PCOS diagnosis in adolescents: the timeline of a controversy in a systematic review

Abstract

Study objective Polycystic ovary syndrome (PCOS) in adolescence, a disorder of exclusion, has proved to be a timeless diagnostic challenge for the clinician. Since 1990, several attempts to provide clear diagnostic criteria have been published, most of the time leading to inconsistencies. We attempted to elucidate the controversies and convergences of this subject by conducting a systematic review of the literature concerning official guidelines or proposed criteria for the diagnosis of PCOS in adolescent girls. Design Based on a term search sequence via electronic databases such as Pubmed, Cochrane, Embase, Scopus and a hands-on review of references and learned societies, all available data were classified and analyzed. Single case reports, original studies with adult population or articles with incomplete diagnostic guidelines were excluded. Results Twelve reports dated from 2006 to 2018 fulfilled the inclusion criteria. Seven of them were endorsed or published by learned societies. All suggested a stricter diagnosis than in adulthood. Polycystic ovarian morphology was used as a necessary criterion only in three guidelines, and there was a tendency for a more objective diagnosis of hyperandrogenism, defined either by clinical features or by biochemical hyperandrogenemia, although in one case both were required. Conclusion Irregular menstrual cycles, allowing for an interval of at least 2 years postmenarche, and hyperandrogenism, usually reinforced by biochemical confirmation, are the main accepted features for PCOS diagnosis in adolescence. Discrepancies among endocrine and reproductive medicine societies still remain, although recent intensified attempts at reaching a consensus should allow for more universally accepted diagnostic criteria.

Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review

“…The first diagnostic criteria of PCOS, the NIH criteria, used oligomenorrhea/amenorrhea as a required element to diagnose PCOS in adult women [ 19 ]. A systematic review evaluating diagnostic criteria for diagnosis of PCOS during adolescence, demonstrated that almost all the studies require menstrual irregularities to be present for the diagnosis of PCOS in adolescents [ 16 ]. However, special criteria should be used to define menstrual irregularity in adolescents ( Table 1 ) [ 17 ].…”

“…The World Health Organization defines adolescence as the period between 10 and 19 years of age, which includes critical changes in growth, puberty, and development. These physiological changes, including menstrual irregularities, hyperandrogenism, and polycystic ovarian morphology (PCOM) overlap with adult diagnostic criteria of PCOS, making diagnosis during adolescence challenging and controversial [ 15 , 16 , 17 , 18 ]. The first diagnostic criteria for PCOS in adult women were established by a consensus meeting at the National Institutes of Health (NIH) in 1990 [ 19 ] and was followed by multiple consensuses, statements and/or guidelines for adult women with limited acknowledgment of the difficulties for diagnosing PCOS in adolescents [ 20 , 21 , 22 , 23 ].…”

Polycystic Ovary Syndrome in Adolescence: Challenges in Diagnosis and Management

“…1 Therefore, several societies started including adolescents as a specific group within their guidelines for the diagnosis of PCOS. 7,10,13 The Amsterdam criteria, in 2012, was the first official consensus directed toward the specificities of adolescents, 13,14 followed by the Endocrine Society (ES) guidelines in 2013 13 and by an adolescent-specific expert consensus by the Pediatric Endocrine Society (PES) in 2015. 13,15 Also in 2015, the American Association of Clinical Endocrinologists (AACE), together with the American College of Endocrinology (ACE), the AES, and other PCOS societies created a practical guideline for evaluation and work-up of PCOS in this age group.…”

“…Ultrasound should be excluded from the diagnostic criteria until the age of 17 years old. 14 Strong efforts have been made within recent years to overcome controversies from previous criteria resulting in three international consensuses for PCOS during adolescence (2015-2018). According to Rosenfield, 9 there are no discrepancies concerning the core diagnostic criteria (►Chart 1).…”

Cardiovascular Risk Factors and Subclinical Atherosclerosis in Greek Adolescents with Polycystic Ovary Syndrome: Its Relationship with Body Mass Index

“…Although there are studies that highlight important aspects in the evaluation of adolescents with PCOS [ 5 ], strategies for risk stratification of comorbidities remain unclear. Metabolic dysregulation observed in adolescents with PCOS presumably leads to long-term increased cardiovascular risk (CVR) [ 6 , 7 ].…”