title: Trends in standard workup performed by pediatric subspecialists for the diagnosis of adolescent polycystic ovary syndrome.
abstract: 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.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  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.
authors.affiliation: Georgetown University School of Medicine, Washington, DC. Electronic address: sarah.elizabeth.powers@gmail.com.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Powers
authors.affiliation: Georgetown University School of Medicine, Washington, DC.
authors.forename: Nicole W
authors.initials: NW
authors.lastname: Uliassi
authors.affiliation: Division of Endocrinology & Metabolism, Department of Medicine, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Sullivan
authors.affiliation: Department of Adolescent & Young Adult Medicine, Center for Translational Science/CRI, Children's National Medical Center, Washington, DC.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Tuchman
authors.affiliation: Department of Pediatric Endocrinology & Diabetes, Children's National Medical Center, Washington, DC.
authors.forename: Rinku
authors.initials: R
authors.lastname: Mehra
authors.affiliation: Department of Obstetrics & Gynecology, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Veronica
authors.initials: V
authors.lastname: Gomez-Lobo
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods*; D000728:Androgens / Q000378:metabolism; D002648:Child; D003276:Contraceptives, Oral / Q000627:therapeutic use; D004704:Endocrinology / Q000379:methods*; D005260:Female; D006176:Gynecology / Q000379:methods*; D006628:Hirsutism / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008599:Menstruation Disturbances / Q000209:etiology; D008687:Metformin / Q000627:therapeutic use; D010372:Pediatrics / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000728:Androgens; D003276:Contraceptives, Oral; D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Adolescent medicine; Adolescents; Diagnosis; Endocrinology; Gynecology; Polycystic ovary syndrome; Specialization; Therapeutics