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• W2073451796 abstract "We describe for the first time a case of vitamin B12 deficiency associated with metformin use in an adolescent girl with PCOS. Polycystic ovarian syndrome in adolescent girls is associated with hyperandrogenism, irregular menses, metabolic syndrome, and insulin resistance [ [1] Warren-Ulanch J. Arslanian S. Treatment of PCOS in adolescence. Best Pract Res Clin Endocrinol Metab. 2006; 20: 311-330 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar ]. Metformin ameliorates insulin resistance can restore regular menses. Metformin use has been linked to vitamin B12 deficiency in adult patients with type 2 diabetes but not in women with PCOS [ [2] Palomba S. Falbo A. Giallauria F. Russo T. Tolino A. Zullo F. et al. Effects of metformin with or without supplementation with folate on homocysteine levels and vascular endothelium of women with polycystic ovary syndrome. Diabetes Care. 2010; 33: 246-251 Crossref PubMed Scopus (55) Google Scholar ]. B12 body stores take years to deplete and therefore it is uncommon to find the B12 deficiency in adolescents [ 3 Rasmussen S.A. Fernhoff P.M. Scanlon K.S. Vitamin B12 deficiency in children and adolescents. J Pediatr. 2001; 138: 10-17 Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar , 4 Ting R.Z. Szeto C.C. Chan M.H. Ma K.K. Chow K.M. Risk factors of vitamin B(12) deficiency in patients receiving metformin. Arch Intern Med. 2006; 166: 1975-1979 Crossref PubMed Scopus (219) Google Scholar ]. A 15 1/2 year old girl presented to NIH for further management for PCOS. After menarche at the age of 11 years, her menses were always irregular. She was obese since the age of three years and she was not vegetarian. Her past medical history was significant for atypical Asperger’s syndrome diagnosed at 5 years old and depression, for which she was treated with several psychotropic medications including lithium, lurasidone, atomoxetine, quetiapine, guanfacine and clonidine. She had no family history of PCOS or type 2 diabetes. She met the NIH criteria for PCOS. For her underlying PCOS, the patient was started on treatment with regular metformin 1000 mg once daily at the age of 13 years old. She was on this dose for approximately one year and then her dose was increased to 2000 mg once daily for a second year. When first evaluated at the NIH, serum vitamin B12, homocysteine, methylmalonic acid, and folate concentrations were measured (Table 1). Other causes of vitamin B12 deficiency such as atrophic gastritis and folate deficiency were ruled out based on finding no measurable intrinsic factor or parietal cell antibodies, normal pepsinogen, gastrin and folate concentrations and she wasn’t taking proton pump inhibitor medications. Treatment with oral cyanocobalamin was initiated at a dose of 1000 μg daily. Repeat assessment after one month’s treatment showed a normal B12. The family reported improvement of her psychiatric symptoms after serum vitamin B12 normalization. Vitamin B12 supplementation was discontinued and the patient returned 5 months later. Her serum B12 concentration had decreased, but remained normal. Due to the lack of available large studies in adolescent girls with PCOS it is premature to suggest universal screening for vitamin B12 deficiency in adolescent girls with PCOS. Clinicians should nonetheless consider assessing vitamin B12 status in adolescent girls treated with metformin who also have other risk factors for B12 deficiency such as obesity." @default.
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• W2073451796 date "2014-08-01" @default.
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• W2073451796 title "Vitamin B12 deficiency in an adolescent girl with polycystic ovarian syndrome" @default.
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• W2073451796 doi "https://doi.org/10.1016/j.ejogrb.2014.04.036" @default.
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