(88) Paratubal Cysts, PCOS, and Obesity in Adolescence: A Retrospective Cohort Study from a Large Integrated Health System

Background: Paratubal cysts arise from Wolffian duct remnants, and have been shown to have androgen receptors. Recent studies in adolescents show an association between paratubal cysts and polycystic ovarian syndrome (PCOS)-associated conditions like hyperandrogenism. A link with PCOS itself has not been demonstrated, and little is known about the chronology of these diagnoses. This study aims to address these gaps in the literature.

Methods: This is an IRB-approved observational cohort study of female adolescents 10-21 years diagnosed with a PTC on surgical pathology between 1/1/ 2014, and 3/31/2018 during surgery for either concern for adnexal torsion or for a persistent adnexal mass. Age- and race/ethnicity-matched controls were assigned in a 3:1 ratio. Participants were assessed for existing or subsequent diagnoses of PCOS and PCOS-associated conditions (acne, hirsutism, Type 2 diabetes, prediabetes, or insulin resistance) over 5 years.

Results: A total of 64 adolescents with a PTC and 192 controls were identified. Median age at PTC diagnosis was 17.0 years (IQR: 14.0-20.0). Compared with controls, girls with a PTC were more likely to be overweight/obese (64.1% vs 46.2%, P=0.01) and have/develop PCOS (20.3% vs 4.7% P< 0.001) compared to controls. There were no significant differences in rates of PCOS-associated conditions. There were no differences in time to diagnosis of PCOS or its associated conditions between the two groups. When girls with a PTC were stratified by BMI group, the underweight/normal weight group was significantly more likely to have undergone surgery for concern for adnexal torsion than the overweight/obese group (87.0% vs 56.1%, P=0.01). There was no difference in cyst size between the weight groups. Girls with PTC who were overweight/obese were more likely to have PCOS than those who were underweight/normal weight (P=0.002), but there were no significant differences in rates of PCOS-associated conditions between the groups.

Conclusions: This is the first study to demonstrate an association between paratubal cyst formation and PCOS. Our findings highlight an important opportunity to screen for PCOS at the time of paratubal cyst diagnosis, especially amongst adolescents who are overweight/obese as they appear to be higher risk. Our study is limited in that it used ICD codes as a proxy for diagnoses, which can be prone to inter-provider differences in charting. This may account for the fact that other studies have shown a link between hyperandrogenism and paratubal cyst formation but this was not demonstrated in our study. Further research concerning the role of hyperandrogenism and PCOS in paratubal cyst formation is needed.