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• W2035217519 abstract "A thorough review of current data, emphasizing larger epidemiologic and phenotypic studies has indicated the following:1) 1.At-risk populations: the “at-risk” populations for PCOS include women with:a)Androgenic dermatologic signs, most notably hirsutism. Current data would suggest that although a majority of patients with hirsutism have PCOS, only between 20% and 40% of patients with persistent acne-only and 10% of those with alopecia-only will demonstrate the disorder.b)Menstrual dysfunction, such that between one-quarter and one-third of all women with oligo-amenorrhea or menstrual dysfunction have PCOS.c)Oligo-ovulatory infertility.d)Polycystic ovaries, with about one-fifth of unselected reproductive-aged women with this morphologic finding having PCOS.e)Insulin resistance and hyperinsulinism, who are at greater risk for developing the disorder, at least as observed in diabetic populations; this association is less certain for women with the metabolic syndrome.2.Features of PCOS: PCOS remains a heterogeneous syndrome, with multiple and variable features, which may include:a)Menstrual and ovulatory dysfunction, with overt oligomenorrhea present in 60% to 75% of affected women, although this prevalence may be lower if the Rotterdam 2003 rather than NIH 1990 diagnostic criteria are used. Because some PCOS patients may have a history of “regular menses” despite being oligo-ovulatory, patients who present with clinical evidence of hyperandrogenism but apparent eumenorrhea should have their ovulatory function evaluated further.b)Hyperandrogenemia, with approximately 70% of PCOS patients demonstrating elevated free T levels, at least when high-quality assay methods are used and patients are diagnosed by the NIH 1990 criteria. The measurement of total T, A4, and DHEAS add a limited incremental amount to the diagnostic value of the androgen screen. The serum measurements of androgens, including free T, should be used only as an adjuvant tool for the diagnosis of hyperandrogenic disorders, and never as the sole criterion for diagnosis or in lieu of the clinical assessment. Basal gonadotropin measurements are of little value for the routine diagnosis of PCOS.c)Hirsutism, which affects approximately 65% to 75% of affected patients of the White, Black, and Southeast Asian races, although likely to be less among women of the Mongolian or Far East extraction. Less prevalent is the sole presence of acne or alopecia, although more accurate studies are required to define the prevalence of these features in PCOS patients.d)Polycystic ovaries, with this morphologic ovarian alteration found in 75% to 90% of women with the clinical diagnosis of the disorder.e)Insulin resistance and hyperinsulinism, which is present in 50% to 70% of patients.3.Disorders to exclude: Consistent with the fact that PCOS is a syndrome, no single test is available to establish its diagnosis, and various disorders may present in a similar fashion, the diagnosis of this disorder may require exclusion of the following:a)Hypo- or hyperthyroidism or hyperprolactinemia; although this is not mandatory to make a diagnosis of PCOS in the absence of other symptoms or signs of thyroid dysfunction. However, despite their low prevalence the low cost of these tests would suggest that the screening of patients with suspected PCOS for thyroid dysfunction or hyperprolactinemia may still be cost-effective.b)21-hydroxylase-deficient NC-CAH, with routine screening using a basal 17-hydroxyprogesterone level recommended in all patients presenting with signs or symptoms suggestive of androgen excess, and particularly in high-risk populations (e.g., Ashkenazi Jews and Europeans of Latin descent). Alternatively, the routine screening for 3β-HSD or 11β-hydroxylase deficient NC-CAH is not recommended.c)Cushing's syndrome, although its very low rate among patients with suspected PCOS precludes recommending the routine screening for this disorder as part of the standard evaluation of these patients.d)Androgen-secreting neoplasms, such that all patients presenting with hyperandrogenic symptomatology should be screened for these tumors, although the initial screening should be primarily clinical.e)The HAIR-AN syndrome, characterized by severe insulin resistance and hyperinsulinism, possibly affecting up to 3% of androgen excess patients.f)Idiopathic hirsutism, which is present in 5% to 7% or less of all hirsute patients seen, and should be diagnosed using strict criteria including normal long-term ovulation, normal androgen levels, and normal ovarian morphology.g)Hyperandrogenic patients who do not fulfill the criteria for PCOS or for other well-known androgen excess disorders (e.g., women with the so-called “idiopathic hyperandrogenism”) remain to be better characterized, and may represent a form of PCOS." @default.
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• W2035217519 date "2009-02-01" @default.
• W2035217519 modified "2023-10-11" @default.
• W2035217519 title "The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report" @default.
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