Clinical utility of magnetic resonance imaging and ultrasonography for diagnosis of polycystic ovary syndrome in adolescent girls

Kenigsberg, Lisa; Agarwal, Chhavi; Sin, Sanghun; Shifteh, Keivan; Isasi, Carmen R.; Crespi, Rebecca; Ivanova, Janeta; Coupey, Susan M.; Heptulla, Rubina A.; Arens, Raanan

doi:10.1016/j.fertnstert.2015.08.002

Cited by 37 publications

(33 citation statements)

References 23 publications

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“…1,4 Consequently, one-third to half of normal adolescents meet adult criteria for PCOM. 52 Fig 6); it has been postulated that these are carriers of PCOS or at risk for PCOS.…”

Section: The Quandary Of Polycystic Ovary Morphology In Adolescencementioning

confidence: 99%

“…1,4 Consequently, one-third to half of normal adolescents meet adult criteria for PCOM. 52 Until further research establishes definitive criteria, current evidence suggests that a mean ovarian volume .12 cc (or single ovary .15 cc) be considered enlarged in adolescents. 1,4,52 PCOM is variably related to hyperandrogenism in adults.…”

mentioning

confidence: 99%

“…52 Until further research establishes definitive criteria, current evidence suggests that a mean ovarian volume .12 cc (or single ovary .15 cc) be considered enlarged in adolescents. 1,4,52 PCOM is variably related to hyperandrogenism in adults. 1 On one hand, it is absent in 5% to 20% of adult PCOS.…”

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confidence: 99%

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The Diagnosis of Polycystic Ovary Syndrome in Adolescents

2015

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Consensus has recently been reached by international pediatric subspecialty societies that otherwise unexplained persistent hyperandrogenic anovulation using age-and stage-appropriate standards are appropriate diagnostic criteria for polycystic ovary syndrome (PCOS) in adolescents. The purpose of this review is to summarize these recommendations and discuss their basis and implications. Anovulation is indicated by abnormal uterine bleeding, which exists when menstrual cycle length is outside the normal range or bleeding is excessive: cycles outside 19 to 90 days are always abnormal, and most are 21 to 45 days even during the first postmenarcheal year. Continued menstrual abnormality in a hyperandrogenic adolescent for 1 year prognosticates at least 50% risk of persistence. Hyperandrogenism is best indicated by persistent elevation of serum testosterone above adult norms as determined in a reliable reference laboratory. Because hyperandrogenemia documentation can be problematic, moderate-severe hirsutism constitutes clinical evidence of hyperandrogenism. Moderate-severe inflammatory acne vulgaris unresponsive to topical treatment is an indication to test for hyperandrogenemia. Treatment of PCOS is symptom-directed. Cyclic estrogenprogestin oral contraceptives are ordinarily the preferred first-line medical treatment because they reliably improve both the menstrual abnormality and hyperandrogenism. First-line treatment of the comorbidities of obesity and insulin resistance is lifestyle modification with calorie restriction and increased exercise. Metformin in conjunction with behavior modification is indicated for glucose intolerance. Although persistence of hyperandrogenic anovulation for $2 years ensures the distinction of PCOS from physiologic anovulation, early workup is advisable to make a provisional diagnosis so that combined oral contraceptive treatment, which will mask diagnosis by suppressing hyperandrogenemia, is not unnecessarily delayed.Polycystic ovary syndrome (PCOS) is the most common cause of chronic hyperandrogenic anovulation and the single most common cause of infertility in young women. 1 It is also a risk factor for metabolic syndrome-related comorbidities and for impaired wellbeing and mortality. 2 Considerable evidence suggests that PCOS has diverse causes, arising as a complex trait with contributions from both heritable and environmental factors that affect ovarian steroidogenesis. 3,4 Insulinresistant hyperinsulinism, in part related to coexistent obesity, is the most common nonsteroidogenic factor. The complex interactions generally mimic an autosomal dominant trait with variable penetrance: the disorder is correlated in identical twins 5 ; about half of sisters are hyperandrogenic, and half of these also have oligo-amenorrhea and thus PCOS 6,7 ; and polycystic ovaries appear to be inherited as an autosomal dominant trait. 7,8 Three percent to 35% of mothers have PCOS, 9,10 and metabolic syndrome prevalence is high in parents and siblings. 11-13 The syndrome was first described...

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“…1,4 Consequently, one-third to half of normal adolescents meet adult criteria for PCOM. 52 Fig 6); it has been postulated that these are carriers of PCOS or at risk for PCOS.…”

Section: The Quandary Of Polycystic Ovary Morphology In Adolescencementioning

confidence: 99%

mentioning

confidence: 99%

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The Diagnosis of Polycystic Ovary Syndrome in Adolescents

2015

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“…Although magnetic resonance (MR) imaging is a valuable alternative for analyzing the follicular characteristics in women with PCOS, it has received little study in adolescent girls (9)(10)(11). MR imaging is a noninvasive modality that is unaffected by fat thickness.…”

Section: Pediatric Imaging: Polycystic Ovary Syndrome In Adolescentsmentioning

confidence: 99%

Polycystic Ovary Syndrome in Adolescents: Which MR Imaging–based Diagnostic Criteria?

et al. 2017

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Purpose To evaluate the validity and reproducibility of magnetic resonance (MR) imaging-based ovarian morphologic measurements for diagnosis of polycystic ovary syndrome (PCOS) in adolescents. Materials and Methods This case-control study included 110 adolescent girls (age range, 13-17 years) who underwent pelvic MR imaging in 2006-2015. The case group included girls with high (n = 40, hyperandrogenism and oligomenorrhea or amenorrhea), intermediate (n = 8, hyperandrogenism), or low (n = 7, oligomenorrhea or amenorrhea) suspicion of PCOS. Control subjects were 55 age-matched (± 2 years) girls with no clinical hyperandrogenism, oligomenorrhea, or amenorrhea. The validity (sensitivity, specificity, and area under the receiver operating characteristic curve [AUC]) of the number of follicles per ovary (FPO) measuring 9 mm or smaller (FPO-9) and FPO measuring 5 mm or smaller (FPO-5), ovarian volume (OV), sphericity index, peripheral distribution of follicles, and absence of a dominant follicle were determined, with girls who were highly suspected of having PCOS compared with control subjects as the reference. Two radiologists independently measured these criteria in 50 girls who were suspected of having PCOS to assess reproducibility (κ and intraclass correlation coefficients [ICCs]). Results All criteria except sphericity index and absence of a dominant follicle were significantly associated with the level of suspicion of PCOS (P ≤ .05). The AUCs for FPO-9 (0.78; 95% confidence interval [CI]: 0.68, 0.87), FPO-5 (0.73; 95% CI: 0.62, 0.83), and OV (0.77; 95% CI: 0.68, 0.87) were significantly greater than 0.5; that was not true for sphericity index (AUC, 0.58; 95% CI: 0.47, 0.70). Sensitivity and specificity for peripheral distribution of follicles were 33% (95% CI: 19%, 49%) and 95% (95% CI: 85%, 99%), respectively; for absence of a dominant follicle, they were 90% (95% CI: 76%, 97%) and 27% (95% CI: 16%, 41%), respectively. Reproducibility was almost perfect for OV (ICC, 0.89), substantial for absence of a dominant follicle (κ, 0.74), moderate for FPO-9 (ICC, 0.54) and FPO-5 (ICC, 0.61), and fair for peripheral distribution of follicles (κ, 0.37). Conclusion The most accurate MR imaging-based diagnostic criteria for PCOS were OV, FPO-9, and peripheral distribution of follicles; however, reproducibility of these measures was moderate, except that for OV (ICC, 0.89). RSNA, 2017 Online supplemental material is available for this article.

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“…Sin embargo, la ecografía sí que resulta una técnica útil para valorar a aquellas pacientes que presentan alteraciones menstruales aisladas (sin hiperandrogenismo) o hiperandrogenismo sin alteraciones menstruales, ya que el diagnóstico del SOP según los criterios de Rotterdam solo podrá realizarse, entonces, en presencia de ovarios con morfología ecográfica poliquística. También resulta de especial utilidad la ecografía transvaginal en la valoración de pacientes con hiperandrogenismo grave o de muy rápi-da evolución para descartar la presencia de tumores ováricos secretores de andrógenos 11,12 (fig. 4).…”

Section: Ecografía Ginecológicaunclassified

El ovario poliquístico y las enfermedades dermatológicas

López¹,

Escalona²,

Álvarez³

2017

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artículo de revisión REsUMENEl síndrome del ovario poliquístico (SOP) es una enfermedad multisistémica, que se caracteriza por disfunción ovulatoria e hiperandrogenismo. Su diagnóstico se basa en los criterios de Rotterdam, y afecta a entre un 6,5 y un 8 % de la población. Su patogenia está determinada por una secreción aumentada de hormona luteinizante, que conduce a un aumento de los andrógenos de origen ová-rico, a lo cual se une un estado hiperinsulinémico, que disminuye la síntesis de globulina de fijación a las hormonas sexuales o SHBG (sex hormone-binding globulin) y potencia la síntesis de andrógenos. A nivel dermatológico, los signos con los que se relaciona son hirsutismo, acné, acantosis nigricans y alopecia.El tratamiento de los trastornos dermatológicos generados por el SOP comprende tanto las medidas terapéuticas locales (p. ej., depilación permanente o definitiva) como las sistémicas. De entre los tratamientos sistémicos, destacamos los anticonceptivos hormonales orales, así como los fármacos antiandrogénicos; ambos grupos de fármacos han demostrado mejorar el acné y el hirsutismo de estas pacientes. Para el tratamiento de la alopecia, el minoxidil al 2 o al 5 % y la finasterida han resultado efectivos. En todos los grupos de pacientes, se recomienda dieta, ejercicio y cambios en el estilo de vida.Palabras clave: ovario poliquístico, hiperandrogenismo, síndrome metabólico, hirsutismo, acné. AbsTRACTPolycystic ovary syndrome (PCOS) is a multisystemic disease. Oligo-anovulation and hyperandrogenism are the most important features of this syndrome. Diagnosis of PCOS is made according to the Rotterdam criteria, and the syndrome affects between 6.5 and 8 % of the female population. Pathogenically, PCOS patients show an increased luteinizing hormone secretion, that generates an increased secretion of androgens, and a hyperinsulinemic state, that

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Clinical utility of magnetic resonance imaging and ultrasonography for diagnosis of polycystic ovary syndrome in adolescent girls

Cited by 37 publications

References 23 publications

The Diagnosis of Polycystic Ovary Syndrome in Adolescents

The Diagnosis of Polycystic Ovary Syndrome in Adolescents

Polycystic Ovary Syndrome in Adolescents: Which MR Imaging–based Diagnostic Criteria?

El ovario poliquístico y las enfermedades dermatológicas

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