AACE/ACE Disease State Clinical ReviewAmerican Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome - Part 1
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INTRODUCTION
The past decade of research into polycystic ovary syndrome (PCOS) has produced important new insights into the evaluation and treatment of this disorder. This document is intended as a guide, highlighting the most current clinical information that a health care provider can use in managing patients with this disorder. It is not intended as a guideline but is written in a question and answer format by experts in clinical practice.
DEFINING PCOS
The Rotterdam criteria for PCOS have been endorsed by the National Institutes of Health (NIH). However, Androgen Excess Society (AES) guidelines may correspond better to the pathogenesis of this disorder, as the AES emphasizes the importance of clinical and/or biochemical hyperandrogenism and placing less importance on polycystic ovary morphology (PCOM). Table 1 lists a comparison of criteria for the diagnosis of PCOS. Nevertheless, there is a general agreement that the diagnosis of PCOS must
Hirsutism
Hirsutism is defined as excessive hair growth in women in a pattern consistent with androgen sensitivity. Hair growth in certain anatomic areas is driven by androgens, and the development of excessive body hair in these areas is a major clinical sign of hyperandrogenism. The hair type present in most women with a hormonal hyperandrogenic disorder is coarse, thickened, pigmented, and long and is called terminal hair. It differs from vellus hair, which is fine, soft, unpigmented, and present in
1. What Makes the Diagnosis of PCOS Challenging in Adolescents? Is It Important to Differentiate PCOS at This Stage, or Is It Acceptable to Delay Diagnosis Until Adulthood?
Because PCOS commonly presents during adolescence, it is important to diagnose the condition as early as possible to evaluate and treat metabolic and cardiovascular (CV) risks, as well as the psychologic and dermatologic issues. There are complicating factors in diagnosing PCOS in adolescent girls, and there is a distinct potential for both over- and underdiagnosis of the syndrome (40). On the one hand, many of the cardinal features of PCOS, including acne, menstrual irregularities, and
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DISCLOSURE
Dr. Neil F. Goodman is on the Speakers Bureau for Abbie. The other authors have no multiplicity of interest to disclose.
The opinions represented in the AACE/ACE Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome are the expressed opinions of the Reproductive Endocrinology Scientific Committee of the American Association of Clinical Endocrinologists and the Androgen Excess and PCOS Society. AACE/ACE Disease State Clinical Reviews are systematically developed documents written to assist health care professionals in medical decision making for specific clinical conditions, but are in no way a substitute for a medical professional's independent judgment and should not be considered medical advice. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment of the authors was applied.
This review article is a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with, and not a replacement for, their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances.