No single test. Polycystic kidneys are a common incidental finding at USS, so not sufficient for diagnosis. Also operator dependent esp teens.
- Hirsutism (even male pattern baldness), But NOT virilisation (eg clitoromegaly, voice changes, musculature).
- acne (moderate to severe),
- irregular periods. Can be amenorrhoeic, dysfunctional uterine bleeding, infertility but 20% have normal cycle.
- Obesity (35-50%, not all),
- Acanthosis nigricans.
Insulin resistance is associated, and obviously presents the most important long term risk. Acanthosis nigricans is highly associated with insulin resistance, family history of type 2 or gestational diabetes a clue.
Differential includes pregnancy, hypothyroidism, hyperprolactinaemia (mild hyperprolactinaemia commonly seen in PCOS, transient), late onset Congenital Adrenal Hyperplasia (CAH), ovarian/adrenal tumour, Cushing syndrome.
- LH/FSH – ratio often high (3:1 or more) but inconsistent so not considered diagnostic
- Testosterone can be high (up to 4.8) – if higher, suggests alternative diagnosis
- Free androgen index (=testosterone x100/SHBG) can be high but our lab only calculates for adults – reference range of up to 7
- SHBG – low in PCOS (and in obesity, hypothyroidism, hyperprolactinaemia). Plus marker of insulin resistance),
- Prolactin, 17OH Progesterone for differential
- Fasting glucose/insulin ratio (under 4.5=insulin resistance, up to 7 in adolescents), glucose tolerance test, lipids.
Manage symptoms (for young people hirsutism, adults infertility) and long term risk viz diabetes and cardiovascular disease.
Note that less than 4 menses per year has higher risk of endometrial cancer.
- oral contraceptive pill (OCP) – progesterone only, or combined, or else 12 week cycles of medroxyprogesterone acetate 5mg BD followed by 1 week break – NOT contraceptive!
- Spironolactone (has anti androgen effect)
- Plucking/shaving/electrolysis/laser, eflornithine cream
- Clomiphene for fertility.