Abstract
Study Objective
To identify clinical features associated with primary ovarian insufficiency (POI)
and collect data on the evaluation and treatment received.
Design
Retrospective chart review. Data were abstracted on etiology of POI, history, laboratory
evaluation, imaging results, return for clinical care, and treatment plans.
Setting
Urban children's hospital in Cincinnati, Ohio.
Participants
Fifty female patients, age 11-26 years, with initial presentation of POI between January
1, 2006 and December 31, 2015.
Main Outcome Measures
Etiology of POI, bone mineral density (BMD), laboratory evaluation, and services utilized
at presentation.
Results
Three hundred thirty-one charts were reviewed, 71 with confirmed diagnosis of POI,
and 50 with sufficient data for inclusion. Among the 50, 21 (42%) had Turner syndrome,
18 (36%) remained idiopathic, and 11 (22%) had another condition (eg, autoimmune polyglandular
syndrome, galactosemia, etc). Thirty-six (72%) were karyotyped; in 14 (28%), 21-hydroxylase
antibodies were measured; 32 (64%) underwent dual-energy x-ray absorptiometry BMD
measures of lumbar spine. Eight of 50 patients (16%) reported fracture. Of these,
at presentation, 4 (50%) had low BMD, and 2 (25%) had slightly low BMD. On initial
spinal dual-energy x-ray absorptiometry, 9 of 32 (28%) had low BMD (Z-score ≤ −2.0)
and 7 of 32 (22%) were slightly low (−1.0 to −1.9). All started estrogen therapy within
2 years of presentation. In follow-up, only 2 patients (4%) saw a mental health consultant
for emotional support.
Conclusion
POI is a model of estrogen deficiency with most cases due to Turner syndrome or idiopathic
causes. At presentation, many had low BMD and few were seen for psychological support
as part of multidisciplinary care.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A clinical research integration special program (CRISP) for young women with primary ovarian insufficiency.Panminerva Med. 2014; 56: 245
- New hopes for the treatment of primary ovarian insufficiency/premature ovarian failure.J Reprod Infertil. 2013; 14: 1
- Primary ovarian insufficiency: a more accurate term for premature ovarian failure.Clin Endocrinol. 2008; 68: 499
- Age at natural menopause in a population-based screening cohort: the role of menarche, fecundity, and lifestyle factors.Fertil Steril. 1997; 68: 95
- Update on primary ovarian insufficiency in adolescents.Curr Opin Pediatr. 2015; 27: 511
- Primary ovarian insufficiency.N Engl J Med. 2009; 360: 606
- An update: spontaneous premature ovarian failure is not an early menopause.Fertil Steril. 2005; 83: 1327
- Development of luteinized graafian follicles in patients with karyotypically normal spontaneous premature ovarian failure.J Clin Endocrinol Metab. 1994; 79: 1470
- Autoimmune oophoritis as a mechanism of follicular dysfunction in women with 46,XX spontaneous premature ovarian failure.Fertil Steril. 2005; 84: 958
- Mutation in the follicle-stimulating hormone receptor gene causes hereditary hypergonadotropic ovarian failure.Cell. 1995; 82: 959
- Early menopause: a hazard to a woman’s health.Indian J Med Res. 2016; 143: 420
- The menopause and aging, a comparative perspective.J Steroid Biochem Mol Biol. 2014; 142: 132
- Hormone replacement therapy and the adolescent.Curr Opin Obstet Gynecol. 2010; 22: 363
- Primary ovarian insufficiency in the adolescent.Curr Opin Obstet Gynecol. 2013; 25: 375
- Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women.Obstet Gynecol. 2014; 123: 193
- Primary ovarian insufficiency: different approaches in three cases and a review of literature.Endocrinol Diabetes Metab Case Rep. 2016; 2016: 160026
- Effect of early menopause on bone mineral density and fractures.Menopause. 2007; 14: 567
- Influence of the menopausal age on the severity of osteoporosis in women with vertebral fractures.Maturitas. 1994; 19: 117
- Early menopause: increased fracture risk at older age.Osteoporos Int. 2003; 14: 525
- Menopause and the risk of coronary heart disease in women.N Engl J Med. 1987; 316: 1105
- Depression in women with spontaneous 46, XX primary ovarian insufficiency.J Clin Endocrinol Metab. 2011; 96: E278
- Women with spontaneous 46,XX primary ovarian insufficiency (hypergonadotropic hypogonadism) have lower perceived social support than control women.Fertil Steril. 2009; 92: 688
- Shyness, social anxiety, and impaired self-esteem in Turner syndrome and premature ovarian failure.JAMA. 2006; 295: 1374
- Meeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure.Obstet Gynecol. 2002; 99: 720
- The psychosocial transition associated with spontaneous 46,XX primary ovarian insufficiency: illness uncertainty, stigma, goal flexibility, and purpose in life as factors in emotional health.Fertil Steril. 2010; 93: 2321
- Primary ovarian insufficiency.Lancet. 2010; 376: 911
- Management of premature ovarian failure.Best Pract Res Clin Obstet Gynaecol. 2009; 23: 129
- Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions.J Clin Densitom. 2014; 17: 225
- Application of the 1994 WHO classification to populations other than postmenopausal caucasian women: the 2005 ISCD official positions.J Clin Densitom. 2006; 9: 22
- Bone mineral density in estrogen-deficient young women.J Clin Endocrinol Metab. 2009; 94: 2277
- Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377
- Bone mineral density in young women with primary ovarian insufficiency: results of a three-year randomized controlled trial of physiological transdermal estradiol and testosterone replacement.J Clin Endocrinol Metab. 2014; 99: 3418
- Bone loss in young women with karyotypically normal spontaneous premature ovarian failure.Obstet Gynecol. 1998; 91: 12
- Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause.Fertil Steril. 2016; 106: 1588
- Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab. 2015; 100: 3975
- Physiological versus standard sex steroid replacement in young women with premature ovarian failure: effects on bone mass acquisition and turnover.Clin Endocrinol. 2010; 73: 707
- Hormone replacement therapy versus the combined oral contraceptive pill in premature ovarian failure: a randomized controlled trial of the effects on bone mineral density.J Clin Endocrinol Metab. 2016; 101: 3497
- A new approach to primary ovarian insufficiency.Obstet Gynecol Clin North Am. 2012; 39: 567
- An open letter to the primary ovarian insufficiency community.Minerva Ginecol. 2014; 66: 519
- Menstruation in adolescents: what do we know? And what do we do with the information?.J Pediatr Adolesc Gynecol. 2014; 27: 309
Article info
Publication history
Published online: August 03, 2017
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
