Trends, in Diagnosis and Treatment of Polycystic Ovarian Syndrome by Specialty.

OBJECTIVE: To identify trends in the diagnostic work- up of polycystic ovarian syndrome (PCOS) performed by specialists in general medicine, endocrinology, and gynecology. STUDY DESIGN: Ret- rospective electronic chart review of adolescents and young women whose workup for PCOS was initiated by specialists in endocrinology, general medicine, or gyne- cology. RESULTS: Of 530 charts reviewed, 84 patients quali- fied for inclusion. Approximately two-thirds of patients seen by generalists and endocrinologists had lipid test- ing done; no gynecologist in this study ordered lipid tests. Cortisol levels and markers of congenital adrenal hyperplasia were more often ordered for patients seen by endocrinologists than for those seen by generalists or gynecologists. There was no significant difference among specialties in the use of diagnostic criteria for PCOS, including menstrual irregularity, hyperandrogenism, ovarian imaging, or exclusion of other etiologies. Women seen by endocrinologists tended to be prescribed met- formin more often; however, there was no significant difference in the use of hormonal contraceptives, piogli- tazone, and spironolactone among specialties. CONCLUSION: Across 3 clinical practice specialties commonly evaluating menstrual irregularity and/or hirsutism in young women, patients were consistently diagnosed with PCOS based on appropriate, clinically- accepted criteria. However, no patients seen by gyne- cologists received lipid test- ing, which is considered an important screening study for cardiovascular disease risk in this population.

Trends in standard workup performed by pediatric subspecialists for the diagnosis of adolescent polycystic ovary syndrome.

OBJECTIVE: The purpose of this study is to identify trends in the clinical workup, diagnosis, and treatment of polycystic ovary syndrome by pediatric endocrinologists, pediatric gynecologists, and adolescent medicine specialists. DESIGN: Retrospective chart review. SETTING: Tertiary care medical center. PARTICIPANTS: Females aged 11-18 y who were evaluated for PCOS from June 2009 to October 2011 were included. Any patients with coexisting diagnoses of other primary etiology for amenorrhea were excluded. Patients were identified by ICD-9 codes for PCOS, hypersecretion of ovarian androgens, irregular menses, hirsutism, oligomenorrhea, or amenorrhea. 261 patients were included: 144 from endocrinology, 9 from gynecology, and 108 from adolescent pediatric practices. RESULTS: There were no significant differences in the androgen labs ordered by the subspecialties. Gynecologists ordered pelvic ultrasonography for 89% (n = 8) of patients, compared to 9% (n = 10) by adolescent medicine specialists and 24% (n = 34) by endocrinologists (P < .0001). Endocrinologists were most likely to treat patients who met diagnostic criteria for PCOS with metformin (58%, n = 66), compared to gynecologists (14%, n = 1) and adolescent medicine specialists (5%, n = 3) (P < .0001). Gynecologists (43%, n = 3) and adolescent medicine specialists (58%, n = 39) were more likely than endocrinologists (24%, n = 27) to treat patients with oral contraceptive pills (P < .0001). CONCLUSIONS: Inconsistent diagnosis and treatment strategies for young women with PCOS are evident among pediatric subspecialties, reflecting lack of standardized care for adolescents. Quantifying outcomes based on diagnostic and therapeutic approaches are important next steps.