الفهرس 
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Abstract
Polycystic ovary syndrome (PCOs) is an endocrine disorder that affects 8-26 %of women of reproductive age (from 12 to 49). Awareness and diagnosis of polycystic ovary syndrome continues to rise in this age group due to increasing obesity and insulin resistance in young girls, (Mchelmore et al., 1999). It seems to begin in the perimenarcheal period and the symptoms and signs of PCOS typically date back to adolescence (Rosenfield., et al 2002) .
Today this syndrome is termed PCOS. It is one of the most prevalent disorders, affecting about 5% of women of reproductive age. At present, 3 definitions of PCOS are most commonly cited. These definitions were proposed by National Institute of Child Health and Human Development (NICHD) in 1990, the European Society for Human Reproduction and Embryology and American Society for Reproductive Medicine (ESHRE/ASRM or Rotterdam) in 2003, and Androgen Excess Society (AES) in 2006. Each of these definitions underlines the importance of excluding other causes of androgen excess and anovulatory fertility before diagnosing PCOS. The NICHD criteria were an important first step toward establishing a universally accepted definition of PCOS. However, this definition was based on majority opinion and not on clinical trial evidence. PCOS is defined as the presence of both androgen excess and oligo-anovulation. In subsequent years it was realized that the clinical presentation of PCOS was much more variable than the NICHD criteria suggested, and polycystic ovarian morphology was often present in women with biochemical and clinical findings of PCOS (Nandi et al., 2014).
In 2003, the revised Rotterdam consensus definition included polycystic ovaries as a third diagnostic marker for PCOS. Based on this definition, a woman with the diagnosis of PCOS should meet 2 of the 3 following criteria: (1) presence of oligo-anovulation or chronic an-ovulation, (2) clinical and/or biochemical signs suggesting hyper-androgenism, and (3) polycystic ovaries on ultrasonographic examination. The Rotterdam definition of PCOS broadened the phenotypic expression of the syndrome and redefined PCOS as primarily a syndrome of ovarian dysfunction (Azziz, 2005).
The aim of the work was to:-
1- Study the age at diagnosis of polycystic ovarian syndrome (PCOS) in apediateric Population.
2-.To compare risk factors involved in causing PCOS in pre adolescents and adolescent girls.
This study was performed on 50 girls; the age range from 9 to 18 years, all these girls with a diagnosis of PCOS.The girls was divided into two groups the first from 9 to13 year and the second fromss13 to 18years. The diagnosis of PCOS was depend on the revised 2003 ESHRE/ASRM Rotterdam criteria which need two out of three of the following characteristics for diagnosis of PCOS, that help us to exclude the other etiologies.
Inclusion criteria:
1) Oligomenorrhea and or/anovulation,
2) Clinical and or/ biochemical signs of hyperandrogenism.
3) Polycystic ovaries on ultrasound:
- More than l0 follicles< 12mm.
- Ovarian volume > 10cm^3
Exclusion criteria:
• Pregnancy.
• Ovarian tumor.
• Congenital adrenal hyperplasia.
• Androgen-secreting tumors
• Cushing syndrome..
In this study mean age 14,8±2.4 and the age of menarche 10-16 years. The clinical manifestation of PCOS was menstrual irregularity in 46girls(92%),hirsutism in 23girls 46% ,acne in 18 girl (36%) acansosis in 18 girls (36%),childhood obesity in 19 girls (38%) ,family history of obesity in in 29 girls (58%),family history of DM in 27 girls (54%), family history of hypertension in 20 girls (40%) and family history of PCOS in 9 girls (18%).
In the current study, menstrual irregularity was noted in 46 girls (92 %) in the form of oligomenorrhea in 14 girls (28%) , hypo-menorrhea in 6 girls (12%) oligohypomenorrhea in 14 girls(28%),menorrhagia in 8 girls (16%) and amenorrhea in 4 girls (8%) amenorrhea was noted in 3 girls (6 %). Ultrasound examination in the studied girls revealed that 47 (94 %) had positive US findings suggestive of pros.
In respect to the hormonal profile in the studied girls the mean level of LH was (8,6±8,9),FSH was (7± 2.1),LH/FSH (1.7±1.6) total testosterone (1.9±1.4) free testosterone (11.1±2.8) SHBG (63.3±47.2)fasting insulin (22.7±3.4) .
• Regarding lipid profile in the studied girls , the present study documented that among the studied patients, 22 girls (44 %) had hypercholesterolemia, 18 girls (36 %) had low HDL, 13 girls (26 %) had high LDL and 20 girls (40%) had hypertriglyceridemia. In the present study, insulin resistance was reported in 24 girls accounting for 48% of the studied girls. The age of diagnosis of PCOS range from 13 to 18 years.
• The risk factors involved in causing PCOS in pre adolescents and adolescent girls were:-
A-Genetic predisposition.
B-Environmental factors.(under nutrition,LBW,SGA).
C-Childhood obesity.
D- Precautious puberty.
E-The timing of menarche.
F-Abnormal LH/FSH ratio and AMH.
• Early diagnosis of PCOS among adolescent and preadolescent girls is important and recommended for early diagnosis of co morbid diseases such as diabetes mellitus, hypertention and obesity.
• The diagnosis is important for Uterine protection, and prevention of endometrial cancer.