Journal Club: April 2020

Article: Evaluation and Management of Primary Ovarian Insufficiency in Adolescents and Young Adults

Rula V. Jang MD, Nana Ama Ofei-Tenkorang BS, Mekibib Altaye PhD, Catherine M. Gordon MD, MSc. J Pediatr Adolesc Gynecol 2018;31:13-18. 



1.Discuss the evaluation for Primary Ovarian Insufficiency (POI) that you perform at your institution. Review the American College of Obstetricians and Gynecologists’ Committee Opinion No. 605 (see Obstet Gynecol 2014;123:193-7),or whichever POI guideline you utilize in your field of practice. Do you follow the recommendations included in the guideline at your institution?

  2. Only 48% of patients met strict inclusion criteria for POI. Discuss how the inclusion and exclusion criteria influenced the makeup of the final sample. Discuss how this can affect the sensitivity and specificity of applying their recommendations to your practice. What do you think about the inclusion of Turner Syndrome but exclusion of other DSD? Discuss how these factors that may influence standardizing the evaluation for POI. 

 3.The demographic characteristics of patients with POI included diverse Tanner staging and menarchal status. Discuss the symptoms and signs that would prompt you to a more rapid evaluation for POI.

 4. The authors defined low bone mineral density on the basis of the 2013 International Society for Clinical Densitometry. Define Z-scores and T-scores, and discuss how the use of different scores, or using the classification of ‘osteopenia’ and ‘osteoporosis,’ might impact the evaluation and management of adolescents with POI.

 5. This study was a retrospective review of patients at a large tertiary care center. What are the implications of doing this study in a tertiary center? Discuss how care for POI might be different in a rural environment, including the pros and cons of burden on the patient, system, and access to subspecialty services.  

 6.The article discusses the major emotional effect of a POI diagnosis, and yet so few women were provided a psychosocial referral. Discuss how to improve the emotional support for adolescents with POI. What system-based and clinic-based changes would you make?

 7. There are different ways to present descriptive statistics of continuous numerical data (e.g. means, medians, standard deviations, 95% confidence intervals and ranges). Discuss the factors that should be considered when selecting the best method to represent a particular data set. Discuss how the utilization of one method may bias the interpretation of data. The authors chose to represent their data utilizing means and standard deviations. Do you agree with this choice, why or why not?

 Additional references:

1. Gordon CM, Kanaoka T, Nelson LM. Update on primary ovarian insufficiency in adolescents. Curr Opin Pediatr. 2015;26(4):511-519.

 2. Covington SN, Hillard PJ, Sterling EW, Nelson LM. A Family Systems Approach to Primary Ovarian Insufficiency. J Pediatr Adolesc Gynecol. 2011;24:137-141.

 3. Tips and Tools for Talking POI