Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Polycystic ovary syndrome - Management
What else might it be?

  • The diagnosis of polycystic ovary syndrome involves the exclusion of all of the following disorders, which may have a similar clinical presentation:
    • Simple obesity.
    • Primary hypothyroidism.
    • Premature ovarian failure.
    • Hyperprolactinaemia.
    • Non-classic congenital adrenal hyperplasia.
    • Cushing's syndrome.
    • Androgen-secreting neoplasm.
    • Hypogonadotropic hypogonadism (that is central origin of ovarian dysfunction).
    • Hyperandrogenic-insulin resistant-acanthosis nigricans (HAIRAN) syndrome.
    • High-dose exogenous androgens.
    • Acromegaly.
  • Also consider drug-related conditions.
    • The following drugs may cause hirsutism:
      • Androgenic drugs, including testosterone, danazol, gestrinone, adrenocorticotropic hormone, high-dose corticosteroids, androgenic progestogens in oral contraceptives, and anabolic steroids.
      • Non-androgenic drugs, including ciclosporin, diazoxide, minoxidil, and phenytoin; rarely, carbamazepine, sodium valproate, and acetazolamide.
    • The following drugs may cause hypertrichosis: ciclosporin, diazoxide, minoxidil, and phenytoin.
Table 1. Conditions for exclusion in the diagnosis of polycystic ovary syndrome.
Condition
Hyperandrogenaemia or hyperandrogenism (or both)
Oligomenorrhoea or amenorrhoea
Distinguishing features
Clinical
Hormonal or biochemical
Simple obesity
Often
Not often
Diagnosed by exclusion
None
Hyperprolactinaemia or prolactinoma
None or mild
Yes
Galactorrhoea
Elevated plasma prolactin level
Non-classic congenital adrenal hyperplasia due to deficiency of 21-hydroxylase
Yes
Not often
Family history of infertility, hirsutism, or both; common in Ashkenazi Jewish people
Elevated basal 17-hydroxyprogesterone level in the morning or on stimulation
Cushing's syndrome
Yes
Yes
Hypertension, striae, easy bruising
Elevated 24-hour urinary free cortisol level
Androgen-secreting tumour (virilizing adrenal or ovarian neoplasm)
Yes
Yes
Clitoromegaly, extreme hirsutism, or male pattern alopecia
Extremely elevated plasma androgen levels
Acromegaly
None or mild
Often
Enlargement of the extremities, coarse features, prognathism
Increased plasma insulin-like growth factor level
Primary hypothyroidism
None or mild
May be present
Goitre may be present
Elevated thyroid-stimulating hormone and subnormal plasma thyroxine levels. Prolactin level may also be increased
Premature ovarian failure
None
Yes
May be associated with other autoimmune endocrinopathies
Elevated plasma follicle-stimulating hormone and normal or subnormal estradiol level
Drug-related conditions
Often
Variably
Evidence provided by drug history, for example use of androgens, sodium valproate, ciclosporins
None
Data from: [Ehrmann, 2005]

[Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004; Ehrmann, 2005; Aronson, 2006; Micromedex, 2009]

© NHS Institute for Innovation and Improvement