<i>Polycystic Ovary Syndrome in Adolescence</i>

Blank, Susan K.; Helm, Kristin D.; McCartney, Christopher R.; Marshall, John C.

doi:10.1196/annals.1429.005

Cited by 89 publications

(56 citation statements)

References 109 publications

(201 reference statements)

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“…• Indeed, PCOS and control population share a significant overlap in ovarian morphology, and a large proportion (estimates range from 10 to 48%) of adolescents who do not have PCOS may have polycysticappearing ovaries. [43][44][45] • A PCOS should never be considered in young women until 2 years of establishing normal menstruations.…”

Section: Discussionmentioning

confidence: 99%

The New Three-dimensional Ultrasound Modes allow a Better Polycystic Ovary Syndrome Ultrasound Diagnosis beyond the Rotterdam Criteria

Raga¹,

Caballero²,

Bonilla³

et al. 2015

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Polycystic ovary syndrome (PCOS) is a complex endocrine con dition affecting reproductiveaged women. The exact etiology of this condition remains elusive and the definition of the syndrome has undergone several revisions in which ovarian morphology plays a central role. This review describes several and modern threedimensional (3D) ultrasound modes including: HDlive TM , virtual organ computeraided analysis (VOCAL), inversion mode, Radiance System Architecture TM , for the study of PCOSrelated ovarian morphology. This stateoftheart technology should be employed-when available, in the evaluation of PCOSrelated ovarian morphology.

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Section: Discussionmentioning

confidence: 99%

The New Three-dimensional Ultrasound Modes allow a Better Polycystic Ovary Syndrome Ultrasound Diagnosis beyond the Rotterdam Criteria

Raga¹,

Caballero²,

Bonilla³

et al. 2015

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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“…However, the adult diagnostic criteria present a practical challenge in adolescents. Many adolescents exhibit physiologic menstrual irregularity and signs of androgen excess (e.g., acne) in the peripubertal period (13). In addition, normative testosterone levels are ill defined in this age group (14), and normal adolescent ovarian morphology overlaps with that of women with PCOS (15,16).…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

Kamboj

Bonny

2017

Transl. Pediatr

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Controversy continues about the underlying etiopathogenesis, diagnostic criteria, and recommendations for polycystic ovary syndrome (PCOS) in adolescents. Recent literature has recognized these deficiencies and evidence based expert recommendations have become more available. The purpose of this chapter is to offer primary care providers a practical understanding and approach to the diagnosis and treatment of PCOS in adolescents. Although the presence of polycystic ovary morphology (PCOM) is included as a key diagnostic criterion of PCOS in adults, it is currently not recommended for the diagnosis in adolescents. As such, the diagnosis of PCOS in adolescents currently hinges on evidence of ovulatory dysfunction and androgen excess. Recommended evidence of ovulatory dysfunction includes: consecutive menstrual intervals >90 days even in the first year after menstrual onset; menstrual intervals persistently <21 or >45 days 2 or more years after menarche; and lack of menses by 15 years or 2-3 years after breast budding. Recommended evidence of androgen excess include: moderate to severe hirsutism; persistent acne unresponsive to topical therapy; and persistent elevation of serum total and/or free testosterone level. Importantly, a definitive diagnosis of PCOS is not needed to initiate treatment. Treatment may decrease risk of future comorbidity even in the absence of a definitive diagnosis. Deferring diagnosis, while providing symptom treatment and regular/ frequent follow-up of symptomology, is a recommended option.The treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. Goals of treatment are to improve quality of life and long-term health outcomes. Lifestyle modifications remain first-line management of overweight and obese adolescents with PCOS. Combined oral contraceptives (COC) are first line pharmacotherapy for management of menstrual irregularity and acne, and metformin is superior to COCs for weight reduction and improved dysglycemia. COCs and metformin have similar effects on hirsutism, but often need to be paired with other treatment modalities to achieve further improvement of cutaneous symptoms. Clinicians should be cognizant that PCOS is associated with significant metabolic and psychological comorbidity and screen for these issues appropriately.

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“…[27][28][29] Fourth, limited normative data of androgen levels by body mass index (BMI) and pubertal stage exist. 19 Fifth, ovarian size appears to be maximal in the perimenarchal period; &25% of adolescent girls have multifollicular ovaries, and polycystic-type ovaries can occur in up to 20-30% of reproductive-age women and 10% of healthy, regularly menstruating girls, [30][31][32] making the differentiation of ''normal'' versus ''abnormal'' ovaries difficult for even experienced specialists. 33 Moreover, a transvaginal ultrasound is often inappropriate for pediatric patients, particularly virginal girls, and the use of a transabdominal ultrasound yields limited resolution of ovarian morphology and has been shown to underestimate the presence of the syndrome.…”

Section: Rotterdam [European Society For Human Reproduction Andmentioning

confidence: 99%

“…4,32,204,205 For the first ''hit,'' one or more of a number of different mechanisms, including primary adrenal, ovarian, and/or neuroendocrine abnormalities, insulin resistance and hyperinsulinemia, and/or prenatal, immediate postnatal, and/or peripubertal androgen exposure, lead to increased androgen production. For the second ''hit,'' the preexisting hyperandrogenism reduces the sensitivity of the GnRH pulse generator to progesteronemediated slowing during pubertal maturation, thereby initiating a series of changes in the HPO axis that result in ovulatory dysfunction and sustained hyperandrogenism (see Fig.…”

mentioning

confidence: 99%

Polycystic Ovary Syndrome in the Pediatric Population

Bremer

2010

Metabolic Syndrome and Related Disorders

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Polycystic ovary syndrome (PCOS) is a common disorder characterized by hyperandrogenism and disordered gonadotropin secretion, often associated with insulin resistance. The syndrome, which modulates both hormonal and metabolic processes, is the most common endocrinopathy in reproductive-age women and increases a woman's risk of infertility, endometrial pathology, and cardiometabolic disease. As it is currently defined, PCOS most likely encompasses several distinct diseases with similar clinical phenotypes but different underlying pathophysiological processes. However, hyperandrogenism remains the syndrome's clinical hallmark. The clinical manifestations of PCOS often emerge during childhood or in the peripubertal years, suggesting that the syndrome is influenced by fetal programming and/or early postnatal events. However, given that the full clinical spectrum of PCOS does not typically appear until puberty, a ''two-hit'' hypothesis has been proposed: (1) a girl develops hyperandrogenism via one or more of many different potential mechanisms; (2) the preexisting hyperandrogenism subsequently disturbs the hypothalamic-pituitary-ovarian axis, resulting in ovulatory dysfunction and sustained hyperandrogenism. No consensus guidelines exist regarding the diagnosis and management of PCOS in the pediatric population; however, because the syndrome is a diagnosis of exclusion, the clinical evaluation of girls suspected of having PCOS is aimed at excluding other causes of androgen excess and menstrual dysfunction. For the syndrome's management, emphasis is placed on lifestyle and symptomdirected treatment.

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Polycystic Ovary Syndrome in Adolescence

Cited by 89 publications

References 109 publications

The New Three-dimensional Ultrasound Modes allow a Better Polycystic Ovary Syndrome Ultrasound Diagnosis beyond the Rotterdam Criteria

The New Three-dimensional Ultrasound Modes allow a Better Polycystic Ovary Syndrome Ultrasound Diagnosis beyond the Rotterdam Criteria

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

Polycystic Ovary Syndrome in the Pediatric Population

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