An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence
Year: 2017
Type: article
Abstract: This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)1. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.
Source: Hormone Research in Paediatrics
DOI: 10.1159/000479371
Authors: Lourdes Ibáñez, Sharon E. Oberfield, Selma Witchel, Richard J. Auchus, R. Jeffrey Chang, Ethel Codner, Preeti Dabadghao, Feyza Darendeliler, Nancy Samir Elbarbary, Alessandra Gambineri, Cecilia Garcia Rudaz, Kathleen M. Hoeger, Abel López-Bermejo, Ken Ong, Alexia S. Peña, Thomas Reinehr, Nicola Santoro, Manuel Tena-Sempere, Rachel Tao, Bulent O. Yildiz, Haya Alkhayyat, Asma Deeb, Dipesalema Joel, Reiko Horikawa, Francis de Zegher, Peter A. Lee
Institutions: Hospital Sant Joan de Déu Barcelona, Instituto de Salud Carlos III, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, Children's Hospital of Pittsburgh, University of Michigan, University of California San Diego, University of Chile, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Istanbul University, Ain Shams University, University of Bologna, Australian National University, University of Rochester Medicine, Hospital Universitari de Girona Doctor Josep Trueta, University of Cambridge, Wellcome/MRC Institute of Metabolic Science, MRC Epidemiology Unit, The University of Adelaide, Witten/Herdecke University, Yale University, Instituto Maimónides de Investigación Biomédica de Córdoba, University of Córdoba, Hacettepe University, Mafraq Hospital, University of Botswana, National Center For Child Health and Development, Universitair Ziekenhuis Leuven, KU Leuven, Pennsylvania State University
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Medical Research Council
Award: G5517677352
OpenAlex ID: W2770022783