Endocrine Abstracts

Introduction: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder of uncertain aetiology, affects 1 in 10 reproductive women and has broad spectrum risks related to reproductive, cardiometabolic and psychosocial health. The wide overlap with other hyperandrogenemic conditions, complexity of PCOS spectrum, and inconsistencies in investigation and management potentially can result in risks of delay in diagnosis and management.

Aim: To evaluate the diagnosis of PCOS and subsequent management.

Method: Retrospective observational data analysis of patients presenting with hyperandrogenaemia in endocrine service (544 patients from 2012 to 2020). 219 (56.1%) patients confirmed to have PCOS based on the Rotterdam criteria were included.

Results: 62.7% reported oligomenorrhoea. Hirsutism was reported in 66.2%, Acne in 21.5%, male pattern alopecia in 14.4% and acanthosis nigricans in 1.5%. The BMI was not recorded for majority (53%), 73% were in overweight/obese range of the ones recorded. 20% did report fertility issues. Biochemical hyperandrogenemia was present in 132 patients. Mean testosterone, androstenedione and free androgen index (FAI) were 2.2 nmol/l , 8.0 nmol/l and 6.8% in patients with biochemical hyperandrogenemia and 1.1n mol/l , 4.6 nmol/l and 2.5% in other PCOS patients with no biochemical hyperandrogenemia. Pelvic USS was performed in 69.2% of patients, 41.2% had findings suggestive of PCOS; ovary enlargement or presence of multiple peripheral follicles or cysts. Combined oral contraceptive pills were used only in 16.5% and Metformin in 46.9%. Mechanical hair removal (20.2%), laser therapy (11.6%), Vaniqa cream (6.6%) and spironolactone (4%) were used for hirsutism.

Conclusion: Variations in clinical and biochemical profiles reflect the complex heterogeneous nature of PCOS. Having different diagnostic criteria, biochemical assay and cut off values further poses diagnostic challenge. The treatment options are limited; lacks robust evidence and uptake of these treatments amongst patients are very inconsistent. Timely diagnosis, robust assessment for cardio metabolic risk factors and individualised care are vital.