Síndrome de ovario poliquísticola distancia anogenital como marcador del entorno androgénico prenatal y revisión y comparación de los criterios diagnósticos

Abstract

OBJECTIVES 1. To assess the association between AGD measurements (DAGAC and DAGAF) in women with PCOS (cases) and without PCOS (controls). 2. To assess the clinical utility of AGD using ROC curves for the diagnosis of PCOS and its different phenotypes. 3. To assess the diagnostic precision of the combination of AGD and AMH in the diagnosis of PCOS. MATERIAL AND METHODS An observational case-control study was carried out at the Gynecology Service of the Hospital Cli?nico Universitario Virgen de la Arrixaca in Murcia (Spain), between September 2014 and May 31st 2016. All the participants, both cases and controls, were women between 18 and 40 years old who did not meet any of the following exclusion criteria: being pregnant or breastfeeding, having been exposed to cancer treatment, having genitourinary prolapse or endocrinological disorders (for example, Cushing's syndrome, congenital adrenal hyperplasia, androgen-secreting tumors, hyperprolactinemia and hyper or hypothyroidism) or were taking hormonal medication, including contraceptives, during the 3 months prior to participating in the study. Cases were women who were treated at the gynecology outpatient clinic of the hospital and included both prevalent cases and new diagnoses. Cases were included after carrying out a medical history with a modified Ferriman-Galwey scale (mF-G) (REF), transvaginal ultrasound (TVUS) and hormone levels if they met the Rotterdam criteria (REFERENCE). To meet these criteria, at least two of the following must be present: 1) clinical hyperandrogenism (mF-G scale 3 12) or biochemical (total testosterone 3 2.6 nmol / l) (REF) with or without androgenic alopecia or the presence of acne ; 2) oligoanovulation (menstrual cycles > 35 days or amenorrhea > 3 months); 3) polycystic ovary morphology (POM) by transvaginal ultrasound (3 12 follicles between 2-9mm in diameter on average in both ovaries). The following PCOS phenotypes were also assessed: (A) hyperandrogenism + oligo / amenorrhea (H + O), (B) hyperandrogenism + polycystic ovary morphology (H + POM), (C) oligo / amenorrhea + POM (O + POM) and (D) hyperandrogenism + oligo / amenorrhea + POM (H + O + POM). Controls were women without PCOS or other relevant gynecological diseases (such as endometriosis) who attended the gynecology outpatient department of the hospital. In both cases and controls, anamnesis, blood draw for serum AMH, TVUS and physical examination with AGD measurements were performed: from the anterior clitoral surface to the upper verge of the anus (AGDAC) and from the posterior fourchette to the upper verge of the anus (AGDAF). A statistical analysis was carried out to assess the association between AGD and the presence of PCOS and its different phenotypes, as well as its usefulness and that of AMH in the diagnosis of the disease. CONCLUSIONS Our results show a significant association between AGDAC and the presence of PCOS, supporting the theory that intrauterine hormonal environment during the fetal life may play an important role in its development. Furthermore, AGDAC could be an effective clinical tool to discriminate the presence of PCOS and its different phenotypes. Similarly, the combination of AMH and AGDAC appears to have greater diagnostic accuracy than either of them alone to predict the presence of the syndrome. Such a combination could be clinically useful and improve the diagnosis and management of these patients.