PCOS

  • There is no agreement as to which tests are truly diagnostic of polycystic ovarian syndrome, particularly in the adolescent population.   Various diagnostic criteria have been proposed, including Sultan & Paris's criteria1:

    4 out of the following 5 criteria are met:

    • Oligomenorrhoea or amenorrhoea two years after menarche
    • Clinical hyperandrogenism: persistent acne, severe hirsutism
    • Biological hyperandrogenism: plasma testosterone > 50 ng/dl, LH/FSH > 2
    • Insulin resistance/hyperinsulinaemia: acanthosis nigricans, abdominal obesity, glucose intolerance
    • Polycystic ovaries on ultrasonography

    Up to 30% of women without PCOS will have polycystic ovaries on ultrasound. 

    It has been suggested that ovaries in the adolescent population should only be considered polycystic if there are more than 25 follicles per ovary (the criteria in adult women is at least 10 follicles measuring from 2-8 mm). Adolescent patients most frequently have transabdominal scanning only, and this is regarded as inferior to transvaginal scanning for visualising ovaries.

    Note:  The normal reference range for androgen levels in women varies between laboratories.  There are no true markers of insulin resistance. 

    The following tests should be considered, but not all will be needed, depending on the patient's presentation:

    Blood tests:

    • 75g OGTT with insulin levels
    • fasting lipids
    • testosterone
    • SHBG
    • free androgen index
    • 17-OH-P
    • FSH, LH
    • TSH
    • Prolactin

    Imaging studies:

    • Pelvic ultrasound

    References

    1. Sultan C, Paris F. Clinical expression of polycystic ovary syndrome in adolescent girls. Fertil Steril 2006;86 (Suppl 1):S6.
    2. Diamanti-Kandarakis E. PCOS in adolescents. Best Pract Res Clin Obstet Gynaecol 2010;24:173-183.

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