Diagnosis of Polycystic Ovarian Syndrome in Adolescence

The definition of PCOS is still controversial, especially during adolescence. Following the last official indications, the ESHRE/ASRM 2006 consensus, to qualify as PCOS at least two of the following symptoms (excluding other causes of hyperandrogenism) should be present: oligoanovulation (oligoamenorrhea); clinical hyperandrogenism and/or biological hyperandrogenemia; and polycystic ovary morphology at ultrasound. Nevertheless, the ultrasound diagnosis of polycystic ovarian syndrome is still an open problem. The frequency of overdiagnosis in particular phases of reproductive age, which reaches the 50% of girls during adolescence, the contrasting guidelines, and the technological advances present difficult challenges to the sonographer. Follicle number and disposition, and ovarian volume represent the most used criteria, but other aspects such as stromal study and ovarian vascularization could help to distinguish healthy and other pathologies from PCOS. Recently, anti-Mullerian hormone assay was introduced as a support for US diagnosis. On the other hand, the definition of polycystic ovaries in adolescence is still uncertain. The symptoms such as oligomenorrhea or amenorrhea, and clinical or biochemical signs of hyperandrogenism such as acne and/or hirsutism are often present also in healthy adolescent. In ultrasound, both follicle number and ovarian size in this age group are under discussion. This chapter critically evaluates the current guidelines, offering an update in this field, and proposes age-related good practice suggestions.