ABSTRACT
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common reproductive endocrinopathy in women of childbearing age, affecting 5-15% women in this age group. Suggestive cardinal features comprise hyperandrogenism, ovulatory dysfunction and/or polycystic ovary appearance. The gold standard radiological tool is the pelvic ultrasound (PUS) whose yield may be limited in overweight and obese adolescent girls. OBJECTIVE AND HYPOTHESES: To evaluate the contribution of pelvic MRI to the diagnosis of PCOS in a specific group of virginal overweight and obese adolescent girls. METHOD: Eight adolescent girls seen for menstrual irregularities or amenorrhea, with features of hyperandrogenism were biochemically screened (LH, FSH, testosterone, S-DHEA, delta-4 androstenedione, 17 (OH) P, SHBG, TSH, free T4, prolactin and lipid profile, fasting blood sugar and HOMA-IR and HOMA-B). Each had PUS and/or pelvic MRI (PMRI) performed. Other causes of hyperandrogenism were excluded. IMAGING: PUS with the trans-abdominal transducer was attempted in only one patient Acuson© scanner, using 3.5-7.5 MHz transducer; PMRI was performed in all patients with phased array coil of 1.5 T Siemens MRI scanner, with T1 and T2-weighted axial and coronal images. PCOS was defined according to the Rotterdam PCOS consensus Workshop. RESULTS: Eight girls (mean age 14,6 ± 1.47 years) are reported, one was overweight (BMI Z-score > 1 SDS), seven others were obese (BMI Z-score > 2 SDS). Mean age at menarche was 11.58 ± 1.11 years, except for one who had not yet entered menarche. All had menstrual irregularities, acanthosis nigricans, acne, hirsutism, and biochemical characteristics of PCOS (high plasma androgens, insulin resistance, glucose/insulin ratio <4.5, decreased SHBG).PUS was not contributive to the diagnosis of PCOS, whereas PMRI showed typical aspect (well delineated peripheral ovarian cysts), with increased ovarian volume and stroma. CONCLUSION: Although PUS remains the gold standard for the diagnosis of PCOS in most cases, its limitations in overweight and obese girls are real and must be considered.If utilization of endovaginal transducer not being feasible in young virginal girls, PMRI could be a useful alternative, allowing greater delineation of structural components of the ovary and better appreciation of both its volume and structural alterations.
ABSTRACT
BACKGROUND: The incidence of childhood type 1 diabetes (T1D) incidence is rising in many countries, supposedly because of changing environmental factors, which are yet largely unknown. The purpose of the study was to unravel environmental markers associated with T1D. METHODS: Cases were children with T1D from the French Isis-Diab cohort. Controls were schoolmates or friends of the patients. Parents were asked to fill a 845-item questionnaire investigating the child's environment before diagnosis. The analysis took into account the matching between cases and controls. A second analysis used propensity score methods. RESULTS: We found a negative association of several lifestyle variables, gastroenteritis episodes, dental hygiene, hazelnut cocoa spread consumption, wasp and bee stings with T1D, consumption of vegetables from a farm and death of a pet by old age. CONCLUSIONS: The found statistical association of new environmental markers with T1D calls for replication in other cohorts and investigation of new environmental areas. TRIAL REGISTRATION: Clinical-Trial.gov NCT02212522 . Registered August 6, 2014.
