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The diagnosis of polycystic ovary syndrome in adolescents

      In women, the definition of polycystic ovary syndrome (PCOS) has become broad and includes several possible phenotypes. Because several features of PCOS may be in evolution in adolescents, we suggest that only firm criteria should be used to make a diagnosis of PCOS during adolescence. Hyperandrogenism, oligomenorrhea, and ovarian morphology change during adolescence and are discussed individually. Adolescents with incomplete criteria for a firm diagnosis of PCOS should be followed up carefully and may be diagnosed at a later time.

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      References

        • Zawadzki J.K.
        • Dunaif A.
        Diagnostic criteria for polycystic ovary syndrome: towards a rationale approach.
        in: Dunaif A. Givens J.R. Haseltine F. Merriam G.R. Polycystic ovary syndrome. Blackwell Scientific Publications, Boston, MA1992: 377-384
        • Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group
        Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).
        Hum Reprod. 2004; 19: 41-47
        • Azziz R.
        • Carmina E.
        • Dewailly D.
        • et al.
        Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome; an androgen excess society guideline.
        J Clin Endocrinol Metab. 2006; 91: 4237-4245
        • Pfeifer S.M.
        • Kives S.
        Polycystic ovary syndrome in the adolescent.
        Obstet Gynecol Clin North Am. 2009; 36: 129-152
        • Yii M.F.
        • Lim C.E.
        • Luo X.
        • et al.
        Polycystic ovarian syndrome in adolescence.
        Gynecol Endocrinol. 2009; 16: 1-6
        • Diamanti-Kandarakis E.
        PCOS in adolescence.
        Best Pract Res Clin Obstet Gynaecol. 2009; 24: 173-183
        • Shayya R.
        • Chang R.J.
        Reproductive endocrinology of adolescent polycystic ovary syndrome.
        BJOG. 2010; 117: 150-155
        • Sultan C.
        • Paris F.
        Clinical expression of polycystic ovary syndrome in adolescent girls.
        Fertil Steril. 2006; 86: 56
        • Ibáñez L.
        • de Zegher F.
        • Potau N.
        Anovulation after precocious pubarche: early markers and time course in adolescence.
        J Clin Endocrinol Metab. 1999; 84: 2691-2695
        • Coviello A.D.
        • Legro R.S.
        • Dunaif A.
        Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance.
        J Clin Endocrinol Metab. 2006; 91: 492-497
        • Rosner W.
        • Auchus R.J.
        • Azziz F.
        • et al.
        Position statement: utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement.
        J Clin Endocrinol Metab. 2007; 92: 405-413
        • Carmina E.
        • Lobo R.A.
        Evaluation of hormonal status.
        in: Strauss III, J.F. Barbieri R.L. Yen and Jaffe's reproductive endocrinology: physiology, pathophysiology and clinical management. 6th ed. Elsevier-Saunders, Philadelphia2009: 801-823
        • Silfen M.E.
        • Denburg M.R.
        • Manibo A.M.
        • et al.
        Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents.
        J Clin Endocrinol Metab. 2003; 88: 4682-4688
        • Olutunmbi Y.
        • Paley K.
        • English III, J.C.
        Adolescent female acne: etiology and management.
        J Pediatr Adolesc Gynecol. 2008; 21: 171-176
        • Chang J.R.
        • Coffler M.S.
        Polycystic ovary syndrome: early detection in adolescence.
        Clin Obstet Gynecol. 2007; 50: 178-187
        • Blank S.K.
        • Helm K.D.
        • McCartney C.R.
        • Marshall J.C.
        Polycystic ovary syndrome in adolescence.
        Ann N Y Acad Sci. 2008; 1135: 76-84
        • Metcalf M.G.
        • Skidmore D.S.
        • Lowry G.F.
        • et al.
        Incidence of ovulation in the years after the menarche.
        J Endocrinol. 1983; 97: 213-219
        • Venturoli S.
        • Porcu E.
        • Fabbri F.
        • et al.
        Menstrual irregularities in adolescents: hormonal pattern and ovarian morphology.
        Horm Res. 1987; 24: 269-279
        • Vikho R.
        • Apter D.
        Endocrine characteristics of adolescent menstrual cycles: impact of early menarche.
        J Steroid Biochem. 1984; 20: 213-216
        • Southam A.L.
        • Richart A.M.
        The prognosis for adolescent with menstrual abnormalities.
        Am J Obstet Gynecol. 1968; 94: 637-647
        • Treloar A.E.
        • Boynton R.E.
        • Behn B.G.
        • Brown B.W.
        Variation of the human menstrual cycle through reproductive life.
        Int J Fertil. 1967; 12: 77-126
        • World Health Organization Task Force on Adolescent Reproductive Health
        World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls, II: longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles.
        J Adolesc Health Care. 1986; 7: 236-244
        • Flug D.
        • Largo R.H.
        • Prader A.
        Menstrual pattern in adolescent Swiss girls: a longitudinal study.
        Ann Hum Biol. 1984; 11: 495-508
        • Apter D.
        • Räisänen I.
        • Ylöstalo P.
        • et al.
        Follicular growth in relation to serum hormonal patterns in adolescent compared with adult menstrual cycles.
        Fertil Steril. 1987; 47: 82-88
        • Gardner J.
        Adolescent menstrual characteristics as predictors of gynecological health.
        Ann Hum Biol. 1983; 10: 31-40
        • Wiksten-Almstromer M.
        • Hirschberg A.L.
        • Hagenfeldt K.
        Prospective follow-up of menstrual disorders in adolescence and prognostic features.
        Acta Obstet Gynecol Scand. 2008; 87: 1162-1168
        • Van Hooff M.H.
        • Voorhorst F.J.
        • Kaptein M.B.
        • et al.
        Predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries for oligoamenorrhea at age 18 years.
        Hum Reprod. 2004; 19: 383-392
        • Morimatsu Y.
        • Matsubara S.
        • Watanabe T.
        • et al.
        Future recovery of the normal menstrual cycle in adolescent patients with secondary amenorrhea.
        J Obstet Gynecol Res. 2009; 35: 545-550
        • Hickey M.
        • Balen A.
        Menstrual disorders in adolescence: investigation and management.
        Hum Reprod Update. 2003; 9: 493-495
        • Balen A.H.
        • Laven J.S.
        • Tan S.L.
        • et al.
        Ultrasound assessment of the polycystic ovary: international consensus definitions.
        Hum Reprod Update. 2003; 9: 505-514
        • Barber T.M.
        • Alvey C.
        • Greenslade T.
        • et al.
        Patterns of ovarian morphology in polycystic ovary syndrome: a study utilizing magnetic resonance imaging.
        Eur Radiol. 2010; 20: 1207-1213
        • Venturoli S.
        • Porcu E.
        • Fabbri R.
        • et al.
        Longitudinal change of sonographic ovarian aspects and endocrine parameters in irregular cycles of adolescence.
        Pediatr Res. 1995; 38: 974-980
        • Mortensen M.
        • Rosenfield R.L.
        • Littlejohn E.
        Functional significance of polycystic-size ovaries in healthy adolescents.
        J Clin Endocrinol Metab. 2006; 91: 3786-3790
        • Chen Y.
        • Yang D.
        • Li L.
        • et al.
        The role of ovarian volume as a diagnostic criterion for Chinese adolescents with polycystic ovary syndrome.
        J Pediatr Adolesc Gynecol. 2008; 21: 347-350
        • Carmina E.
        • Orio F.
        • Palomba S.
        • et al.
        Ovarian size and blood flow in women with polycystic ovary syndrome (PCOS) and their correlations with some endocrine parameters.
        Fertil Steril. 2005; 84: 413-419
        • Jonard S.
        • Robert Y.
        • Dewailly D.
        Revisiting the ovarian volume as a diagnostic criterion for polycystic ovaries.
        Hum Reprod. 2005; 20: 2893-2898
        • Herter L.D.
        • Magalháes J.A.
        • Spritzer P.M.
        Relevance of the evaluation of ovarian volume in adolescent girls with menstrual disorders.
        J Clin Ultrasound. 1996; 24: 243-248
        • Belosi C.
        • Selvaggi L.
        • Apa R.
        • et al.
        Is the PCOS diagnosis solved by ESHRE/ASRM 2003 consensus or could it include ultrasound examination of the ovarian stroma?.
        Hum Reprod. 2006; 21: 2308-2315