Is puberty delayed in girls with IDDM?

ABSTRACT

To describe monarchal age and prevalence of menstrual dysfunction in girls with insulin-dependent diabetes mellitus [IDDM], 40 females regularly attending the Diabetic Clinic, Children's Hospital, Ain Shams University were enrolled in this study. Their ages ranged between 13 and 18 years [mean 16.2 +/- 1.2 SD ys] and mean duration of diabetes was 7.7 [ +/- 3.3 SD] ys [range I to 14 ys]. An age comparable group of non diabetic females was used as controls [n = 40]. Information concerning menstrual history was completed in a structured questionnaire. Diabetic females were classified acordingly into 10 with delayed puberty [group 1], 10 with disturbed menstrual cycles [group II] and 20 with regular menstrual cycles [group III]. Weight, height, body mass index and Tanner stage were recorded. Two patients in group I were Tanner 1, five were Tanner 2, and three were Tanner 3. In group II 60%, 30% and 10% had secondary amenorrhea, oligomenorrhea and polymenorrhea respectively. Glycated hemoglobin [HbAlc], urinary albumin excretion rate and gonadofropin [FSH, LH], progesterone, estradiol and testosterone hormone levels in serum were analyzed. Pelvic ultrasound was done for all diabetic patients and control subjects. Growth and bone age retardation was mainly observed in group I patients. Poor glycemic control [HbAlc > 10%] was detected among 45% of diabetic subjects [n = 18]. LH level was significantly lower in group I and II patients whereas FSH level was lower among group II patients only compared to group III and controls [P<0.05]. Serum progesterone and estradiol were lower in group I patients compared to other groups [P<0.05]. Irregular menstrual cycles were associated with LH/FSH ratio of more than 2. Polycystic ovarian changes were identified among 45% [9/20] of subjects with IDDM [groups II and III], 66.6% [6/9] of them had secondary amenorrhea. Infantile uterus and small sized ovaries were observed in one patient with primary amenorrhea. It was evident that the overall prevalence of menstrual dysfunction is increased in diabetic females compared to controls. In this era of emphasis on tight glycemic control and its impact in preventing complications, the consequences of poor glycemic control on reproductive potential appear to be important