Endocrine Abstracts

Polycystic ovary syndrome (PCOS) may be diagnosed in adult women using the Rotterdam criteria and includes the presence of at least two of the following:- androgen excess, ovulatory dysfunction, or polycystic ovaries on ultrasound scan. The diagnosis of PCOS in adolescents is challenging since these criteria may define normal pubertal physiological features. PCOS is a diagnosis of exclusion and investigation for other possible underlying pathologies, such as non-classical congenital adrenal hyperplasia, is important. PCOS may be associated with other co-morbidities, such as obesity and insulin resistance and these should be actively sought. The use of a ‘symptoms-based’ approach for adolescents is discussed, focusing treatment on the primary presenting problems (frequently hirsutism or menstrual irregularity). The first line treatment of PCOS in adolescents is the use of hormonal contraceptives such as the oral combined contraceptive pill (OCP). The progestogen in the OCP suppresses LH and ovarian androgen production while the oestrogen increases SHBG, thus reducing circulating bioavailable androgen. The OCP seems to have more impact on distressing symptoms such as hirsutism, acne and menstrual irregularity than metformin. The role of metformin in treating PCOS in adolescents is also discussed, together with the difficulties in planning duration of treatment. Other approaches include lifestyle measures (exercise programmes and healthy diet) in those girls with PCOS who are also obese. Non-medical therapies, such as physical means of hair removal, are described, particularly for girls who decline or do not tolerate medical treatment.