone levels in two. Among the adults, half of the cases had a pathologic
explanation for ovarian torsion. One out of the five cases had a contralateral ovary
that was significantly enlarged and this was noted in a woman with a diagnosis of
PCOS. The remaining two cases had extensive necrosis of the torsed ovary and no other
diagnosis was made.
We propose that premenarcheal girls presenting with ovarian torsion, without obvious
ovarian pathology, be screened for ultrasound and biochemical evidence of PCOS. In
those with evidence of PCOS, treatment with oral contraceptives should be considered
taking into account the age and pubertal development, to decrease ovarian volume.