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Hyperandrogenism seen as central part of PCOS.

Polycystic ovary syndrome is primarily a disorder of hyperandrogenism--either biochemical or clinical, or both, according to a newly released position statement from the Androgen Excess Society.

"Overall, ... women with oligomenorrhea and polycystic-appearing ovaries on ultrasonography but no evidence of hyperandrogenism do not have PCOS," wrote the society's seven-person task force of international experts (J. Clin. Endocrin. Metab. [Epub doi:10.1210/jc.2006-0178]).

The task force also acknowledged a minority opinion that there may possibly be forms of polycystic ovary syndrome (PCOS) "without overt evidence of hyperandrogenism," although "more data are required before validating this supposition."

A diagnosis of hyperandrogenism can be made biochemically by the confirmation of elevated circulating androgens or clinically with the observation of hirsutism, according to Dr. Ricardo Azziz, who chaired the Androgen Excess Society (AES) task force.

"People ... often rely heavily on biochemical androgen levels, which is a mistake because it can leave out those patients with hirsutism but normal androgen levels. You have to look at the clinical picture as well," he said in an interview.

The AES position statement, produced after a systematic review of 527 published, peer-reviewed medical articles, is aimed at establishing an evidence-based definition of PCOS, said Dr. Azziz, director of the Center for Androgen-Related Disorders and professor and chair of obstetrics and gynecology at Cedars-Sinai Medical Center at the University of California, Los Angeles.

The position statement stipulates that all three of the following criteria must be present for a diagnosis of PCOS:

* Hyperandrogenism--either biochemical or clinical, or both.

* Oligo-ovulation or polycystic ovaries, or both.

* Exclusion of other androgen excess disorders. The two definitions that are currently used were established by expert panels--the first at the National Institutes of Health in 1990 and the second, in Rotterdam in 2003. They differ markedly on the necessity of hyperandrogenism for diagnosing PCOS and the relevance of an ultrasound finding of polycystic ovaries. (See box.)

The AES statement is a combination and clarification of the NIH and Rotterdam definitions and the first definition to come out of a review of evidence-based data, Dr. Azziz said. "With this definition, we capture what we think is the majority of patients with PCOS. It is broader than the NIH criteria but doesn't capture as much as the Rotterdam criteria, which were overly broad and resulted in the diagnosis of PCOS in women who simply had irregular ovulation and polycystic-looking ovaries. There may still be a few patients who may not be captured by this definition who in the future may be identified by new tests."

Another important aspect of the statement is its de-emphasis of ultrasound findings in the diagnosis, said Dr. Neil Goodman, a reproductive endocrinologist in private practice in Miami and professor of medicine at the University of Miami. "Up to 20% of women with regular cycles, no hirsutism, and no evidence of androgen excess can have a polycystic ovary appearance on ultrasound," said Dr. Goodman, who is chair of the American Association of Clinical Endocrinologists' task force on hyperandrogenic disorders and was not involved with the AES task force. "We need to document hyperandrogenism before we diagnose PCOS."


Montreal Bureau
Current Definitions of PCOS Differ

NIH Criteria (1990)   Rotterdam Criteria (2003)   AES Statement (2006)
Should include:       Should include at least     Should include:
                      least two:

Hyperandrogenism,     Clinical and/or             Hyperandrogenism,
biochemical or        biochemical signs of        either biochemical
clinical              hyperandrogenism            or clinical or

Oligo-ovulation       Oligo-ovulation and/or      Oligo-ovulation or
                      anovulation                 polycystic ovaries
                                                  or both

Exclusion of other    Polycystic ovaries          Exclusion of other
known disorders                                   androgen excess

Source: Journal of Clinical Endocrinology and Metabolism
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Title Annotation:polycystic ovary syndrome
Author:Johnson, Kate
Publication:Family Practice News
Geographic Code:1USA
Date:Oct 15, 2006
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