title: Differences in the management of adolescents with polycystic ovary syndrome across pediatric specialties.
abstract: OBJECTIVE
  Evaluate for differences in the management of adolescents with polycystic ovarian syndrome (PCOS) across 3 pediatric specialties.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  METHODS
  Academic children's hospital.
  
  
  METHODS
  181 adolescents seen between July 2008 and June 2010 by providers in Pediatric Endocrinology (PEndo), Adolescent Medicine (AMed), or Pediatric and Adolescent Gynecology (PGyn) identified via billing data (ICD-9 code for PCOS, 256.4).
  
  
  METHODS
  None.
  
  
  METHODS
  (1) Percentage of adolescents with a billing diagnosis of PCOS who met diagnostic criteria; (2) Percentage of individuals screened for comorbidities and differences across specialties; (3) Differences in treatment recommendations across specialties; (4) Factors associated with recommendation for metformin and hormonal contraceptives.
  
  
  RESULTS
  Thirteen percent of PEndo patients did not meet diagnostic criteria for PCOS; 20% of AMed and PGyn patients did not meet criteria. There were significant differences in rates of screening for obesity, insulin resistance, and Type 2 diabetes. There were significant differences in treatment recommendations for lifestyle changes, metformin, and anti-androgen therapy across specialties. Specialty and obesity were significant predictors of metformin recommendation; specifically PEndo predicted metformin recommendation. PGyn and AMed specialties predicted hormonal contraceptive recommendation.
  
  
  CONCLUSIONS
  The variability observed among specialties may be due to differences in training, accounting for a range of comfort with aspects of PCOS. Formulation of consensus guidelines for diagnosis and management of PCOS are needed, along with broad educational efforts. By correctly diagnosing, screening for comorbidities, and managing PCOS appropriately during adolescence, providers may reduce the risk for long-term consequences.
authors.affiliation: Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Auble
authors.forename: Deborah
authors.initials: D
authors.lastname: Elder
authors.forename: Andrea
authors.initials: A
authors.lastname: Gross
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hillman
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine; D000726:Androgen Antagonists / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004704:Endocrinology; D005260:Female; D006176:Gynecology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D008019:Life Style; D008687:Metformin / Q000627:therapeutic use; D009765:Obesity / Q000150:complications / Q000175:diagnosis; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
chemical_list: D000726:Androgen Antagonists; D003278:Contraceptives, Oral, Hormonal; D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Hirsutism; Metformin; PCOS; Rotterdam criteria