Diagnostic Evaluation, Comorbidity Screening, and Treatment of Polycystic Ovary Syndrome in Adolescents in 3 Specialty Clinics

作者：Sebastian Meghna R^*; Wiemann Constance M; Bacha Fida; Taylor Sharonda J Alston

来源：Journal of Pediatric and Adolescent Gynecology, 2018, 31(4): 367-371.

DOI：10.1016/j.jpag.2018.01.007

• Polycystic ovary syndrome
• Metabolic syndrome
• Adolescence

Study Objective: A polycystic ovary syndrome (PCOS) diagnosis in adolescence can have significant long-term health implications. The criteria for its diagnosis in adolescents have been subject to much debate. In this study we aimed to characterize the variability in diagnosis and management among different pediatric specialties.
Design, Setting, Participants, and Interventions: This was a retrospective review of electronic medical records of female patients (11-21 years old) who presented to 3 specialties (adolescent medicine [ADO], pediatric endocrinology [ENDO], and gynecology [GYN]), with a postvisit diagnosis of PCOS, menstrual disorders, or hirsutism, at a large tertiary care center, from November 1, 2011 to October 31, 2012. Demographic, clinical, laboratory, and treatment data were abstracted.
Main Outcome Measures: Testing for diagnosis of PCOS and its comorbidities, and treatment strategies in the 3 pediatric specialties.
Results: One hundred forty-one patients (50 ADO, 48 ENDO, and 43 GYN) were eligible. Testing for hyperandrogenemia (17-hydroxy-progesterone, dehydroepiandrosterone, estradiol), thyroxine, and use of pelvic ultrasound differed among specialties. Providers failed to document weight concerns in 28.3% (29 of 101) of overweight or obese patients. Patients seen by ENDO were most likely, and GYN least likely, to be identified as having elevated weight, and to be tested for glucose abnormalities, dyslipidemia, and liver disease. ENDO providers prescribed metformin more often and hormonal therapy less often than ADO and GYN.
Conclusion: There is considerable variability across pediatric specialties in the evaluation of PCOS, with significant underassessment of comorbidities. Use of unified guidelines, including for the evaluation of comorbidities, would improve evidence-based management of adolescent PCOS.

• 出版日期2018-8