Stricter PCO morphology definition alone does not identify PCO syndrome

By Eleanor McDermid
Horm Res Paediatr 2017; Advance online publication
30 November 2017

medwireNews: Using the Worldwide Pediatric Consensus (PedC) criteria reduces the proportion of adolescent girls diagnosed with polycystic ovarian morphology (PCOM) but does not identify those with polycystic ovarian syndrome (PCOS), say researchers.

The PedC criteria advise a diagnosis of PCOM in adolescents when ovarian volume is larger than 12 mL on transabdominal ultrasonography, which is two standard deviation scores greater than the average volume in healthy young women. They do not recommend a follicle count.

Using this definition, Paulina Merino (University of Chile, Santiago) and co-researchers identified PCOM in 12.8% of 102 healthy adolescent girls aged between 11.4 and 19.8 years. The rates using less restrictive criteria were 23.5% for the Androgen Excess-Polycystic Ovarian Syndrome Society definition and 34.3% for the Rotterdam Consensus.

Adolescents with PCOM had no sign of hyperandrogenism, however, with testosterone, androstenedione and free androgen index levels being similar between those with and without PCOM, regardless of the definition used.

“The presence of PCOM in very young women, irrespective of the diagnostic criteria that were used, should be not be confused with PCOS”, writes the team in Hormone Research in Paediatrics.

The researchers note that although enlarged ovaries are predictive of PCOS, this is true only in combination with irregular menstruation, whereas girls with isolated PCOM continue to have normal ovulatory function and androgen levels.

They therefore stress that “when the ovarian volume is larger than 12 mL in very young women without hirsutism or oligomenorrhea, a wait-and-see approach may be advisable, and the subject should not be misdiagnosed with PCOS.”

All study participants with PCOM by all definitions had elevated levels of anti-Müllerian hormone, with, for example, average levels of 8.4 pmol/L in those with PCOM by the Rotterdam Consensus versus 4.6 pmol/L in those without.

“These data suggest that enlarged ovaries observed in transabdominal ultrasonography during adolescence, even without the assessment of follicle number, are associated with a larger number of small follicles”, notes the team.

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