ACR Codes: 8.-1
Polycystic Ovary Syndrome (PCOS) is classically associated with amenorrhea, infertility, hirsutism, insulin-resistance and obesity, although not all of these characteristics need to be present to consider such a diagnosis, as is the case with this patient. According to the 1990 NIH Conference on PCOS, two diagnostic criteria are used commonly to provide a diagnosis of PCOS: menstrual irregularity and either chemical or biological evidence of hyperandrogenism. Menstrual irregularity is described as either amenorrhea (no menses for 3 consecutive months) or oligomenorrhea (less than 9 menses in one year). Occasionally, menses will appear as irregular spotting due to unopposed estrogen levels, as evident in this patient. While ultrasound can not be used to make the diagnosis of PCOS, it is often used to aid in such a diagnosis. Polycystic ovaries are described as the presence of at least eight small follicles, measuring 2-8mm in diameter in each ovary. While 80-100% of women diagnosed with PCOS have polycystic ovaries on ultrasound, up to 20-25% of regularly ovulating women can have similarly appearing ovaries. Additionally, most women with idiopathic hirsutism or other disorders causing androgen excess such as congenital adrenal hyperplasia or ovarian/adrenal tumors can have polycystic ovaries. This underscores the importance of considering such other diagnoses. Often, other androgen excess disorders present with severe hirsutism or virilization, whereas PCOS usually presents with either mild or subclinical hirsutism. This patient presents with irregular menses and typical polycystic ovaries on ultrasound examination. Laboratory analysis of androgen levels are needed to clinch the diagnosis as she does not have clinical signs of hirsutism.
Reference(s): Chang, Jeffrey and Seth E. Katz. “Diagnosis of Polycystic Ovary Syndrome.” Endocrinology and Metabolism Clinics 28: June 1999, 397-408.
Lewis, Vivian. “Polycystic Ovary Syndrome: A Diagnostic Challenge.” Obstetrics and Gynecology Clinics 28: March 2001.
Taylor, Ann E. and Robert L. Barbieri. “Diagnosis and Treatment of Polycystic Ovary Syndrome in Adults.” UpToDate Online Version 10.3, 29 March 2002.
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