Endocrine Abstracts

JOINT892

Introduction: Polycystic Ovarian Syndrome (PCOS) may affect up to 18% of adolescent girls and has significant implications on reproductive, metabolic and mental health. The diagnosis of adolescent PCOS is challenging due to differing criteria and manifestations. Adolescents with obesity are at higher risk of PCOS and should be screened accordingly. However, screening for obesity-associated comorbidities, including PCOS, have not been standardized. A scoping review was conducted to evaluate and compare the presence and extent of recommendations for PCOS screening and management in national and international guidelines for pediatric obesity, and to summarize recommendations from guidelines developed specific to adolescent PCOS.

Methods: A scoping review protocol was developed in accordance with the PRISMA extension for scoping reviews checklist. Databases searched included: PubMed, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature and various guideline repositories. The inclusion criteria include (1) national or international guidelines, consensus or position statements written by government, professional bodies or expert panels, and (2) pertained to the clinical management of paediatric obesity or adolescent PCOS, and (3) published in English or with available English translations. The Appraisal of Guidelines for Research and Evaluation (AGREE)-II instrument was used for quality assessment of the included articles. Recommendations for the screening and management of PCOS in adolescents with obesity were made, with certainty of evidence ascribed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Results: Fourteen of 32 international childhood/adolescent obesity guidelines included some mention of PCOS screening and/or management, and 7 adolescent PCOS specific guidelines were summarized. Details of recommendations varied across the guidelines, even in the PCOS-specific guidelines. Based on the strength and quality of evidence presented, we summarize key recommendations for PCOS screening and management: (1) Perform a comprehensive menstrual history for overweight or obese patients, (2) Assess onset and progression of hirsutism, and onset and severity of cystic or inflammatory acne, (3) PCOS-specific investigations include serum free/total testosterone and sex hormone-binding globulin, (4) Routine pelvic ultrasound and serum anti-Mullerian hormone measurements are not recommended in adolescents, (5) Individualised PCOS management with weight management as a cornerstone, (6) Combined oral contraceptives and metformin may be useful for management.

Conclusion: Adolescent obesity and PCOS guidelines have been inconsistent with the recommendations on PCOS screening management. Given the significant morbidities associated with PCOS, appropriate screening and prompt management is essential and should be part of routine care in adolescents with obesity.