Clinical Endocrinology

Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management

Authors

  • Andrea J. Cussons,

    1. Department of Endocrinology and Diabetes and
    2. Keogh Institute for Medical Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia,
    3. University of Western Australia, School of Medicine and Pharmacology, Royal Perth Hospital Unit, and
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  • Bronwyn G. A. Stuckey,

    Corresponding author
    1. Department of Endocrinology and Diabetes and
    2. Keogh Institute for Medical Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia,
      B. G. A. Stuckey, Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia 6009. Tel.: + 61 8 9346 2008; Fax: + 61 8 9346 3003; E-mail: bstuckey@cyllene.uwa.edu.au
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  • John P. Walsh,

    1. Department of Endocrinology and Diabetes and
    2. Keogh Institute for Medical Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia,
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  • Valerie Burke,

    1. University of Western Australia, School of Medicine and Pharmacology, Royal Perth Hospital Unit, and
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  • Robert J. Norman

    1. Research Centre for Reproductive Health, The Queen Elizabeth Hospital; Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
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B. G. A. Stuckey, Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia 6009. Tel.: + 61 8 9346 2008; Fax: + 61 8 9346 3003; E-mail: bstuckey@cyllene.uwa.edu.au

Summary

Background  Women with polycystic ovarian syndrome (PCOS) commonly consult endocrinologists or gynaecologists and it is not known whether these specialty groups differ in their approach to management.

Objective  To compare the investigation, diagnosis and treatment practices of endocrinologists and gynaecologists who treat PCOS.

Design and Setting  A mailed questionnaire containing a hypothetical patient's case history with varying presentations − oligomenorrhoea, hirsutism, infertility and obesity − was sent to Australian clinical endocrinologists and gynaecologists in teaching hospitals and private practice.

Results  Evaluable responses were obtained from 138 endocrinologists and 172 gynaecologists. The two specialty groups differed in their choice of essential diagnostic criteria and investigations. Endocrinologists regarded androgenization (81%) and menstrual irregularity (70%) as essential diagnostic criteria, whereas gynaecologists required polycystic ovaries (61%), androgenization (59%), menstrual irregularity (47%) and an elevated LH/FSH ratio (47%) (all P-values < 0·001). In investigation, gynaecologists were more likely to request ovarian ultrasound (91%vs. 44%, P < 0·001) and endocrinologists more likely to measure adrenal androgens (80%vs. 58%, P < 0·001) and lipids (67%vs. 34%, P < 0·001). Gynaecologists were less likely to assess glucose homeostasis but more likely to use a glucose tolerance test to do so. Diet and exercise were chosen by most respondents as first-line treatment for all presentations. However, endocrinologists were more likely to use insulin sensitizers, particularly metformin, for these indications. In particular, for infertility, endocrinologists favoured metformin treatment whereas gynaecologists recommended clomiphene.

Conclusions  There is a lack of consensus between endocrinologists and gynaecologists in the definition, diagnosis and treatment of PCOS. As a consequence, women may receive a different diagnosis or treatment depending on the type of specialist consulted.

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