An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence
Por:
Ibañez-Toda L, Oberfield SE, Witchel SF, Auchus RJ, Chang RJ, Codner E, Dabadghao P, Darendeliler F, Elbarbary NS, Gambineri A, Garcia Rudaz C, Hoeger KM, López-Bermejo A, Ong K, Peña AS, Reinehr T, Santoro N, Tena-Sempere M, Tao R, Yildiz BO, Alkhayyat H, Deeb A, Joel D, Horikawa R, de Zegher F and Lee PA
Publicada:
1 ene 2017
Ahead of Print:
13 nov 2017
Resumen:
This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)(1). The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Mullerian hormone, hyper-insulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents. (C) 2017 S. Karger AG, Basel.
Filiaciones:
Ibañez-Toda L:
Endocrinology, Hospital Sant Joan de Deu, Esplugues, Barcelona, Spain
CIBERDEM, ISCIII, Madrid, Spain
Oberfield SE:
Division of Pediatric Endocrinology, CUMC, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
Witchel SF:
Division of Pediatric Endocrinology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
Auchus RJ:
University of Michigan, MSRBII, Ann Arbor, Michigan, USA
Chang RJ:
Department of Reproductive Medicine, UCSD School of Medicine, La Jolla, California, USA
Codner E:
Institute of Maternal and Child Research, University of Chile, School of Medicine, Santiago, Chile
Dabadghao P:
Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Darendeliler F:
Istanbul Tip Fakültesi, Çocuk Klinigi, Istanbul, Turkey
Elbarbary NS:
Ain Shams University, Cairo, Faculty of Medicine, Cairo, Egypt
Gambineri A:
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Garcia Rudaz C:
Division of Women, Youth and Children, Australian National University, Canberra, Australian Capital Territory, Australia
Hoeger KM:
Department of OBGYN, University of Rochester Medical Center, Rochester, New York, USA
López-Bermejo A:
Pediatric Endocrinology, Hospital de Girona Dr. Josep Trueta, Girona, Spain
Ong K:
MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
Peña AS:
Women's and Children's Hospital, North Adelaide, South Australia, Australia
Reinehr T:
University of Witten/Herdecke, Vestische Kinder- und Jugendklinik, Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Datteln, Germany
Santoro N:
Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
Tena-Sempere M:
University of Córdoba, Edificio IMIBIC, Córdoba, Spain
Tao R:
Division of Pediatric Endocrinology, CUMC, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
Yildiz BO:
Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
Alkhayyat H:
Medical University of Bahrain, BDF Hospital, Riffa, Bahrein
Deeb A:
Mafraq Hospital, Abu Dhabi, United Arab Emirates
Joel D:
Department of Paediatrics and Adolescent Health, University of Botswana Teaching Hospital, Gaborone, Botswana
Horikawa R:
Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
de Zegher F:
Department Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
Lee PA:
Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
Green Submitted
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