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Special Features: Ricardo Azziz, Enrico Carmina, Didier Dewailly, Evanthia Diamanti-Kandarakis, Hector F. Escobar-Morreale, Walter Futterweit, Onno E. Janssen, Richard S. Legro, Robert J. Norman, Ann E. Taylor, and Selma F. Witchel Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline J Clin Endocrinol Metab 2006; 91: 4237-4245 [Abstract] [Full text] [PDF]

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E-Letter to the Editor: Androgen Excess Guidelines Are Too Restrictive

Corrine K. Welt   (30 November 2006)

E-Letter to the Editor: Androgen Excess Guidelines Are Too Restrictive 30 November 2006
Corrine K. Welt, clinical research, physician Massachusetts General Hospital Send letter to journal: Re: E-Letter to the Editor: Androgen Excess Guidelines Are Too Restrictive cwelt{at}partners.org Corrine K. Welt	The Androgen Excess Society has issued guidelines for defining polycystic ovary syndrome (PCOS) (1). Although the Society hopes to provide a definition for PCOS based on clear-cut and current evidence, their position statement seems premature and overly restrictive for the following reasons. First, a number of the studies used for prevalence data defined PCOS in a manner that makes it difficult to ascertain the true prevalence of its features. For example, if oligo-anovulation was part of a study definition, the ‘prevalence’ of oligo-anovulation would be 100%. Second, the anchor applied to the syndrome, metabolic morbidity, is arbitrary. If infertility were chosen as the anchor, a disorder that also impacts health care coverage, different criteria may have emerged as most important. Third, the authors themselves allude to the inaccuracy and insensitivity of androgen measurements. They also discuss the need to clarify the prevalence and use of acne and alopecia as markers of hyperandrogenism in PCOS. These limitations suggest that a category of PCOS without hyperandrogenism, as it has been defined in the AES report, is needed, particularly to consider the most controversial PCOS subgroup defined by the Rotterdam criteria, namely women with oligo-anovulation and PCO morphology on ultrasound in the absence of hyperandrogenism (2). Three examining this subgroup (3-5) suggest metabolic abnormalities in women with oligo-anovulation-PCO, including an increased waist circumference (4), increased fasting insulin (3) and decreased SHBG (3, 4) compared to controls, as well as fasting insulin and SHBG levels similar to those in women with PCOS defined by the NIH criteria (3, 5). This too suggests that a broader definition of PCOS, such as that provided by the Rotterdam criteria, would better promote further research into the nature and breadth of this disorder’s phenotypes. References 1. Azziz R, Carmina E, Dewailly D, amanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF. 2006. Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. J Clin Endocrinol Metab 91:4237-4245 2. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). 2004. Hum Reprod 19:41-47 3. Norman RJ, Hague WM, Masters SC, Wang XJ. 1995. Subjects with polycystic ovaries without hyperandrogenaemia exhibit similar disturbances in insulin and lipid profiles as those with polycystic ovary syndrome. Hum Reprod 10:2258-2261 4. Dewailly D, Catteau-Jonard S, Reyss AC, Leroy M, Pigny P. 2006. Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metab 91:3922-3927 5. Welt CK, Gudmundsson JA, Arason G, Adams J, Palsdottir H, Gudlaugsdottir G, Ingadottir G, Crowley WF. 2006. Characterizing Discrete Subsets of Polycystic Ovary Syndrome as Defined by the Rotterdam Criteria: The Impact of Weight on Phenotype and Metabolic Features. J Clin Endocrinol Metab September 26, epub ahead of print, doi:10.1210/jc.2006-1327.