Diagnosing PCOS: what to look for

Menstrual irregularity, acne, and other characteristics often seen in adolescent girls may be misdiagnosed as polycystic ovarian syndrome (PCOS). “One must be careful to label an adolescent girl with PCOS and be diligent in follow-up to be sure the condition is really present,” advised Sherry L. Franklin, MD, in a session titled “Polycystic ovarian syndrome (PCOS): evaluation and management” on Saturday, October 11.

Franklin, who is assistant clinical professor at the University of California, San Diego, and affiliated with Rady Children’s Hospital of San Diego and the Pediatric Endocrinology of San Diego Medical Group, said that PCOS is the leading cause of menstrual irregularities and hyperandrogenism in adolescents and the most common hormonal disorder in obesity. Girls with PCOS have an increased risk of infertility, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Multiple factors contribute to the development of the syndrome, including genetics, environmental factors, and possibly epigenetics. The heterogeneity of its clinical manifestations may be explained by the interaction of the disease with the environment, Franklin explained.

Criteria for the diagnosis of PCOS include hyperandrogenism and menstrual irregularity in the absence of other known disorders, such as congenital adrenal hyperplasia and ovarian/adrenal tumors, according to the National Institutes of Health. Clinical manifestations include acne; hirsutism; increased growth hormone and insulin-like growth factor 1; anovulatory menstrual cycles; and menstrual irregularity.

Franklin pointed out that some of these characteristics can also be seen in normal premenarchal and early menarchal girls, and she listed a number of findings that can help distinguish PCOS from normal adolescent characteristics: acne on the chest or back; early-onset inflammatory acne that is severe or refractory to conventional therapy; excessive sweating; seborrhea; excessive body hair (ie, Ferriman-Gallwey score ≥8); male-pattern hair loss; biochemical hyperandrogenemia; amenorrhea; dysfunctional uterine bleeding; and oligomenorrhea. Various laboratory assays are also helpful in the differential diagnosis.

Weight loss is the primary goal of treatment, Franklin said, because it can decrease insulin resistance, improve the cardiometabolic profile, improve self-image, reduce androgen levels, and normalize menstruation.

Metformin can be useful in preventing and treating PCOS. Oral contraceptives normalize menstruation and improve the metabolic profile, but they can lead to weight gain and have other adverse effects so their use is controversial. -Karen Rosenberg