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Polycystic Ovarian Syndrome
Bryan R. Foster, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Polycystic ovarian syndrome (PCOS)
              • Polycystic ovarian morphology (PCOM)
            • Synonyms

              • Stein-Leventhal syndrome: Hyperandrogenemia → polycystic ovaries, hirsutism, menstrual abnormalities, obesity
            • Definitions

              • Complex heterogenous syndrome of ovulatory dysfunction, menstrual irregularity, and androgen excess
              • Rotterdam criteria for PCOS developed in 2003: 2 of 3 criteria must be present
                • Oligo- or anovulation
                • Hyperandrogenism (clinical or biochemical)
                • Polycystic ovaries (by ultrasound)
              • Some authors suggest polycystic ovarian morphology (PCOM) are more correctly polyfollicular, PCOS should be called "functional hyperandrogenism"
                • Subtypes of functional hyperandrogenism account for variable clinical presentation
                  • Allow for better individualized treatment
                  • Decrease bias in future scientific/clinical studies
              • Polycystic ovarian morphology (PCOM) is term for ovaries meeting criteria on ultrasound only
                • Isolated PCOM may be found in up to 22-30% of normal female population
                  • Isolated PCOM in adult premenopausal healthy women is not related to metabolic variables
                  • Meaning of PCOM in asymptomatic population is currently unknown

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Dewailly D et al: Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 20(3):334-52, 2014
                                      2. Lujan ME et al: Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod. 28(5):1361-8, 2013
                                      3. Battaglia C et al: Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion. J Ultrasound Med. 31(7):1015-24, 2012
                                      4. Catteau-Jonard S et al: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Ultrasound Obstet Gynecol. 40(2):223-9, 2012
                                      5. Lee TT et al: Polycystic ovarian syndrome: role of imaging in diagnosis. Radiographics. 32(6):1643-57, 2012
                                      6. Rackow BW: Polycystic ovary syndrome in adolescents. Curr Opin Obstet Gynecol. 24(5):281-7, 2012
                                      7. Dewailly D et al: Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 26(11):3123-9, 2011
                                      8. Nardo LG et al: Evidence-based approach for the use of ultrasound in the management of polycystic ovary syndrome. Minerva Ginecol. 60(1):83-9, 2008
                                      9. Porter MB: Polycystic ovary syndrome: the controversy of diagnosis by ultrasound. Semin Reprod Med. 26(3):241-51, 2008
                                      10. Mahajan NN et al: Sonographic evaluation of the endometrium in patients with a history or an appearance of polycystic ovarian syndrome. J Ultrasound Med. 26(6):862; author reply 862, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Polycystic ovarian syndrome (PCOS)
                                                  • Polycystic ovarian morphology (PCOM)
                                                • Synonyms

                                                  • Stein-Leventhal syndrome: Hyperandrogenemia → polycystic ovaries, hirsutism, menstrual abnormalities, obesity
                                                • Definitions

                                                  • Complex heterogenous syndrome of ovulatory dysfunction, menstrual irregularity, and androgen excess
                                                  • Rotterdam criteria for PCOS developed in 2003: 2 of 3 criteria must be present
                                                    • Oligo- or anovulation
                                                    • Hyperandrogenism (clinical or biochemical)
                                                    • Polycystic ovaries (by ultrasound)
                                                  • Some authors suggest polycystic ovarian morphology (PCOM) are more correctly polyfollicular, PCOS should be called "functional hyperandrogenism"
                                                    • Subtypes of functional hyperandrogenism account for variable clinical presentation
                                                      • Allow for better individualized treatment
                                                      • Decrease bias in future scientific/clinical studies
                                                  • Polycystic ovarian morphology (PCOM) is term for ovaries meeting criteria on ultrasound only
                                                    • Isolated PCOM may be found in up to 22-30% of normal female population
                                                      • Isolated PCOM in adult premenopausal healthy women is not related to metabolic variables
                                                      • Meaning of PCOM in asymptomatic population is currently unknown

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Dewailly D et al: Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 20(3):334-52, 2014
                                                                          2. Lujan ME et al: Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod. 28(5):1361-8, 2013
                                                                          3. Battaglia C et al: Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion. J Ultrasound Med. 31(7):1015-24, 2012
                                                                          4. Catteau-Jonard S et al: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Ultrasound Obstet Gynecol. 40(2):223-9, 2012
                                                                          5. Lee TT et al: Polycystic ovarian syndrome: role of imaging in diagnosis. Radiographics. 32(6):1643-57, 2012
                                                                          6. Rackow BW: Polycystic ovary syndrome in adolescents. Curr Opin Obstet Gynecol. 24(5):281-7, 2012
                                                                          7. Dewailly D et al: Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 26(11):3123-9, 2011
                                                                          8. Nardo LG et al: Evidence-based approach for the use of ultrasound in the management of polycystic ovary syndrome. Minerva Ginecol. 60(1):83-9, 2008
                                                                          9. Porter MB: Polycystic ovary syndrome: the controversy of diagnosis by ultrasound. Semin Reprod Med. 26(3):241-51, 2008
                                                                          10. Mahajan NN et al: Sonographic evaluation of the endometrium in patients with a history or an appearance of polycystic ovarian syndrome. J Ultrasound Med. 26(6):862; author reply 862, 2007