Excluding other related diseases for making a precise diagnosis of PCOS: What does it mean in real practice

Excluding other related diseases for making a precise diagnosis of PCOS: What does it mean in real practice?

Hengameh Abdi

Endocrine Research Center

Research Institute for Endocrine sciences

Shahid Beheshti University of Medical Sciences

15 November 2018

Outlines

14. Background
14. Overview of related statements from international societies
14. In women suspected to have PCOS, to exclude other disorders:
    • Which investigations should be done in all women?
    • Which investigations should be done in selected women?
14. Conclusions
14. We suggest that the diagnosis of PCOS be made if two of the three following criteria are met: androgen excess, ovulatory dysfunction, or polycystic ovaries (PCO), whereas disorders that mimic the clinical features of PCOS are excluded.
14. These include, in all women: thyroid disease, hyperprolactinemia, and nonclassic congenital adrenal hyperplasia (primarily 21-hydroxylase deficiency by serum 17-hydroxyprogesterone [17-OHP]). In select women with amenorrhea and more severe phenotypes, we suggest more extensive evaluation excluding other causes.

Diagnosis after exclusion of:

14. Other causes of chronic anovulation:
    • Thyroid disorders
    • Hyperprolactinemia
    • Pregnancy
    • Hypothalamic amenorrhea
    • Primary ovarian insufficiency
14. Other causes of androgen excess:
    • Nonclassical congenital adrenal hyperplasia
    • Idiopathic hirsutism/Idiopathic hyperandrogenism
    • Androgen-secreting tumor
    • Severe insulin resistance syndromes
    • Cushing syndrome
    • Acromegaly