Please use this identifier to cite or link to this item: https://doi.org/10.1111/cen.13755
Title: Simplified 4-item criteria for polycystic ovary syndrome: A bridge too far?
Authors: Indran, Inthrani R 
Huang, Zhongwei 
Khin, Lay Wai 
Chan, Jerry KY 
Viardot-Foucault, Veronique
Yong, Eu Leong 
Keywords: Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
anti-mullerian hormone
diagnosis
female infertility
oligomenorrhoea
polycystic ovary syndrome
ANTI-MULLERIAN HORMONE
ANTRAL FOLLICLE COUNT
DIAGNOSTIC-CRITERIA
PHENOTYPIC FEATURES
ROTTERDAM CRITERIA
WOMEN
PREVALENCE
METAANALYSIS
DEFINITION
MANAGEMENT
Issue Date: 1-Aug-2018
Publisher: WILEY
Citation: Indran, Inthrani R, Huang, Zhongwei, Khin, Lay Wai, Chan, Jerry KY, Viardot-Foucault, Veronique, Yong, Eu Leong (2018-08-01). Simplified 4-item criteria for polycystic ovary syndrome: A bridge too far?. CLINICAL ENDOCRINOLOGY 89 (2) : 202-211. ScholarBank@NUS Repository. https://doi.org/10.1111/cen.13755
Abstract: Objectives: Although the Rotterdam 2003 polycystic ovarian syndrome (PCOS) diagnostic criteria is widely used, the need to consider multiple variables makes it unwieldy in clinical practice. We propose a simplified PCOS criteria wherein diagnosis is made if two of the following three items were present: (i) oligomenorrhoea, (ii) anti-mullerian hormone (AMH) above threshold and/or (iii) hyperandrogenism defined as either testosterone above threshold and/or the presence of hirsutism. Design setting and participants: This prospective cross-sectional study consists of healthy women (n = 157) recruited at an annual hospital health screen for staff and volunteers from the university community, and a patient cohort (n = 174) comprising women referred for suspected PCOS. Main outcome measures: We used the healthy cohort to establish threshold values for serum testosterone, antral follicle counts (AFC), ovarian volume (OV) and AMH. Women from the patient cohort, classified as PCOS by simplified PCOS criteria, AMH alone and Rotterdam 2003, were compared with respect to prevalence of oligomenorrhoea, hyperandrogenism and metabolic indices. Results: In healthy women, testosterone ≥1.89 nmol/L, AFC ≥22 follicles and OV ≥8.44 mL, best predicted oligomenorrhoea and were used as threshold values for PCOS criteria. An AMH level ≥37.0 pmol/L best predicted polycystic ovarian morphology. AMH alone as a single biomarker demonstrated poor specificity (58.9%) for PCOS compared to Rotterdam 2003. In contrast, there was a 94% overlap in women selected as PCOS by the simplified PCOS criteria and Rotterdam 2003. The population characteristics of these two groups of PCOS women showed no significant mean differences in androgenic, ovarian, AMH and metabolic (BMI, HOMA-IR) variables. Conclusions: Our data recommend the simplified PCOS criteria with population-specific thresholds for diagnosis of PCOS. Its ability to replace ovarian ultrasound biometry with the highly correlated variable AMH, and use of testosterone as a single marker for hyperandrogenaemia alongside the key symptoms of oligomenorrhoea and hirsutism confers significant clinical potential for the diagnosis of PCOS.
Source Title: CLINICAL ENDOCRINOLOGY
URI: https://scholarbank.nus.edu.sg/handle/10635/205823
ISSN: 03000664
13652265
DOI: 10.1111/cen.13755
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