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Objective: Polycystic ovary syndrome (PCOS) in adolescents is associated with adverse metabolic outcomes. The association of menstrual irregularity with metabolic risk among adolescents with PCOS was assessed. Method: A retrospective medical record review of 366 adolescents with PCOS aged 13-18 years was conducted, from which 265 girls newly diagnosed with PCOS were included and divided into those presenting with primary amenorrhea (PA), secondary amenorrhea (SA) and oligomenorrhea (OM). Androgen concentrations and markers of metabolic risk were compared among the groups. Results: Most subjects presented with OM (PA = 17, SA = 30 and OM = 218). Subjects with PA were younger than those with OM but not different from those with SA. Mean BMI was not different between groups. Total testosterone and insulin levels were higher in PA than SA and OM (p < 0.01 and 0.02, respectively). Fasting glucose was higher in PA than OM (p = 0.048) but not different from SA. Triglyceride levels were higher in PA than SA and OM (p < 0.001 each). More subjects with PA and SA had metabolic syndrome (52%) than those with OM (29.1%) (p = 0.027). The differences in triglycerides and glucose persisted despite BMI adjustment in multivariate regression models. Conclusion: Adolescents with PCOS presenting with PA are at risk of metabolic disease beyond expected based on BMI.

Early diagnosis of uterine hemangiomas may direct management decisions improving long-term outcome in children, adolescents and adulthood.

To estimate the incidence of breast carcinoma and survival in patients younger than 25 years old, and to describe presenting clinical signs and symptoms of breast cancer in this age group.A population-based descriptive study and case review in Olmsted County, Minnesota, was conducted using the resources of the Rochester Epidemiology Project. Participants were Olmsted County girls and women younger than 25 years old with histopathologically confirmed breast carcinoma diagnosed between 1935 and 2005. Nonresidents who presented to a medical facility within Olmsted County during this time period were included in some portions of the analysis. Main outcome measures were age-adjusted incidence, 5-year survival, and clinical presentation of breast carcinoma in girls and women younger than 25 years of age.With four breast carcinomas observed in Olmsted County residents over 1,201,539 person-years, the annual age-adjusted incidence of breast cancer in this population was 3.2 per million (95% confidence interval, 0.1-6.2). All four cancers occurred in the 20- to 24-year age group (age-specific incidence, 16.2 per million). Eight additional cases of breast carcinoma were identified in nonresidents. Delay in diagnosis was common. All had at least one feature worrisome for an aggressive neoplasm identified in their clinical history, on physical examination or by imaging.Breast carcinoma in young women is very rare, associated with delayed diagnosis, and usually associated with concerning features requiring biopsy.III.

Fibroadenomas are the most common breast masses in adolescent women, therefore it is important that health providers understand their assessment and management. This review discusses an approach to investigation and management of fibroadenomas in adolescents.Fibroadenomas are benign tumors which commonly present in late adolescence. They are classified according to their histology and size. Simple fibroadenomas are the most common type and usually present as smooth mobile masses up to 3 cm in diameter. Giant fibroadenomas are more uncommon but typically present in adolescence. Fibroadenomas associated with other soft-tissue masses should raise the possibility of an inherited syndrome. Assessment of breast masses in this age group generally involves clinical assessment through history and physical examination and, when imaging is needed, ultrasonography. As the incidence of primary breast malignancy is very low in this age group, core biopsy is not routinely recommended. Large or rapidly growing tumors, or those associated with suspicious features, warrant surgical excision. New minimally invasive excision techniques are being introduced which are associated with high initial success rates.Whereas the vast majority of fibroadenomas in teenagers may be monitored with surveillance alone, new minimally invasive techniques may play an important role in the management of selected patients.

To compare changes in fasting glucose among adolescents with polycystic ovary syndrome (PCOS) with those in obese adolescents without PCOS.Retrospective cohort study of 310 adolescents with PCOS and 250 obese adolescents (age range 13 to 18 years) seen at Mayo Clinic, Rochester, MN, from 1996 to 2012.Included for analysis were 98 adolescents with PCOS and 150 obese adolescents who had 2 or more fasting glucose measurements separated by at least 6 months. Adolescents with impaired fasting glucose (IFG) or diabetes were excluded. Multivariate models were used to assess predictors of change in fasting glucose.At diagnosis, adolescents with PCOS had lower body mass index (BMI) (kg/m(2)) and older age than obese adolescents (P.001). Adolescents with PCOS had shorter follow-up (P = .02). Baseline fasting glucose was not different between groups. Mean change in fasting glucose was 2.4 ± 9.4 mg/dL per year for PCOS and 2.2 ± 6.2 mg/dL per year for obese adolescents (P = .83). Significant predictors for change in fasting glucose were BMI and fasting glucose at diagnosis (P.01). Within the PCOS cohort, BMI was a significant predictor for development of IFG (P = .003). Prevalence of hypertension increased in the PCOS cohort from baseline to follow-up (P = .02). PCOS and BMI were significantly associated with development of HTN in the entire cohort.Adolescent girls with PCOS do not show a significant change in fasting glucose or an increased risk for the development of IFG compared with obese adolescents. BMI, not PCOS status, was the strongest predictor for changes in fasting glucose and development of IFG over time.

Gynecomastia is defined as an enlargement of the male breast. It is often benign, and can be the source of significant embarrassment and psychological distress. A general medical history and careful physical examination are essential to distinguish normal developmental variants from pathological causes. Treatment is geared toward the specific etiology when identified. In the majority of cases of pubertal gynecomastia, observation and reassurance are the mainstays of therapy as the condition usually resolves naturally. Pharmacological treatment and surgery are recommended only in selected cases.

The purpose of this review is to familiarize physicians who provide medical care to the young with knowledge about breast anomalies that present during childhood and adolescence. The scope includes congenital and developmental abnormalities, including breast masses. Both diagnosis and management are addressed. Congenital and acquired anomalies of the breast most often present during adolescence. The most common anomalies are polythelia and breast asymmetry. Surgical intervention for anomalies should be tailored and timed to the individual patient's situation and need not wait until adolescence is completed. Breast masses in adolescents are most likely to be fibrocystic changes or fibroadenoma. Malignancy of the breast is rare and not likely to be adenocarcinoma. When imaging is needed, ultrasonography is the preferred modality. Not all breast masses, including fibroadenomas, need to be excised.

To determine which factors are associated with duration of use of a levonorgestrel implant (Norplant) for contraception in adolescents and young adults.We retrospectively studied 144 young women (14 to 21 years of age) who chose a levonorgestrel contraceptive implant at Mayo Clinic Rochester between April 1990 and December 1993.The following information was obtained at the time of insertion of the implant and from any follow-up visits: demographics, prior contraceptive experiences, frequency and management of complications, complications noted at removal of the implant, and subsequent contraceptive choice. The duration of use was examined.Of the 144 young women who underwent insertion of a Norplant system, 75 telephoned or made a medical appointment because of implant-related side effects. During the follow-up period, 64 patients had the Norplant system removed. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83 % and for at least 24 months was 63 %. Duration of Norplant use was not found to differ with respect to age, prior contraceptive use, or timing of insertion, but it was significantly shorter among those with a prior pregnancy than in those who had never been pregnant.These findings suggest that a group of young women who are likely to continue use of a contraceptive implant (with or without treatment for side effects) are those who have never been pregnant.A retrospective study of 144 US women 14-21 years of age who requested and received the Norplant contraceptive implant system at the Mayo Clinic (Rochester, Minnesota) in 1990-93 analyzed the factors associated with duration of method use. Of the 124 women who reported past use of contraception, 94 (76%) had been pregnant at least once. The method most commonly used before Norplant was oral contraception (57%). The reasons for Norplant selection were its convenience (86%) and problems tolerating the pill (14%). Of the 130 Norplant users who either telephoned or made a clinic appointment after insertion, 60% reported side effects such as breakthrough bleeding, headache, and depression or mood swings. 64 women had the implants removed. The median duration of Norplant use was 29 months. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83% and 63% for at least 24 months. Age, prior contraceptive use, and timing of insertion had no impact on duration of Norplant use. Multivariate analysis indicated that women with at least 1 prior pregnancy had a two-fold increased risk of Norplant removal compared to those who had never been pregnant. Larger studies are needed to identify additional factors associated with long-term use of injectable contraception among young women and to suggest interventions that would improve compliance with routine follow-up.

Study Objective To study outcome of pregnant adolescents and single young women who attended and those who chose not to attend a nonurban, developmentally appropriate, pilot antenatal clinic called the “Young Moms’ Clinic.” To study “perceived” outcome among the Young Moms’ Clinic participants. Methods A multidisciplinary clinic was established to provide education about pregnancy, childbirth, infant care, contraception, and healthy lifestyles to young mothers with similar backgrounds. Over a 2-year period, all adolescents and single young mothers aged 13–23 years were invited to attend the Young Moms’ Clinic after the first trimester. The Clinic group consisted of the first 101 young women who were invited and chose to attend. The nonclinic group consisted of the first 95 young wonlen who were invited but declined to attend. Both groups had the same obstetric care givers, had a similar number of prenatal visits (median number, 12), and delivered in the same hospital. Univariate and multivariate analyses were performed to determine whether participation in the clinic was an independent factor in outcome. Results Maternal weight gain and infant birth weight were significantly higher in the Clinic group. Pregnancy complications (preterm labor, intrauterine growth retardation, anemia) were significantly higher in the nonclinic group. Participants in the nonclinic group were almost three times as likely to have cesarean section delivery as those in the Clinic group. Neonatal intensive care unit transfer occurred only in infants of the control group. Conclusions Participation of pregnant adolescent and young adult women from a nonurban community in a developmentally targeted pilot, prenatal program resulted in fewer pregnancy complications and improved outcome in comparison with those who chose not to participate in the program. The results may be subject to bias because of self-selection among partIcIpants.

Juvenile polyposis syndrome (JPS) is a hereditary condition characterized by development of gastrointestinal polyps, and caused by mutations in SMAD4 or BMPR1A genes. Juvenile polyps can also be found in a related group of syndromes with multisystemic involvement including Cowden disease, Lhermitte–Duclos disease, Bannayan–Riley–Ruvalcaba syndrome, and Proteus-like syndrome, all grouped as PTEN hamartoma tumor syndromes (PHTS). In all these conditions including JPS, polyps manifest in older childhood or early adulthood. Infantile juvenile polyposis (JPI) is a rare entity, presenting in the first year of life with severe gastrointestinal symptoms. Many of these patients have associated macrocephaly, hypotonia, and congenital anomalies. It was recently recognized that patients with infantile polyposis have a 10q23 microdeletion, involving both BMPR1A and PTEN genes. There is a major risk for gastrointestinal malignancies in these patients, but the risk for development of other tumors is not known. We describe a patient with a history of infantile polyposis, macrocephaly, developmental delay, hypotonia, and a 10q23 microdeletion. At age 14 she presented with bilateral mucinous cystadenoma of the ovary. This type of tumor was not previously reported in association with JPS, 10q23 microdeletion syndrome, or infantile polyposis. We believe that ovarian cystadenomas may be another neoplastic complication of infantile polyposis, and that our report widens the spectrum of the 10q23 microdeletion phenotype. © 2010 Wiley-Liss, Inc.

SUMMARY A review of the medical literature on breast disorders in children and adolescents leads to a number of conclusions. Though females may develop breast masses early in life, the risk of malignancy is extremely low. Therefore, most breast masses in the young can be managed conservatively without surgery. Breast masses in young girls may represent thelarche or tumors of adjacent structures, but are unlikely to be malignant. The most common form of bilateral breast enlargement in prepubertal girls is premature thelarche, a benign, transient, and incomplete form of precocious puberty. Fibroadenoma is the most common cause of breast mass in female adolescents. In the rare case in which a breast mass in this population is malignant, it is more likely to be a noncarcinomatous or metastatic cancer. Because of the low risk of malignancy and the relatively different composition of the adolescent as compared to the adult breast, mammography is not recommended for routine screening or routine imaging of breast masses in adolescents. The role of breast self-examination should be further studied.

Background Phyllodes breast tumors, particularly malignant ones, are rare in adolescents. Tumor behavior does not correlate with histopathology. This case of an adolescent with a malignant phyllodes tumor, followed by the occurrence of a borderline ovarian tumor, also uncommon in adolescence, may shed light on our understanding of phyllodes and uncommon gynecologic malignancies in the young. Case A-14 year-old Caucasian female underwent wide local excision of a 4-cm malignant phyllodes breast tumor. At 17 years of age she had excision of a serous borderline tumor of the ovary. Comments The occurrence of two rare neoplasms in an adolescent female raises questions about a common underlying etiology, such as a genetic mutation. Genetic evaluation of minors is a sensitive and complex issue. Natural history studies regarding phyllodes tumors presenting in adolescence are needed to establish recommendations regarding best practice, including the role of genetic evaluation in this population.

Patient is a 13-year-old girl who presents to the gynecology clinic with a three-month history of growing bilateral breast masses. She noticed the start of breast development about one year ago and she has not started her menses. She describes her breasts as firm and nontender and she denies any discharge. She thought this was normal breast development but did mention it to her mother who notified her nephrologist. Her past medical history reveals that she has end-stage renal disease due to nephrotic syndrome and underwent a renal transplant two years ago. She has otherwise no complaints. Her current medications include cyclosporin and prednisone. There is no family history of breast cancer. (excerpt)

Objective : We retrospectively evaluated the clinical presentation and histopathologic findings of benign and malignant adnexal masses in infants, children, and adolescents. Study Design : Between 1955 and 1992, 486 patients (aged 7 days through 20 years) with adnexal masses were surgically evaluated. Results : Of 521 adnexal masses, 92% were benign, including 335 nonneoplastic and 144 of 186 (77%) neoplastic lesions. The frequency of ovarian malignancies correlated inversely with patient age. Germ cell, stromal, and epithelial malignancies accounted for 40%, 21%, and 33%, respectively, of the 42 cancers. Nonconcordance between preoperative and postoperative diagnoses was noted in 94 cases. The most common preoperative diagnosis necessitating reassignment was acute appendicitis. During the last decade of this study, ultrasonography and computed tomography missed no malignancies. Conclusion : Physicians who care for young girls must be familiar with the differential diagnosis of adnexal masses to advise conservative management when appropriate and surgical intervention when necessary.

A 3 year old boy with systemic histiocytosis, diabetes insipidus and a lytic parietal bone lesion experienced episodes of central neurogenic hyperventilation 3 weeks after radiation to the head but was conscious and alert at presentation. At admission, the P aO2 was 133 mmHg, P aCO2 was 8 mmHg and pH 7.65. Magnetic resonance imaging revealed a pontomedullary lesion that resolved during the ensuing year. Central neurogenic hyperventilation has not been described previously as a complication of systemic histiocytosis

1. To investigate whether there is a nyctohemeral rhythm in bone turnover, we measured serum bone Gla-protein (osteocalcin, an index of osteoblast activity) concentration every 2 h and urinary deoxypyridinoline (a marker of bone collagen resorption) excretion for 8 h periods in 10 pubertal girls (aged 10–14 years), 15 premenopausal women (aged 20–49 years) and 17 postmenopausal women (aged 50–75 years). 2. The serum concentration of bone Gla-protein and the urinary excretion of deoxypyridinoline were five times higher in the pubertal girls than in the premenopausal women. The urinary excretion of deoxypyridinoline in the postmenopausal women was twice that in the premenopausal women. 3. There was a nyctohemeral pattern in all age groups with mean night-time increases of 28% (P 4. There also were nyctohemeral patterns in the urinary excretion of calcium (P 5. The serum level of parathyroid hormone increased with age, but this effect was only observed at night (01.00 to 07.00 hours). There was a nyctohemeral rhythm of the serum intact parathyroid hormone level at all ages, with a peak in the afternoon and night. 6. Thus, at night, there is a large increase in bone resorption and a small increase in osteoblastic activity, representing a nyctohemeral rhythm of bone turnover. Although the amplitudes of bone formation and bone resorption are greater during growth, the pattern of nyctohemeral changes present during growth continues up to the age of 75 years.

Of the 1 million pregnancies among adolescents in the United States each year, approximately 500,000 result in live births. These pregnancies are at high risk but are amenable to obstetric and pediatric intervention. Medical, social, and economic risks for both the adolescent mother and her infant are substantially decreased by early and comprehensive prenatal care. A combined obstetric and pediatric protocol for the management of adolescent pregnancy can improve both the perinatal and the long-term outcome.

Sixty-two males consecutively admitted to an adolescent chemical dependency unit for treatment over a one-year period were studied. When interviewed, all denied having urogenital symptoms. Forty-eight reported having had sexual intercourse. Of these 48, 34 were screened (urethral swab) for Neisseria gonorrhoeae, Chylamydia trachomatis, Ureaplasma urealyticum, and Gardnerella vaginalis. Eighteen of the 34 males who had complete screening were found to harbor one or more organisms: 3 had Chlamydia, 13 had Ureaplasma, and 11 had Gardnerella. In addition, 61 of the original 62 subjects were tested for serum antibodies to Treponema pallidum and for pyuria. No subjects were found to have syphilis. Pyuria was present in all subjects with Chlamydia but in only two with Ureaplasma or Gardnerella.

Glucose turnover rates were estimated with [2H2]glucose in five children with glycogen storage disease type I (GSD I) during sequential withdrawal of an infusion of glucose to determine whether their hypoglycemia was the result of decreased glucose production or increased rates of glucose utilization. Plasma glucose concentrations were 78 +/- 5 mg/dl during infusion of glucose at 6 mg X kg-1 X min-1 and decreased to 53 +/- 3 and 45 +/- 7 mg/dl during the 3 and 1.5 mg X kg-1 X min-1 glucose infusions, respectively. Total glucose flux during the 6 mg X kg-1 X min-1 glucose infusion was 7.3 +/- 0.7 mg X kg-1 X min-1 and decreased with reduction in the rate of glucose infused. Endogenous glucose production increased with each decrease in the rate of exogenous glucose infused. Following discontinuation of glucose infusion, endogenous glucose production was 3.9 +/- 0.3 mg X kg-1 X min-1, a value that was lower (P less than 0.05) than that observed in overnight-fasted normal children (6.3 +/- 0.3 mg X kg-1 X min-1) but not statistically different from the Ra of normal children fasted for 30 h (4.1 +/- 0.5 mg X kg-1 X min-1). Thus, children with GSD have glucose production rates that are 40% lower than those of normal children fasted overnight but equal to those of normal children fasted 30 h. Rates of glucose utilization during the 6 mg X kg-1 X min-1 glucose infusion were higher (0.05 less than P less than 0.1) than those of overnight-fasted normal children, despite lower plasma glucose concentrations when expressed on a body weight basis but not when expressed on the basis of estimated brain weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Most breast disease in adolescents, including that resulting in surgery, is benign; however, malignant conditions do occur. The distribution of diagnoses in adolescent females undergoing breast surgery was determined. Records and histologic material were reviewed from 185 females under 18 years of age. The patients range in age from 11 to 17 years, median 16 years. One hundred patients (54%) had surgery for fibroadenoma. Twenty-four patients (13%) had reduction mammoplasty. Although juvenile or “virginal” hypertrophy is a subjective diagnosis, more than 500 g of breast tissue was excised in 10 patients. The spectra of “fibrocystic” and proliferative breast disease was identified in 44 patients (24%). Four patients (2.6% of those with breast mass) had malignant neoplasms: a 15-year-old with primary rhabdomyosarcoma, a 17-year-old with metastatic rhabdomyosarcoma, a 13-year-old with metastatic neuroblastoma, and a 12-year-old with non-Hodgkin's lymphoma. The remaining diagnoses were 4 polythelia, 2 accessory breast tissue, 2 mastitis, 2 intramammary lymph node, 2 hemangioma, and 1 fat necrosis. Although fibroadenoma is the most common breast mass (65% of masses) in adolescents undergoing breast surgery, a variety of other conditions may necessitate surgery for diagnostic and/or therapeutic purposes. In this study, 2.6% of patients with breast mass had a malignant neoplasm. Therefore, malignancy must be considered in the diagnosis and the consideration for surgery in adolescent females presenting with breast mass.

We describe a 4½-year-old girl with breast development due to a sex cord—stromal tumor histologically identified as a gynandroblastoma. Excision of this tumor resulted in complete resolution of symptoms without tumor recurrence.

In conclusion, the diagnosis of toxoplasmosis after bone marrow transplant can be difficult. We believe that serologic studies for Toxoplasma should be obtained routinely prior to bone marrow transplant. The combination of positive pretransplant serology, unexplained fever, and neurologic changes, especially between days 20 to 100 after transplant, should alert the Clinician to the possibility of toxoplasmosis. Finally, possible prevention with TMPS M Z deserves special consideration in these patients; our data suggest that discontinuing T M P S M Z after transplant in the patien t who has positive pretransplant toxoplasma serology puts the patient at increased risk for reactivation of latent T. gondii infection.

Hyperinsulinemia, a common cause of persistent hypoglycemia in infants and children, can result in permanent damage to the central nervous system. Thus, early diagnosis and treatment are important. The typical clinical manifestation of hyperinsulinemic hypoglycemia is symptomatic hypoglycemia that responds poorly to medical therapy. Affected infants may have tremors, jitteriness, apnea, cyanosis, or seizures. If initial medical therapy (frequent feedings, large amounts of intravenously administered glucose, diazoxide, and glucocorticoids) fails to stabilize plasma glucose levels, subtotal pancreatectomy is indicated. This surgical intervention does not completely correct the hypoglycemia in all patients, but it effectively reduces the severity of the condition. Surgical treatment of pediatric patients with Cushing's syndrome or aldosteronoma has also been effective. In our experience, survival of patients with adrenocortical adenomas has been 100%, whereas only five of nine children with adrenocortical carcinomas survived, and four of the five were younger than 10 years of age.