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Controversies of the assesment and management of polycystic ovary syndrome in adolescents

  • Alexia Peña
  • Preeti Dabadghao
Open Access
Oral presentation

Keywords

Metformin Acne Spironolactone Polycystic Ovary Syndrome Congenital Adrenal Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
The diagnosis of polycystic ovary syndrome (PCOS) in adolescents is difficult as the pathological criteria used in adults like menstrual irregularities, acne, hirsutism and polycystic ovarian morphology could be normal physiological findings during puberty; in addition the syndrome is heterogeneous and there is limited high quality evidence. [1, 2, 3] Three international conferences have been held reporting different criteria for diagnosis of PCOS in women [Table 1]. [4, 5, 6] The 2011 Australian PCOS evidence-based guideline [1], the 2012 international evidence-based workshop [2] and the 2013 Endocrine Society Clinical Practice Guideline [3] highlight the issues of applying adult criteria to diagnose PCOS in adolescents.
Table 1

Diagnostic criteria for PCOS in women

PCOS definition

Clinical (modified Ferriman-Gallway score >8*) or biochemical hyperandrogenemia (elevated total or free testosterone level **)

Oligomenorrhoea (< 6-9 menstrual cycles per year) or oligo-anovulation

Polycystic ovaries on ultrasound (>12 follicles in one ovary or volume >10 cc)

NICHD 1990 [4]

Yes

Yes

 

Rotterdam 2003 [5]

Yes

Yes

Yes

 

2 of 3 criteria

AE-PCOS 2009 [6]

Yes

Yes

Yes

  

1 of 2 criteria

* Ethnicity should be considered when assessing hirsutism

**Testosterone assays, puberty and time of the sample should be considered when reviewing levels.

All criteria require exclusion of other conditions: non-classic congenital adrenal hyperplasia, hypothyroidism, Cushing syndrome, hyperprolactinemia or androgen producing tumours which can cause a PCOS-like picture.

Although diagnosis of PCOS is based on its reproductive manifestations, it is a metabolic disorder. PCOS adolescents are at a high risk of having or developing glucose tolerance abnormalities, dyslipidemia and hypertension. Insulin resistance and the consequent development of hyperinsulinaemia seem to be the central pathophysiological mechanism that links PCOS to its associated metabolic derangements; this can occur independent of weight status. Obesity, which is commonly associated with PCOS, exaggerates insulin abnormalities. Adolescents with PCOS should have evaluation of glucose homeostasis and insulin resistance at diagnosis.

PCOS management should include a multidisciplinary team and should be individualized depending on the predominant complaint and weight status. Lifestyle modifications should be the first line treatment in the presence of overweight, obesity and/or insulin resistance. Metformin can also be added. Cyclical progesterone withdrawn bleed or cyclical oral contraceptive pills are used for menstrual irregularities. Antiandrogens like spironolactone and oral contraceptive pills are used for hirsutism. Permanent treatment with laser or electrolysis is usually advised after a course of antiandrogens.

Various aspects of adolescent PCOS will be discussed based on illustrative cases.

References

  1. 1.
    Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BJ, Wong JL, et al: Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust. 2011, 195 (6): S65-S112. 10.5694/mja11.10915.CrossRefPubMedGoogle Scholar
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    Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al: Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013, 98 (12): 4565-4592. 10.1210/jc.2013-2350.CrossRefPubMedGoogle Scholar
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    Zawadzki JK, Dunaif A: Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Polycystic Ovary Syndrome. Edited by: Dunaif A, Givens JR, Haseltine FP, Merriam GR. 1992, Boston: Blackwell Scientific Publications, 377-384.Google Scholar
  5. 5.
    Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004, 81 (1): 19-25.CrossRefGoogle Scholar
  6. 6.
    Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis R, Escobar-Morreale HF, Futterweit W, et al: The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009, 91 (2): 456-488. 10.1016/j.fertnstert.2008.06.035.CrossRefPubMedGoogle Scholar

Copyright information

© Peña and Dabadghao; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Alexia Peña
    • 1
  • Preeti Dabadghao
    • 2
  1. 1.Department of Endocrinology/Diabetes, Women’s and Children’s HospitalThe University of AdelaideAdelaideAustralia
  2. 2.Department of EndocrinologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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