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Polycystic Ovary Syndrome (PCOS) is a metabolic disorder characterized by insulin resistance, hyperandrogenemia and in some cases polycystic ovaries. The prevalence of type 2 diabetes is 10 times as high among young women with PCOS as among those without, and impaired glucose tolerance or overt type 2 diabetes develops by the age of 30 in 30-50% of obese women with PCOS.
For diagnostic purposes, a teen who has had menarche for two years must have two of the following three findings:
The hyperinsulinism stimulates ovarian as well as adrenal androgen production. PCOS is a diagnosis of exclusion.
Thyroid, prolactin and FSH levels should be normal. Testosterone and DHEAS may be mildly elevated. Ovarian and adrenal tumors need to be excluded if testosterone>150ng/dl or DHEAS>700mcg/dl. If DHEAS is elevated, obtain an am 17 hydroxyprogesterone to rule out congenital adrenal hyperplasia.
Cushing's syndrome needs to be ruled out if hypertension, short stature and striae are present.
A course of provera at 10 mg /day for 7 days is indicated if a patient has not had a period for greater than 3 months.
Weight loss and increased physical activity induces a decrease in insulin resistance and androgenic activity. Refer the patient to weight management.
If the patient continues to have symptoms of hyperandrogenemia, menstrual irregularity or glucose intolerance after six months of treatment the following treatment options are available:
Barbara Davis Center for Childhood Diabetes