Clinical Variability in Approaches to Polycystic Ovary Syndrome
ABSTRACT The objective of this study was to evaluate methods of initial diagnosis and management of polycystic ovary syndrome (PCOS) among members of the North American Society for Pediatric and Adolescent Gynecology (NASPAG) to assess the degree of practice heterogeneity among specialist providers of adolescent care.
Cross-sectional, anonymous, internet survey
NASPAG membership (N = 326; Respondents = 127 (39%))
Percentage of respondents who incorporated specific tests at initial diagnosis was highly variable ranging from 87% (thyroid stimulating hormone) to 17% (sex hormone binding globulin). Oral contraceptives and diet modification/exercise were the most common therapies recommended by 98% and 90% of respondents respectively.
Considerable practice heterogeneity was present with regards to diagnostic testing for suspected PCOS. Recommendations for first-line therapy were more consistent. Future studies should clarify the clinical utility of specific diagnostic tests for adolescents, such that selection of diagnostic testing is evidence based.
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ABSTRACT: Polycystic ovary syndrome is a common endocrine disorder often diagnosed in adolescence or early adulthood. In adolescence, the many similarities between normal features of puberty and symptoms of PCOS make it challenging to confirm the diagnosis. Even among adult women, the changing definitions of PCOS may lead to inaccurate diagnoses. Women may present with a variety of symptoms to different healthcare providers, and may be treated only for the presenting symptoms without evaluation of the syndrome and its associated morbidities. Timely evaluations, accurate diagnosis, appropriate interventions, and multidisciplinary healthcare teams can be valuable because women with PCOS have an increased risk for obesity, impaired glucose tolerance, diabetes, dyslipidemia, metabolic syndrome, infertility, endometrial cancer and anxiety and mood disorders. Appropriate transition of care for the adolescent from pediatric to adult health care providers should include education of the patient and her parents regarding the chronic nature of the syndrome and need for continued follow up. Girls with symptoms suggestive of PCOS who fail to fulfill diagnostic criteria should undergo prolonged observation. Early identification of PCOS at different entry points in the health care system will require physician education and improved access.The Journal of Clinical Endocrinology and Metabolism 02/2014; 99(5):jc20134190. DOI:10.1210/jc.2013-4190 · 6.31 Impact Factor
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ABSTRACT: Objective: The purpose of this study is to identify trends in the clinical workup, diagnosis, and treatment of polycystic ovary syndrome by pediatric endocrinologists, pediatric gynecologists, and adolescent medicine specialists. Design: Retrospective chart review. Setting: Tertiary care medical center. Participants: Females aged 11-18 y who were evaluated for PCOS from June 2009 to October 2011 were included. Any patients with coexisting diagnoses of other primary etiology for amenorrhea were excluded. Patients were identified by ICD-9 codes for PCOS, hypersecretion of ovarian androgens, irregular menses, hirsutism, oligomenorrhea, or amenorrhea. 261 patients were included: 144 from endocrinology, 9 from gynecology, and 108 from adolescent pediatric practices. Results: There were no significant differences in the androgen labs ordered by the subspecialties. Gynecologists ordered pelvic ultrasonography for 89% (n = 8) of patients, compared to 9% (n = 10) by adolescent medicine specialists and 24% (n = 34) by endocrinologists (P < .0001). Endocrinologists were most likely to treat patients who met diagnostic criteria for PCOS with metformin (58%, n = 66), compared to gynecologists (14%, n = 1) and adolescent medicine specialists (5%, n = 3) (P < .0001). Gynecologists (43%, n = 3) and adolescent medicine specialists (58%, n = 39) were more likely than endocrinologists (24%, n = 27) to treat patients with oral contraceptive pills (P < .0001). Conclusions: Inconsistent diagnosis and treatment strategies for young women with PCOS are evident among pediatric subspecialties, reflecting lack of standardized care for adolescents. Quantifying outcomes based on diagnostic and therapeutic approaches are important next steps.Journal of Pediatric and Adolescent Gynecology 02/2015; 26(2). DOI:10.1016/j.jpag.2014.03.002 · 1.81 Impact Factor
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ABSTRACT: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women that manifests itself with a variety of features. For this reason, three different diagnostic criteria have been introduced. For adults, the National Institutes of Health Conference (NIH) criteria, which consists of hyperandrogenism and oligo-anovulation, is the most widely used. Symptoms of PCOS usually start with puberty and may overlap with normal pubertal development. Hormonal fluctuations during this period make the diagnosis of PCOS more difficult. Until now, there is no validated diagnostic criteria for PCOS in adolescents. Although menstrual disorders and cosmetic problems are the most common complaints of adolescents with PCOS, patients should also be evaluated for the potential risk for insulin resistance, obesity, subclinical atherosclerosis, diabetes, metabolic syndrome and cardiovascular disease. Obesity is the most prominent predictor of metabolic syndrome. As the incidence of obesity is increasing both in childhood and adolescence, governments will be faced with a social and economic burden in the future. Adolescents with PCOS are more obese than normal adolescents and have an increased risk of metabolic syndrome. It is suggested that abdominal adiposity increases the risk of metabolic syndrome by inducing various cytokine secretions. Although there is no consensus on metabolic syndrome criteria in the adolescent period, International Diabetes Federation (IDF) criteria may be used for children older than 10 years. Various clinical and metabolic markers are investigated for the prediction of metabolic syndrome in the literature. Waist circumference, serum triglycerides and androgens are the suspected predictors of metabolic syndrome. The prevention of abdominal adiposity and the early diagnosis of PCOS in adolescence should be the main target for the prevention of metabolic syndrome. Clinicians should investigate adolescents with PCOS for metabolic and cardiovascular risks and take preventive action. A Mediterranean diet, low in fat and high in fruits and vegetables, along with moderate-intensity exercise and smoking cessation are the recommended interventions for especially obese adolescents with PCOS. Metformin may be the treatment of choice when lifestyle modifications are ineffective.03/2014; 15(1):49-55. DOI:10.5152/jtgga.2014.95776