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Differences in the management of adolescents with polycystic ovary syndrome across pediatric specialties. J Pediatr Adolesc Gynecol 2013 Aug;26(4):234-8

Date

06/04/2013

Pubmed ID

23726135

Pubmed Central ID

PMC7024914

DOI

10.1016/j.jpag.2013.03.007

Scopus ID

2-s2.0-84880717199   27 Citations

Abstract

STUDY OBJECTIVE: Evaluate for differences in the management of adolescents with polycystic ovarian syndrome (PCOS) across 3 pediatric specialties.

DESIGN: Retrospective review of medical records.

SETTING: Academic children's hospital.

PARTICIPANTS: 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).

INTERVENTIONS: None.

MAIN OUTCOME MEASURES: (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.

Author List

Auble B, Elder D, Gross A, Hillman JB

Author

Bethany Auble MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adolescent Medicine
Androgen Antagonists
Contraceptives, Oral, Hormonal
Diabetes Mellitus, Type 2
Endocrinology
Female
Gynecology
Humans
Hypoglycemic Agents
Insulin Resistance
Life Style
Metformin
Obesity
Polycystic Ovary Syndrome
Practice Patterns, Physicians'
Retrospective Studies