目的:根据2003年鹿特丹标准诊断为多囊卵巢综合征(PCOS)的青少年的特征是什么,根据国际循证指南,谁不符合诊断?
结论:与对照组相比,具有PCOS特征但不符合循证指南青少年标准的青少年表现出不利的代谢特征,并且与符合青少年标准的青少年具有相当大的代谢和激素特征.
背景:基于国际证据的PCOS指南建议不应使用超声诊断妇科年龄<8岁的女孩的PCOS。到目前为止,很少有研究根据鹿特丹标准对诊断为PCOS但不符合更新指南诊断的女孩的临床特征进行评估.
方法:这是一项回顾性研究,和受试者从2004年到2022年接受护理。
方法:根据2003年鹿特丹标准和健康对照诊断患有PCOS的青春期女孩。所有参与者都在月经初潮后2至8年之间。
结果:在根据鹿特丹标准诊断为PCOS的315名女孩中,月经不调(IM)/高雄激素血症(HA)/多囊卵巢(PCO),IM/HA,HA/PCO,IM/PCO表型占206(65.4%),30(9.5%),12(3.8%),67名(21.3%)参与者,分别。根据循证指南,79名具有HA/PCO或IM/PCO表型的女孩(25.1%)未被诊断为PCOS,并与国际准则保持一致;他们被指定为“高危”组。不出所料,符合循证指南青少年标准的女孩表现出最差的代谢特征(广泛性或中心性肥胖程度,胰岛素抵抗的频率,前驱糖尿病或糖尿病,和代谢综合征)和多毛症评分高于高危人群或对照组。大约90%的高危人群没有超重或肥胖,这与控件相似。然而,他们表现出更糟糕的代谢特征,血压升高,甘油三酯,和胰岛素抵抗参数高于对照组;此外,这些情况与符合青少年标准的女孩相似。在女孩符合青少年标准的情况下,风险组的血清LH水平和LH/FSH比相似地升高。
结论:我们无法评估对照组的激素或超声参数。
结论:与常规鹿特丹标准相比,最近的国际循证指南-避免超声在青少年PCOS诊断中的应用-仍然提供了识别处于危险中的年轻女孩的机会,与这项研究的结果一致。对该青少年人群的实用方法包括建立IM或HA(未显示超声)并指定“处于危险中”的PCOS状态,并定期检查新出现或恶化的PCOS相关症状或代谢异常,随后的重新评估包括超声或抗苗勒管激素,初潮后8年一次.
背景:本研究未获得资助。作者没有利益冲突要披露。
背景:不适用。
OBJECTIVE: What are the characteristics of adolescents diagnosed with polycystic ovary syndrome (PCOS) based on the 2003 Rotterdam criteria, but who do not meet the diagnosis according to the international evidence-based
guideline?
CONCLUSIONS: Adolescents who had features of PCOS but did not meet the evidence-based
guideline adolescent criteria exhibited unfavorable metabolic profiles compared to controls and shared considerable metabolic and hormonal features with adolescents who did meet the adolescent criteria.
BACKGROUND: The international evidence-based PCOS
guideline recommended that ultrasound should not be used for the diagnosis of PCOS in girls with a gynecological age of <8 years. Thus far, few studies have evaluated the clinical characteristics of the girls diagnosed with PCOS based on the Rotterdam criteria but who do not meet the diagnosis according to the updated guideline.
METHODS: This is a retrospective study, and subjects attended for care from 2004 to 2022.
METHODS: Adolescent girls with PCOS diagnosed according to the 2003 Rotterdam criteria and healthy controls. All participants were between 2 and 8 years since menarche.
RESULTS: Of the 315 girls diagnosed with PCOS according to the Rotterdam criteria, those with irregular menstruation (IM)/
hyperandrogenism (HA)/polycystic ovary (PCO), IM/HA, HA/PCO, and IM/PCO phenotypes accounted for 206 (65.4%), 30 (9.5%), 12 (3.8%), and 67 (21.3%) participants, respectively. According to the evidence-based
guideline, 79 girls (25.1%) with the HA/PCO or IM/PCO phenotypes were not diagnosed with PCOS, and aligned to the international guideline; they were designated as the \'at-risk\' group. As expected, the girls meeting the evidence-based guideline adolescent criteria showed the worst metabolic profiles (degree of generalized or central obesity, frequency of insulin resistance, prediabetes or diabetes, and metabolic syndrome) and higher hirsutism scores than the at-risk group or controls. Approximately 90% of the at-risk group were not overweight or obese, which was similar to the controls. However, they showed worse metabolic profiles, with higher blood pressure, triglyceride, and insulin resistance parameters than controls; furthermore, these profiles were similar to those of the girls meeting the adolescent criteria. The at-risk group showed similarly elevated serum LH levels and LH/FSH ratio with the girls meeting adolescent criteria.
CONCLUSIONS: We could not evaluate hormonal or ultrasound parameters in controls.
CONCLUSIONS: Compared to the conventional Rotterdam criteria, the recent international evidence-based guideline-avoiding ultrasound in PCOS diagnosis in adolescents-still gives the opportunity to identify young girls at risk, aligned to the findings in this study. A practical approach to this adolescent population would involve establishing IM or HA (with ultrasound not indicated) and designating \'at-risk\' PCOS status with regular check-ups for newly developed or worsening PCOS-related symptoms or metabolic abnormalities, with subsequent reassessment including ultrasound or anti-Müllerian hormone, once 8 years post-menarche.
BACKGROUND: No funding was received in support of this study. The authors have no conflicts of interest to disclose.
BACKGROUND: N/A.