Endocrine Abstracts

Objective: Diagnostic uncertainty arises for paediatric patients when establishing a diagnosis of polycystic ovarian syndrome (PCOS) due to concurrent pubertal changes. Management decisions can also therefore be challenging. The investigations and management of patients referred to the Paediatric Endocrinology Service was audited against international guidelines.

Methods: Retrospective audit of patients referred with suspected PCOS to the Paediatric Endocrine Service in Cardiff from 2018 to 2022.

Results: 26 patients were identified, median age 14.5 years, referred with symptoms suggestive of PCOS. Table 1 shows the initial investigations. Total testosterone was raised in 79%, 63% had an LH:FSH ratio greater than 1 and 56% had low SHBG levels. Pelvic ultrasounds were performed in 74% of patients, 67% of those who did not meet diagnostic criteria for PCOS had ultrasound findings consistent with PCOS, indicating the lack of specificity. 73% of patients had an elevated BMI, lifestyle advice or a referral to dietetics was made for 65% and 62% discussed or received the combined contraceptive pill.

Conclusions: Care should be taken to avoid both the under and over-investigation for PCOS during the period of physiological pubertal changes. There is an excessive reliance on pelvic ultrasounds to investigate PCOS in this age group. Early detection and regular screening for co-morbidities, such as cardiovascular disease and type 2 diabetes can aid the prevention of complications. Transitioning adolescents with PCOS to adult services facilitates long-term management. Guideline recommendations for investigations: (*) recommended, (−) not recommended.Table 1 Frequency of investigations for suspected PCOS in primary and secondary care among adolescents