ABSTRACT
STUDY OBJECTIVE: The objective of this study was to evaluate methods of initial diagnosis and management of polycystic ovary syndrome (PCOS) among members of the North American Society for Pediatric and Adolescent Gynecology (NASPAG) to assess the degree of practice heterogeneity among specialist providers of adolescent care. DESIGN: Cross-sectional, anonymous, internet survey PARTICIPANTS: NASPAG membership (N = 326; Respondents = 127 (39%)) RESULTS: Percentage of respondents who incorporated specific tests at initial diagnosis was highly variable ranging from 87% (thyroid stimulating hormone) to 17% (sex hormone binding globulin). Oral contraceptives and diet modification/exercise were the most common therapies recommended by 98% and 90% of respondents respectively. CONCLUSION: Considerable practice heterogeneity was present with regards to diagnostic testing for suspected PCOS. Recommendations for first-line therapy were more consistent. Future studies should clarify the clinical utility of specific diagnostic tests for adolescents, such that selection of diagnostic testing is evidence based.
Subject(s)
Metabolic Syndrome/diagnosis , Polycystic Ovary Syndrome/diagnosis , Polycystic Ovary Syndrome/therapy , Practice Patterns, Physicians' , Adolescent , Contraceptives, Oral/therapeutic use , Cross-Sectional Studies , Data Collection , Exercise , Feeding Behavior , Female , Hormones/blood , Humans , Hypoglycemic Agents/therapeutic use , Metabolic Syndrome/complications , Metformin/therapeutic use , Mineralocorticoid Receptor Antagonists/therapeutic use , Polycystic Ovary Syndrome/complications , Referral and Consultation , Sex Hormone-Binding Globulin , Spironolactone/therapeutic useABSTRACT
Polycystic ovary syndrome (PCOS) can be identified in the adolescent years but is a process with genetic and epigenetic origins. Intrauterine growth retardation and premature adrenarche may precede the presentation of hyperandrogenism and oligo/anovulation. Other causes of hyperandrogenism and ovulatory dysfunction must be ruled out before PCOS is diagnosed. Obesity and insulin resistance often are associated features and greatly increase a girl's risk of developing metabolic syndrome and type 2 diabetes mellitus. Oral contraceptives, metformin, antiandrogens, and lifestyle modifications can have roles in alleviating the symptoms of PCOS and are reviewed in this article.
