Pediatric emergency medicine trisk 1011 1011
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (129.23 KB, 1 trang )
TABLE 51.2
CRITERIA FOR THE DIAGNOSIS OF POLYCYSTIC OVARY
SYNDROME
Rotterdam (2003) Requires two of
three
Androgen Excess Society (2009)
1. Oligo- or anovulation
1. Hyperandrogenism: hirsutism and/or
hyperandrogenemia
2. Clinical or biochemical signs of
hyperandrogenism
2. Ovarian dysfunction: oligoanovulation and/or polycystic
3. Polycystic ovaries and exclusion of
ovaries
other etiologies
3. Exclusion of other androgen excess
or related disorders
Adapted from The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003
consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril
2004;81(1):19–25. Adapted from Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS
Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril
2009;91(2):456–488.
Treatment goals for adolescent patients with PCOS are to restore monthly
menstrual cycles, to minimize hirsutism, to prevent the development of
endometrial hyperplasia, and, it is hoped, to reduce the long-term risks of relative
infertility, glucose intolerance, endometrial adenocarcinoma, and cardiovascular
morbidity. Weight reduction, a challenging health issue in itself, can ameliorate
the endocrinologic derangements and promote ovulation and regular menstruation
in obese teens with PCOS, but few adolescents are able to achieve or to maintain
substantial weight loss. The appropriate treatment of adolescents who do not
desire pregnancy is a combined estrogen–progestin method which is available in
a variety of delivery systems (pill, ring, or patch for example)—to suppress
ovarian or adrenal androgen production and to produce monthly menstrual
bleeding. In adults, metformin has been used to treat PCOS by increasing
peripheral tissue sensitivity to insulin. Spironolactone and other antiandrogenic
medications have also been used in the treatment of PCOS. The practitioner
should keep in mind that ovulatory cycles can potentially be restored with the use
of metformin or antiandrogenics. Any adolescent who is sexually active with
males should be counseled about contraceptive methods, regardless of whether
she has PCOS or not. Initiation of these second-line therapies should be left to
outpatient specialists such as gynecology or adolescent medicine.
