{
"topic": "Polycystic Ovary Syndrome",
"slug": "polycystic-ovary-syndrome",
"category_id": 15298,
"passage_count": 14,
"source_chars": 13100,
"enough_material": true,
"references": [
{
"title": "Signs and Symptoms in Pediatrics",
"author": "Henry M. Adam,Jane Meschan Foy",
"pages": [
555
]
},
{
"title": "Update in Pediatrics",
"author": null,
"pages": [
55
]
},
{
"title": "The Clinician's Guide to Pediatric Nutrition",
"author": "Natalie D. Muth;Mary Tanaka;",
"pages": [
356
]
},
{
"title": "Algorithms in Pediatrics",
"author": null,
"pages": [
112,
113,
118
]
},
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
3369
]
},
{
"title": "The Harriet Lane Handbook (The Johns Hopkins Hospital)",
"author": null,
"pages": [
347
]
},
{
"title": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital)",
"author": null,
"pages": [
347
]
},
{
"title": "Cover",
"author": "Vitalsource Download",
"pages": [
1192
]
}
],
"passages": [
{
"source": "Signs and Symptoms in Pediatrics, p. 555",
"text": "**POLYCYSTIC OVARY SYNDROME.** Polycystic ovary syndrome (PCOS) was fi rst described by Stein and Leventhal in 1935.[19] It is the most common endocrine disorder aff ecting adolescent females and women of childbearing age. Although a single cause continues to elude scientists, much has been discovered regarding contributing factors and comorbidities. Th e diagnostic criteria have been adjusted and remain variable given diff erent expert panel consensus statements. Th is, as well as imprecision with androgen assays, has made determination of true prevalence diffi cult.[20,21] Most endocrinologists accept menstrual irregularities as the symptom of anovulation, combined with either biochemical or clinical evidence of ovarian hyperandrogenism as the pillars of diagnosis of PCOS. Although polycystic ovaries can support the diagnosis of PCOS, their absence does not rule out the diagnosis.[22] As with the workup of the younger child for premature pubarche, it is imperative to exclude other causes of"
},
{
"source": "Update in Pediatrics, p. 55",
"text": "## **Polycystic Ovarian Syndrome** Polycystic ovarian syndrome (PCOS) is a condition of androgen excess and menstrual cycle irregularities that lead to a constellation of symptoms. **The diagnosis of PCOS affects about 10% of adolescent females** (Fitzgerald et al. 2018), but this number can be higher among individuals with a positive family history of PCOS. The etiology is multifactorial, and research is ongoing. The current understanding of its pathophysiology includes a complex interplay between genetic factors, insulin resistance, and environmental factors that lead to hyperinsulinemia and increased circulating androgens. Adult PCOS diagnostic criteria regarding imaging do not apply to adolescents due to the potential for normal adolescent ovaries to already appear \u201cpolycystic\u201d due to early anovulatory cycles in puberty. The suggested criteria for diagnosing PCOS in adolescents in Witchel et al. are (Witchel et al. 2019): - being at least 2 years post menarche"
},
{
"source": "The Clinician's Guide to Pediatric Nutrition, p. 356",
"text": "## **Polycystic Ovary Syndrome** Polycystic ovary syndrome (PCOS) is associated with obesity and excess adiposity. Polycystic ovary syndrome in adolescence includes irregular menstrual cycles (, 21 or . 45 days in the 1\u20133 years post-menarche and , 21 days or . 35 days or , 8 cycles per year for . 3 years post-menarche, or . 90 days for any one cycle) and hyperandrogenism (as assessed by calculated free testosterone level, free androgen index or bioavailable testosterone level, and clinical signs of severe acne and hirsutism). Polycystic ovary syndrome is a strong risk factor for the development of type 2 diabetes. There is a high association of PCOS with depression, anxiety, and disordered eating in women, with a likely increased prevalence among adolescents as well. In adolescents, features of PCOS that do not meet criteria for diagnosis are a risk factor for developing PCOS, and the adolescent may be monitored for the development of PCOS over time.[43] Treatment of PCOS generally includes"
},
{
"source": "Algorithms in Pediatrics, p. 112",
"text": "## **DIAGNOSIS IS BY CLINICAL EXAMINATION, ULTRASOUND, AND LABORATORY** Polycystic ovarian syndrome is most simply clinically defined as the presence of: - Hyperandrogenism (clinically and/or biochemically) - Chronic anovulation in the absence of specific adrenal and/or pituitary disease. ## **Hyperandrogenism** Hyperandrogenism may present clinically as hirsutism, acne, and male-pattern alopecia _._ - Hirsutism: the growth of coarse hair on a woman in a male pattern (upper lip, chin, chest, upper abdomen, back, etc.) - Acne: pubertal acne in general is twice as prevalent in adolescent males versus females and males are more likely to have severe disease. Thus, an adolescent female with moderate-to-severe acne should be investigated for PCOS - Virilization: clitoromegaly, deepening voice, increased musculature, or rapidly progressive hirsutism or alopecia), however, is not a feature of PCOS, but instead of more severe hyperandrogenism. ## **Chronic Anovulation** It may result in:"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 3369",
"text": "Polycystic ovary syndrome (PCOS) is a common disorder of reproductive hormone function. The most widely accepted approach to the diagnosis of PCOS in adult females is the Rotterdam criteria, which require two out of three of the following features: **oligomenorrhea** , clinical or biochemical **hyperandrogenism** , and ovaries with a **polycystic morphology** on ultrasound examination (\u226520 follicles in one ovary and/or ovarian volume >10 mm[3] ). Increased levels of antim\u00fcllarian hormone may be a marker of ovarian dysfunction and antral follicle count. Alternative criteria, such as the Androgen Excess Society and National Institutes of Health, place a greater emphasis on requiring hyperandrogenism be present (Table 589.1). The disorder, affecting 5\u201310% of females of reproductive age, depending on the diagnostic criteria used, typically emerges in adolescence when a normal menstrual pattern is not established and there is clinical evidence of androgen excess. Although not part of the _diagnostic_ schemes,"
},
{
"source": "Algorithms in Pediatrics, p. 113",
"text": "- Hyperechoic central stroma. ## **PATHOPHYSIOLOGY OF POLYCYSTIC OVARIAN SYNDROME** Polycystic ovaries develop, when the ovaries are stimulated to produce androgens, either through excess of luteinizing ## **Clinical Pearl** ## **DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS (TABLE 2)** Not all women with PCOS have polycystic ovaries, nor do all women with ovarian cysts have PCOS; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. The diagnosis is straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of - Polycystic ovarian syndrome (PCOS) should be considered and appropriate assessment should be undertaken before commencement of the oral contraceptive pills in adolescents with irregular periods, i.e., irregular cycles (\u226535 days or <21 days), 2 years following menarche. Other causes of irregular cycles, such as thyroid dysfunction or hyperprolactinemia, need to be considered and excluded prior to the diagnosis of PCOS."
},
{
"source": "Algorithms in Pediatrics, p. 112",
"text": "## **Chronic Anovulation** It may result in: - Oligomenorrhea - Amenorrhea - Dysfunctional uterine bleeding - Infertility. However, around 20% of patients with PCOS may have normal menstrual cycles. Often, menstrual abnormalities are long-standing, even since menarche although primary amenorrhea very rare (Box 1). ## **POLYCYSTIC OVARIAN SYNDROME DIAGNOSTIC CRITERIA** Polycystic ovarian syndrome includes a wide spectrum of clinical symptoms and signs. Three different diagnostic classifications had been proposed to define this disease till November 2015. The first one was published in 1990, and is known as the \u201cNational Institute of Health criteria\u201d. Later, in 2003, an expert panel met in Rotterdam and added **Box 1: Clinical features of polycystic ovarian syndrome** ||\u2022|Oligomenorrhea/amenorrhea|\u2022|Hirsutism| |---|---|---|---|---| ||\u2022
\u2022|Acne
Obesity|\u2022
\u2022|Acanthosis nigricans
Male-pattern alopecia| **SECTION 2:** Adolescence "
},
{
"source": "The Harriet Lane Handbook (The Johns Hopkins Hospital), p. 347",
"text": "## **C. Polycystic Ovarian Syndrome[48]** ## 1. **Clinical features in adolescents:** - a. Diagnostic criteria (must have features of both): - (1) Hyperandrogenism: Either clinical or biochemical - (a) Clinical: Hirsutism, acne, male pattern alopecia - (b) Biochemical characteristics: Elevated androgens including DHEA- S (see Table 10.28 for normal values), free or total testosterone - (2) Menstrual abnormalities: Amenorrhea or oligomenorrhea (chronic anovulation). **NOTE** : Appearance of multiple ovarian cysts is a diagnostic criterion for adults, but not for adolescents, as this can be a normal finding in adolescent females. - b. Common cause of female infertility. - c. Often LH>FSH, but this is not required for diagnosis. - d. Chronic anovulation and unopposed estrogen exposure increase risk for endometrial cancer. - e. Associated with insulin resistance and increased risk of type 2 diabetes. ## 2. **Management:**"
},
{
"source": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital), p. 347",
"text": "## **C. Polycystic Ovarian Syndrome[48]** ## 1. **Clinical features in adolescents:** - a. Diagnostic criteria (must have features of both): - (1) Hyperandrogenism: Either clinical or biochemical - (a) Clinical: Hirsutism, acne, male pattern alopecia - (b) Biochemical characteristics: Elevated androgens including DHEA- S (see Table 10.28 for normal values), free or total testosterone - (2) Menstrual abnormalities: Amenorrhea or oligomenorrhea (chronic anovulation). **NOTE** : Appearance of multiple ovarian cysts is a diagnostic criterion for adults, but not for adolescents, as this can be a normal finding in adolescent females. - b. Common cause of female infertility. - c. Often LH>FSH, but this is not required for diagnosis. - d. Chronic anovulation and unopposed estrogen exposure increase risk for endometrial cancer. - e. Associated with insulin resistance and increased risk of type 2 diabetes. ## 2. **Management:**"
},
{
"source": "Cover, p. 1192",
"text": "**Polycystic Ovarian Syndrome** PCOS is the most common endocrine disorder in reproductive-aged women and a common cause of eugonadotropic secondary amenorrhea in adolescents. PCOS can also cause primary amenorrhea. Differing definitions and diagnostic criteria describe this clinically heterogeneous syndrome. The hallmarks of PCOS include ovulatory dysfunction and hyperandrogenism. Ovulatory dysfunction is clinical evidence of menstrual cycle irregularity or polycystic ovaries on ultrasound or other imaging. Hyperandrogenism is either (1) the clinical presence of hirsutism, inflammatory acne, or androgenic alopecia, _or_ (2) biochemical elevations in serum testosterone and/or dehydroepiandrosterone sulfate (DHEAS). The hyperandrogenism is secondary to ovarian thecal cell proliferation and the resultant excess androgen production. The current hypothesis is that peripheral insulin resistance, which may or may not manifest as increased serum insulin levels, and an increase in serum LH relative to FSH contribute"
},
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 159",
"text": "Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women. It affects 6%\u201315% of women of reproductive age. PCOS is characterized by ovarian dysfunction, disordered gonadotropin secretion, and hyperandrogenism, which cause irregular periods, hirsutism, and acne. Many adolescents with PCOS are overweight and the association of PCOS with insulin resistance in adults is well established. Adolescents with PCOS are at increased risk for obesity-related morbidities including type 2 diabetes mellitus, cardiovascular disease including dyslipidemia, obstructive sleep apnea, low self-esteem, depression and anxiety; and adult reproductive health problems including infertility and endometrial cancer."
},
{
"source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 549",
"text": "**84** 526 SECTION XIV \u2022 Adolescent Medicine Oana Tomescu and Sara B. Kinsman _P_ olycystic ovarian syndrome (PCOS), the most common endocrinopathy affecting women, frequently presents during adolescence. PCOS is characterized by anovulatory menstrual dysfunction, hyperandrogenism, obesity, and metabolic disturbances including insulin-resistance and dyslipidemia. Pediatricians who learn to identify and manage PCOS can help address their adolescent patients\u2019 immediate health concerns and reduce the likelihood of later sequelae, including endometrial hyperplasia and cardiovascular disease."
},
{
"source": "Algorithms in Pediatrics, p. 118",
"text": "[Figure OCR, page 118, figure 2] KEY POINTS. @ Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among young women affecting approxi- mately 5-10% = One of the leading causes of infertility & There is not a single diagnostic test for PCOS @ Associated with a range of metabolic abnormalities which can lead to long-term health problems @ Lifestyle changes play an important role in management of the syndrome = Management should be individually tailored for each patient depending on the type of symptoms and clinical features found & Prevent weight gain and address weight loss if needed as body mass index >30 limits fertility @ About 5-10% weight loss will greatly assist in symptom control = Women with PCOS have increased risk of endometrial cancer with prolonged amenorrhea; aim for >4 periods/year unless on contraception. ## **CHAPTER 23** ## **Approach to a Case of Sexual Abuse in Children/Adolescent**  _Sushma P Desai_"
},
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 159",
"text": "The management of primary or secondary amenorrhea depends on the underlying pathology. Hormonal treatment is used in patients with hypothalamic, pituitary, and ovarian causes. Surgical repair may be required in patients with outflow tract anomalies. ## **B. Polycystic Ovary Syndrome** ## ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES - \u00bb Typical features of polycystic ovary syndrome include: menstrual irregularities, clinical signs of hyperandrogenism (eg, hirsutism and moderate-to-severe acne), and overweight or obesity. - \u00bb In addition to the laboratory evaluation for secondary amenorrhea, testing for hyperandrogenemia includes: total and free testosterone, dehydroepiandrosterone sulfate, and androstenedione. - \u00bb Obese adolescents with polycystic ovary syndrome should be screened for lipid abnormalities, glucose intolerance and/or type 2 diabetes, obstructive sleep apnea and depression and anxiety."
}
]
}