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INTRODUCTION

Polycystic ovarian syndrome (PCOS) is a common endocrinopathy typified by oligoovulation or anovulation, signs of androgen excess, and an excess of small ovarian cysts. These signs and symptoms vary widely between women and within individuals over time. Women with this endocrine disorder also have higher rates of obesity, dyslipidemia, and insulin resistance, which raise long-term health risks. As a result, women with PCOS may first present to various medical specialists, including pediatricians, gynecologists, internists, endocrinologists, or dermatologists.

DEFINITION

Polycystic Ovarian Syndrome

In 2003 in Rotterdam, The Netherlands, PCOS in adults was redefined in a consensus meeting between the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM)—The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004. As shown in Table 18-1, affected individuals must meet two out of three criteria. However, because other etiologies, such as congenital adrenal hyperplasia, androgen-secreting tumors, and hyperprolactinemia, also may lead to oligoovulation and/or androgen excess, these must be excluded. Thus, PCOS currently is a diagnosis of exclusion.

TABLE 18-1Definition of PCOS

The Rotterdam criteria constitute a broader spectrum than that formerly put forward by the National Institutes of Health (NIH) Conference in 1990 (Zawadzki, 1990). The prominent difference is that the NIH Conference defined PCOS without regard to ovarian sonographic appearance. A third organization—The Androgen Excess and PCOS Society (AE-PCOS)—also has defined criteria for PCOS (Azziz, 2006). Subsequently, an NIH (2012) workshop emphasized the variable presentation of PCOS. Their consensus recommended the 2003 Rotterdam criteria be used to assign one of four specific patient phenotypes (see Table 18-1).

Importantly, these same criteria are not appropriate for adolescents. Guidance regarding specific criteria and thresholds are found later in those specific sections. In sum, the diagnosis of PCOS in adolescence is challenging because many symptoms of PCOS mimic the normal physiologic responses of puberty. For adolescents with incomplete criteria for a firm diagnosis of PCOS, careful surveillance ...

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