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Impact of Diagnostic Criteria

Impact of Diagnostic Criteria

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Polycystic Ovary Syndrome

Part of the book series: Contemporary Endocrinology ((COE))

Summary

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of the reproductive-aged women with considerable metabolic and reproductive morbidity. There has been an ongoing debate regarding definition and diagnostic criteria of PCOS since its first description by Stein and Leventhal in 1935. The most widely used diagnostic criteria (so-called 1990 NIH criteria) define PCOS as the presence of hyperandrogenism and oligo-ovulation after exclusion of the other known disorders. Alternatively, a recently convened international workshop sponsored by European Society of Human Reproduction and Embryology (ESHRE)/American Society for Reproductive Medicine (ASRM) suggested that PCOS should be defined by the presence of two of the following three criteria: (1) oligo- or anovulation; (2) clinical and/or biochemical signs of hyperandrogenism; and (3) polycystic ovaries (PCO). The Rotterdam conference provided clear guidelines for determination of clinical, hormonal, and biochemical features of PCOS, and acknowledged the limitations and difficulties in assessment of clinical hyperandrogenism, hyperandrogenemia, and PCO. Essentially, all patients diagnosed by 1990 NIH criteria would also be defined as having PCOS according to 2003 Rotterdam criteria. However, Rotterdam conference introduced two new phenotypes: (1) hyperandrogenism with PCO and normal ovulation, and (2) PCO and oligo-anovulation without hyperandrogenism. Hyperandrogenic ovulatory women with PCO appear to have similar metabolic and reproductive features, albeit at a modest level, compared with classic PCOS patients with hyperandrogenic chronic anovulation. However, data are scarce regarding phenotypic features of normoandrogenic oligo-ovulatory women with PCO. The 2003 Rotterdam criteria will potentially increase the number of individuals identified as having PCOS, as it will capture the phenotypes that appear to represent the milder forms of the syndrome. Studies assessing the metabolic and reproductive characteristics of the different subgroups of PCOS patients diagnosed by Rotterdam criteria are urgently needed. It is of utmost importance that the applied diagnostic criteria in clinical studies of PCOS are thoroughly documented for the interpretation and comparability of the results.

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References

  1. Vallisneri A. Storia della generazione dell’uomo e dell’animale; 1721. Cited in Cooke ID, Lunenfeld B. Res Clin Forums 1989; 11:109–113.

    Google Scholar 

  2. Chereau A. Mémories pour servir a l‘étude des maladies des ovaries. Masson & Cie 1844:Paris: Fortin.

    Google Scholar 

  3. Stein IF, Leventhal, M.L. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29:181–91.

    Google Scholar 

  4. Balen A, Michelmore K. What is polycystic ovary syndrome? Are national views important? Hum Reprod 2002; 17:2219–27.

    Article  PubMed  Google Scholar 

  5. Homburg R. What is polycystic ovarian syndrome? A proposal for a consensus on the definition and diagnosis of polycystic ovarian syndrome. Hum Reprod 2002; 17:2495–9.

    Article  PubMed  CAS  Google Scholar 

  6. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome. In: Dunaif A, Givens J, Haseltine F, Merriam GR, eds. Polycystic Ovary Syndrome. Boston: Blackwell Scientific Publications, 1992:377–84.

    Google Scholar 

  7. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998; 83:3078–82.

    Article  PubMed  CAS  Google Scholar 

  8. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 1999; 84:4006–11.

    Article  PubMed  CAS  Google Scholar 

  9. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000; 85:2434–8.

    Article  PubMed  CAS  Google Scholar 

  10. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89:2745–9.

    Article  PubMed  CAS  Google Scholar 

  11. 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; 81:19–25.

    Google Scholar 

  12. Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19:41–7.

    Article  Google Scholar 

  13. Carmina E. Diagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines. Minerva Ginecol 2004; 56:1–6.

    PubMed  CAS  Google Scholar 

  14. Dunaif A. Hyperandrogenemia is necessary but not sufficient for polycystic ovary syndrome. Fertil Steril 2003; 80:262–3.

    Article  PubMed  Google Scholar 

  15. Azziz R. Androgen excess is the key element in polycystic ovary syndrome. Fertil Steril 2003; 80:252–4.

    Article  PubMed  Google Scholar 

  16. Azziz R. Diagnostic criteria for polycystic ovary syndrome: a reappraisal. Fertil Steril 2005; 83: 1343–6.

    Article  PubMed  Google Scholar 

  17. Azziz R. Diagnosis of polycystic ovarian syndrome: the rotterdam criteria are premature. J Clin Endocrinol Metab 2006; 91:781–5.

    Article  PubMed  CAS  Google Scholar 

  18. Franks S. Diagnosis of polycystic ovarian syndrome: in defense of the rotterdam criteria. J Clin Endocrinol Metab 2006; 91:786–9.

    Article  PubMed  CAS  Google Scholar 

  19. Goldzieher JW, Axelrod LR. Clinical and biochemical features of polycystic ovarian disease. Fertil Steril 1963; 14:631–53.

    PubMed  CAS  Google Scholar 

  20. Smith KD, Steinberger E, Perloff WH. Polycystic ovarian disease. A report of 301 patients. Am J Obstet Gynecol 1965; 93:994–1001.

    PubMed  CAS  Google Scholar 

  21. Franks S. Polycystic ovary syndrome: a changing perspective. Clin Endocrinol (Oxf) 1989; 31: 87–120.

    CAS  Google Scholar 

  22. Conway GS, Honour JW, Jacobs HS. Heterogeneity of the polycystic ovary syndrome: clinical, endocrine and ultrasound features in 556 patients. Clin Endocrinol (Oxf) 1989; 30:459–70.

    CAS  Google Scholar 

  23. Balen AH, Conway GS, Kaltsas G, et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995; 10:2107–11.

    PubMed  CAS  Google Scholar 

  24. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992; 167:1807–12.

    PubMed  CAS  Google Scholar 

  25. The evaluation and treatment of androgen excess. Fertil Steril 2004; 82 Suppl 1:S173–80.

    Google Scholar 

  26. Rosner W. Errors in the measurement of plasma free testosterone. J Clin Endocrinol Metab 1997; 82:2014–5.

    PubMed  CAS  Google Scholar 

  27. Yildiz BO, Gedik O. Insulin resistance in polycystic ovary syndrome: hyperandrogenemia versus normoandrogenemia. Eur J Obstet Gynecol Reprod Biol 2001; 100:62–6.

    Article  PubMed  CAS  Google Scholar 

  28. Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril 2005; 83:1717–23.

    Article  PubMed  Google Scholar 

  29. Azziz R, Sanchez LA, Knochenhauer ES, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab 2004; 89:453–62.

    Article  PubMed  CAS  Google Scholar 

  30. Carmina E, Lobo RA. Do hyperandrogenic women with normal menses have polycystic ovary syndrome? Fertil Steril 1999; 71:319–22.

    Article  PubMed  CAS  Google Scholar 

  31. O’Driscoll JB, Mamtora H, Higginson J, Pollock A, Kane J, Anderson DC. A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia. Clin Endocrinol (Oxf) 1994; 41:231–6.

    CAS  Google Scholar 

  32. Dewailly D, Robert Y, Helin I, et al. Ovarian stromal hypertrophy in hyperandrogenic women. Clin Endocrinol (Oxf) 1994; 41:557–62.

    CAS  Google Scholar 

  33. Clayton RN, Ogden V, Hodgkinson J, et al. How common are polycystic ovaries in normal women and what is their significance for the fertility of the population? Clin Endocrinol (Oxf) 1992; 37:127–34.

    CAS  Google Scholar 

  34. Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf) 1999; 51:779–86.

    Article  CAS  Google Scholar 

  35. Kiddy DS, Sharp PS, White DM, et al. Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol (Oxf) 1990; 32:213–20.

    CAS  Google Scholar 

  36. Kousta E, White DM, Cela E, McCarthy MI, Franks S. The prevalence of polycystic ovaries in women with infertility. Hum Reprod 1999; 14:2720–3.

    Article  PubMed  CAS  Google Scholar 

  37. Homburg R. Polycystic ovary syndrome - from gynaecological curiosity to multisystem endocrinopathy. Hum Reprod 1996; 11:29–39.

    PubMed  CAS  Google Scholar 

  38. Enskog A, Henriksson M, Unander M, Nilsson L, Brannstrom M. Prospective study of the clinical and laboratory parameters of patients in whom ovarian hyperstimulation syndrome developed during controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril 1999; 71:808–14.

    Article  PubMed  CAS  Google Scholar 

  39. Adams J, Franks S, Polson DW, et al. Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone. Lancet 1985; 2:1375–9.

    Article  PubMed  CAS  Google Scholar 

  40. Eden JA. Which is the best test to detect the polycystic ovary? Aust N Z J Obstet Gynaecol 1988; 28:221–4.

    PubMed  CAS  Google Scholar 

  41. Saxton DW, Farquhar CM, Rae T, Beard RW, Anderson MC, Wadsworth J. Accuracy of ultrasound measurements of female pelvic organs. Br J Obstet Gynaecol 1990; 97:695–9.

    PubMed  CAS  Google Scholar 

  42. Amer SA, Li TC, Bygrave C, Sprigg A, Saravelos H, Cooke ID. An evaluation of the inter-observer and intra-observer variability of the ultrasound diagnosis of polycystic ovaries. Hum Reprod 2002; 17:1616–22.

    Article  PubMed  CAS  Google Scholar 

  43. Farquhar CM, Birdsall M, Manning P, Mitchell JM, France JT. The prevalence of polycystic ovaries on ultrasound scanning in a population of randomly selected women. Aust N Z J Obstet Gynaecol 1994; 34:67–72.

    PubMed  CAS  Google Scholar 

  44. Ardaens Y, Robert Y, Lemaitre L, Fossati P, Dewailly D. Polycystic ovarian disease: contribution of vaginal endosonography and reassessment of ultrasonic diagnosis. Fertil Steril 1991; 55:1062–8.

    PubMed  CAS  Google Scholar 

  45. Franks S, Adams J, Mason H, Polson D. Ovulatory disorders in women with polycystic ovary syndrome. Clin Obstet Gynaecol 1985; 12:605–32.

    PubMed  CAS  Google Scholar 

  46. Birdsall MA, Farquhar CM. Polycystic ovaries in pre and post-menopausal women. Clin Endocrinol (Oxf) 1996; 44:269–76.

    Article  CAS  Google Scholar 

  47. Herter LD, Magalhaes JA, Spritzer PM. Relevance of the determination of ovarian volume in adolescent girls with menstrual disorders. J Clin Ultrasound 1996; 24:243–8.

    Article  PubMed  CAS  Google Scholar 

  48. Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries–a common finding in normal women. Lancet 1988; 1:870–2.

    Article  PubMed  CAS  Google Scholar 

  49. Koivunen R, Laatikainen T, Tomas C, Huhtaniemi I, Tapanainen J, Martikainen H. The prevalence of polycystic ovaries in healthy women. Acta Obstet Gynecol Scand 1999; 78:137–41.

    Article  PubMed  CAS  Google Scholar 

  50. Abdel Gadir A, Khatim MS, Mowafi RS, Alnaser HM, Muharib NS, Shaw RW. Implications of ultrasonically diagnosed polycystic ovaries. I. Correlations with basal hormonal profiles. Hum Reprod 1992; 7:453–7.

    PubMed  CAS  Google Scholar 

  51. Kaltsas GA, Korbonits M, Isidori AM, et al. How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing’s syndrome? Clin Endocrinol (Oxf) 2000; 53:493–500.

    Article  CAS  Google Scholar 

  52. Ehrmann DA, Rosenfield RL, Barnes RB, Brigell DF, Sheikh Z. Detection of functional ovarian hyperandrogenism in women with androgen excess. N Engl J Med 1992; 327:157–62.

    Article  PubMed  CAS  Google Scholar 

  53. Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A. Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype. J Clin Endocrinol Metab 2005; 90:2571–9.

    Article  PubMed  CAS  Google Scholar 

  54. Loucks TL, Talbott EO, McHugh KP, Keelan M, Berga SL, Guzick DS. Do polycystic-appearing ovaries affect the risk of cardiovascular disease among women with polycystic ovary syndrome? Fertil Steril 2000; 74:547–52.

    Article  PubMed  CAS  Google Scholar 

  55. Franks S. Polycystic ovary syndrome. N Engl J Med 1995; 333:853–61.

    Article  PubMed  CAS  Google Scholar 

  56. Carmina E, Lobo RA. Polycystic ovaries in Hirsute women with normal menses. Am J Med 2001; 111:602–6.

    Article  PubMed  CAS  Google Scholar 

  57. Robinson S, Kiddy D, Gelding SV, et al. The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries. Clin Endocrinol (Oxf) 1993; 39:351–5.

    CAS  Google Scholar 

  58. Chang PL, Lindheim SR, Lowre C, et al. Normal ovulatory women with polycystic ovaries have hyperandrogenic pituitary-ovarian responses to gonadotropin-releasing hormone-agonist testing. J Clin Endocrinol Metab 2000; 85:995–1000.

    Article  PubMed  CAS  Google Scholar 

  59. Vanky E, Kjotrod S, Salvesen KA, Romundstad P, Moen MH, Carlsen SM. Clinical, biochemical and ultrasonographic characteristics of Scandinavian women with PCOS. Acta Obstet Gynecol Scand 2004; 83:482–6.

    Article  PubMed  Google Scholar 

  60. Carmina E, Rosato F, Janni A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab 2006; 91:2–6.

    Article  PubMed  CAS  Google Scholar 

  61. Taponen S, Ahonkallio S, Martikainen H, et al. Prevalence of polycystic ovaries in women with self-reported symptoms of oligomenorrhoea and/or hirsutism: Northern Finland Birth Cohort 1966 Study. Hum Reprod 2004; 19:1083–8.

    Article  PubMed  CAS  Google Scholar 

  62. Norman RJ, Hague WM, Masters SC, Wang XJ. Subjects with polycystic ovaries without hyperandrogenaemia exhibit similar disturbances in insulin and lipid profiles as those with polycystic ovary syndrome. Hum Reprod 1995; 10:2258–61.

    PubMed  CAS  Google Scholar 

  63. Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference? Clin Endocrinol (Oxf) 2002; 57:343–50.

    Article  CAS  Google Scholar 

  64. Carmina E, Legro RS, Stamets K, Lowell J, Lobo RA. Difference in body weight between American and Italian women with polycystic ovary syndrome: influence of the diet. Hum Reprod 2003; 18: 2289–93.

    Article  PubMed  Google Scholar 

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Authors
  1. Bulent O. Yildiz MD
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Editors and Affiliations

  1. Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, IL

    Andrea Dunaif MD

  2. Department of Reproductive Medicine, University of California, San Diego School of Medicine, La Jolla, CA

    R. Jeffrey Chang MD

  3. Institute of Reproductive and Developmental Biology, Imperial College London, London, UK

    Stephen Franks MD, FMEDSCI

  4. Department of Ob/Gyn, Penn State College of Medicine, Hershey, PA

    Richard S. Legro MD

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© 2008 Humana Press

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Yildiz, B.O. (2008). Impact of Diagnostic Criteria. In: Dunaif, A., Chang, R.J., Franks, S., Legro, R.S. (eds) Polycystic Ovary Syndrome. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-108-6_21

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  • DOI: https://doi.org/10.1007/978-1-59745-108-6_21

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-831-7

  • Online ISBN: 978-1-59745-108-6

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