Endocrine Abstracts

This retrospective review of all adult women referred to a dedicated University Clinic for presumed polycystic ovarian syndrome (PCOS) aims to determine i) the true PCOS prevalence and ii) to evaluate baseline demographics by diagnostic criteria and their relationship to metabolic and cardiovascular risk parameters. All charts were reviewed. The diagnosis of PCOS rests on excluding another endocrinopathy, and fulfilling any two of the three criterias as per the Rotterdam statement, i.e. oligomenorrhoea, hyperandrogenism, and/or polycystic ovaries. We reviewed coexistent hypertension, dyslipidaemia, dysglycaemia, metabolic syndrome (MetS), and NAFLD in the proven PCOS cohort. The cohort was also divided into three groups based on their inclusion criteria: group 1 (oligomenorrhoea and hyperandrogenism), group 2 (oligomenorrhea and polycystic ovaries), and group 3 (hyperandrogenism and polycystic ovaries) and these factors assessed per category. 250 women were referred with a presumed diagnosis of PCOS. 134 (54%) had confirmed PCOS. The other 116 (46%) included ectopic Cushing’s, prolactinoma, nonclassical CAH, PIH, POF, hypothalamic, and obesity driven oligomenorrhoea. The PCOS cohort had a mean systolic BP 124.78 (S.D. 15.8) and a mean diastolic BP 75.46 (S.D. 9.4). Mean age was 27.74 years (S.D. 6.7 years). Mean BMI was 31 (S.D. 8.34). 30.4% of the PCOS group were normal weight or underweight (BMI <24.9). 71.6% had a BMI >24.9 (21.6% overweight and 48% obese). Metabolic datasets were incomplete but 2.5% had pre-diagnosed DM2 and one patient was diagnosed at presentation. 9/54 patients evaluated had ↑ ALT/GGT. 120 patients met group 1 criteria, six met group 2 criteria, and four met group 3 criteria and 14 patients only met all three. 124/134 PCOS women had hyperandrogenism either biochemically alone (8), phenotypically alone (4) but most (113) having both. Hypertension was more prevalent in group 1 (20/120) vs group 2 (0/6) vs group 3 (0/4). The BMI range was higher in group 1 (31.42+8.28) and group 3 (33.89+14.77) vs group 2 (25.52+5.59) raising a question of a relationship to hyperandrogenism. Equally group 1 were more likely to have ↑ Tg levels (18/120 vs 1/6 vs 0/4), ↓ HDL (30/120 vs 1/6 vs 1/6) and MetS (10/120 vs 1/6 vs 0/6). 38 women having a BMI <25 had no hypertension or MetS. Of 60 women with a BMI >35, 13 had hypertension and 11 had MetS. This is the first review of an Irish cohort. It is striking that 30% of proven PCOS patients have a normal BMI undermining the assumption of obesity as a prerequisite phenotype. 90% were diagnosed with oligomenorrhoea and hyperandrogenism alone. In keeping with the international literature, this cohort has greatest metabolic risk mandating focused risk assessment and intervention. Our data is weakened by sporadic metabolic testing but nonetheless supports new guidelines recommending this. Finally, our results reiterate the principle of PCOS as a diagnosis of exclusion with almost 50% having a different underlying diagnosis.

Disclosure: Student research grant of 2000 euros from the Irish Endocrine Society.