多囊卵巢綜合征的診斷和治療2013
《多囊卵巢綜合征的診斷和治療2013》內(nèi)容預(yù)覽：
Participants: An Endocrine Society-appointed Task Force of experts, a methodologist, and a medicalwriter developed the guideline.Evidence: This evidence-based guideline was developed using the Grading of Recommendations,Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendationsand the quality of evidence.
Consensus Process: One group meeting, several conference calls, and e-mail communicationsenabled consensus. Committees and members of The Endocrine Society and the European Societyof Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematicreviews were conducted to summarize supporting evidence.
Conclusions:Wesuggest using the Rotterdam criteria for diagnosing PCOS (presence of two of thefollowing criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing adiagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism iscentral to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausalwomen.
Evaluation of women with PCOS should exclude alternate androgen-excess disordersandriskfactors for endometrial cancer,mooddisorders, obstructive sleep apnea, diabetes,andcardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalitiesand hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility;metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities,but it has limited or no benefit in treating hirsutism, acne, or infertility.
Hormonal contraceptivesand metformin are the treatment options in adolescents with PCOS. The role of weightloss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable riskbenefitratio overall, and statins require further study.
We suggest that the diagnosis of polycystic ovary syndrome(PCOS) be made if two of the three following criteriaare met: androgen excess, ovulatory dysfunction, orpolycystic ovaries (PCO) (Tables 1 and 2), whereas disordersthat mimic the clinical features of PCOS are excluded.These include, in all women: thyroid disease, hyperprolactinemia,and nonclassic congenital adrenalhyperplasia (primarily 21-hydroxylase deficiency by serum17-hydroxyprogesterone [17-OHP]) (Table 3).
In selectwomen with amenorrhea and more severe phenotypes,we suggest more extensive evaluation excludingother causes (Table 4) (2|QQQE).Diagnosis in adolescentsWe suggest that the diagnosis of PCOS in an adolescentgirl be made based on the presence of clinicaland/or biochemical evidence of hyperandrogenism (afterexclusion of other pathologies) in the presence of persistentoligomenorrhea.
Anovulatory symptoms and PCOmorphology are not sufficient to make a diagnosis in adolescents,as they may be evident in normal stages in reproductivematuration Diagnosis in perimenopause and menopause1.3 Although there are currently no diagnostic criteriafor PCOS in perimenopausal and menopausal women, wesuggest that a presumptive diagnosis ofPCOScan be basedupon a well-documented long-term history of oligomenorrheaand hyperandrogenism during the reproductiveyears.
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