Best PCOD and Adolescent clinic in Gurgaon Sector 66
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Best PCOD and Adolescent clinic in Gurgaon Sector 66
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Best PCOD and Adolescent clinic in Gurgaon Sector 66
Adolescent girls with PCOS may present with abnormal menstrual periods, hirsutism, and/or acne. A stepwise diagnostic approach is recommended in these patients. Historical details should include a review of exogenous medication intake.
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Androgenic steroids and some anti-seizure medications may cause clinical features similar to those seen in PCOS, and medications commonly used to treat acne may resolve or mask some PCOS features .
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Various patterns of menstrual irregularity may be seen in adolescents with PCOS including primary amenorrhea (absence of menarche by 15 years of age or 2–3 years after breast budding), secondary amenorrhea (more than 90 days without a period with history of prior menstrual periods), oligomenorrhea, and even excessive uterine bleeding (4).
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Best PCOD and Adolescent clinic in Gurgaon Sector 66
It is extremely important that clinicians remain cognizant of other possible underlying pathologies such as thyroid dysfunction, elevated prolactin, hypercortisolemia, and other causes of virilization, which may result in a similar clinical presentation. Clinical and biochemical work up should evaluate for these conditions.
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Laboratory evaluation
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Measurements of total and/or free testosterone have been the most recommended hormone determinations to document hyperandrogenemia .
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Dehydroepiandrosterone sulfate (DHEAS) level is also useful to screen for primary adrenal source of hyperandrogenemia.
Best PCOD and Adolescent clinic in Gurgaon Sector 66
These hormone levels should preferably be drawn in the morning. A normal afternoon androgen level does not necessarily exclude hyperandrogenemia. If a patient meets clinical criteria for PCOS but the laboratory evaluation fails to demonstrate hyperandrogenemia, repeat morning hormone levels can be drawn. The clinician should be aware that if treatment has been initiated in the interim, hormone levels may be altered.
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Additional laboratory work up may be individualized as needed to rule out other causes of hyperandrogenemia or menstrual irregularity based on clinical features. Generally this work up includes: 17-hydroxyprogesterone (17-OHP), androstenedione, free thyroxine (FT4), thyroid-stimulating hormone (TSH), LH, FSH, and prolactin. Pregnancy should be ruled out in all patients.
Best PCOD and Adolescent clinic in Gurgaon Sector 66
A cosyntropin (ACTH) stimulation test should be ideally performed to screen for non-classic congenital adrenal hyperplasia (NC-CAH). However, undertaking the ACTH stimulation testing in all patients may not be practical. Recommendations have been made about the usefulness of a morning 17-OHP level of >200 mg/dL as a screening tool for NC-CAH. It has been reported to detect a majority of women with non-classic CAH.
Best PCOD and Adolescent clinic in Gurgaon Sector 66
Pelvic ultrasonography is generally not recommended for a diagnosis of PCOS in adolescents. The ultrasonographic criteria for diagnosis of PCOS in adolescents are not well defined (4). However, pelvic ultrasonography may be indicated based on clinical features to rule out other underlying pathology (28). Some experts in the field feel it is important to exclude rare causes of androgen producing tumors in all adolescent girls presenting with anovulatory symptoms and hyperandrogenemia (29).