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Horm Res Paediatr. 2017;88(6):371-395. doi: 10.1159/000479371. Epub 2017 Nov 13.

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence.

Author information

1
Endocrinology, Hospital Sant Joan de Deu, Esplugues, Barcelona, Spain.
2
CIBERDEM, ISCIII, Madrid, Spain.
3
Division of Pediatric Endocrinology, CUMC, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.
4
Division of Pediatric Endocrinology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
5
University of Michigan, MSRBII, Ann Arbor, Michigan, USA.
6
Department of Reproductive Medicine, UCSD School of Medicine, La Jolla, California, USA.
7
Institute of Maternal and Child Research, University of Chile, School of Medicine, Santiago, Chile.
8
Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
9
Istanbul Tıp Fakültesi, Çocuk Kliniği, Istanbul, Turkey.
10
Ain Shams University, Cairo, Faculty of Medicine, Cairo, Egypt.
11
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
12
Division of Women, Youth and Children, Australian National University, Canberra, Australian Capital Territory, Australia.
13
Department of OBGYN, University of Rochester Medical Center, Rochester, New York, USA.
14
Pediatric Endocrinology, Hospital de Girona Dr. Josep Trueta, Girona, Spain.
15
MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom.
16
The University of Adelaide and Robinson Research Institute, Adelaide, South Australia, Australia.
17
University of Witten/Herdecke, Vestische Kinder- und Jugendklinik, Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Datteln, Germany.
18
Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
19
University of Córdoba, Edificio IMIBIC, Córdoba, Spain.
20
Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey.
21
Medical University of Bahrain, BDF Hospital, Riffa, Bahrein.
22
Mafraq Hospital, Abu Dhabi, United Arab Emirates.
23
Department of Paediatrics and Adolescent Health, University of Botswana Teaching Hospital, Gaborone, Botswana.
24
Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan.
25
Department Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium.
26
Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.

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.

KEYWORDS:

Anti-androgen; Hirsutism; Hyperinsulinism; Insulin sensitizers; Menstrual irregularities; Obesity; Polycystic ovarian morphology; Polycystic ovary syndrome

PMID:
29156452
DOI:
10.1159/000479371
[Indexed for MEDLINE]
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