ESPE Abstracts

Background: Polycystic ovary syndrome (PCOS) continues to be a diagnostic challenge in adolescent girls. Symptoms like oligomenorrhea and acne, and polycystic ovarian morphology on ultrasound can be normal variants in adolescents. In addition to diagnostic difficulties, there is lack of randomized controlled trials for PCOS treatments specific to adolescents. Current guidelines for diagnosis and management of PCOS in adolescents have large variations and rely on extrapolation of adult data, leading to inconsistencies in endocrinologists’ practice. The aim of this study was to map out current PCOS diagnostic and management practices at the paediatric endocrine clinic in the Royal London Children’s Hospital.

Methods: Data of 46 adolescent girls presenting with PCOS-like symptoms to the paediatric endocrine clinic were collected from electronic records. A non-exhaustive list of patients was obtained to provide a snapshot of current practice. 6 patients were excluded as they ended up having an alternative diagnosis. Data on patient demographics, symptoms, investigations, management and outcomes was collected.

Results: The median age at first clinic visit was 15.3 years, and median age at menarche 11 years. The majority of girls presented with irregular periods (63%), others with secondary amenorrhea (25%),10% with primary amenorrhea and 1% with normal cycles. 65% of girls were Asian, 12% White, 3% Black, 5% Mixed, 10% Other and 5% Not Stated. 85% were overweight (BMI SDS >1), of which 85% were obese (BMI SDS > 2). 48% reported hirsutism, 38% acne, 23% mental health problems and 20% had a positive family history. 65% had acanthosis nigricans. The most commonly performed investigations (>90%) were androstenedione, DHEAS, testosterone and LH/FSH. 60% had pelvic ultrasound (20% GP-initiated). 45% underwent oral glucose tolerance testing; 22% had impaired glucose tolerance and 78% had normal results. Regarding management, 75% received lifestyle advice. Pharmacological management was given to 40% with progesterone only hormonal contraception in 10% and combined contraception in 12%. 13% of the girls received metformin as well as hormonal contraception and 2 patients received metformin only. Menstruation outcomes were only documented for 35%, stating periods were more regular or had commenced. Changes in Body Mass Index (BMI) were available for 78% of patients with a median change in BMI SDS of –0.01.

Conclusion: This study can serve as a benchmark for comparison for other clinicians facing similar challenges as well as support the need for further research into diagnostic tools and treatment protocols.