Gerard Conway1, Didier Dewailly1, Evanthia Diamanti-Kandarakis1, Hector F Escobar-Morreale1, Steven Franks1, Alessandra Gambineri1, Fahrettin Kelestimur1, Djuro Macut1, Dragan Micic1, Renato Pasquali2, Marija Pfeifer1, Duarte Pignatelli1, Michel Pugeat1, Bulent Yildiz1. 1. Department of EndocrinologyUniversity College London Hospitals, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceThird Department of MedicineNeuroendocrine Clinic, University of Athens-Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, University Medical Centre, Ljubljana, SloveniaDepartment of EndocrinologyHospital S. Joao, Porto, PortugalInserm U863 IFR6Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, FranceDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey. 2. Department of EndocrinologyUniversity College London Hospitals, London NW1 2BU, UKDepartment of Endocrine Gynaecology and Reproductive MedicineCentre Hospitalier de Lille, Hopital Jeanne de Fiandre, Lille, FranceThird Department of MedicineNeuroendocrine Clinic, University of Athens-Medical School, Athens, GreeceDepartment of Endocrinology and NutritionUniversidad de Alcalá and Hospital Universitario Ramón y Cajal and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, SpainImperial College LondonInstitute of Reproductive and Developmental Biology, London, UKDivision of EndocrinologyDepartment of Medical and Surgical Sciences, St Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, ItalyDepartment of EndocrinologySchool of Medicine, Erciyes University, Kayseri, TurkeyClinic for EndocrinologyDiabetes and Metabolic Diseases, School of Medicine, University of Belgrade, Belgrade, SerbiaDepartment of EndocrinologyDiabetes and Metabolic Diseases, University Medical Centre, Ljubljana, SloveniaDepartment of EndocrinologyHospital S. Joao, Porto, PortugalInserm U863 IFR6Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université Lyon-1, Lyon, FranceDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey renato.pasquali@unibo.it.
Abstract
BACKGROUND: There is evidence for differences between endocrinologists and other specialists in their approach to diagnosis and management of the polycystic ovary syndrome (PCOS). OBJECTIVE: A mailed survey consisting of a simple questionnaire aiming to understand current practice for diagnosis and management of the PCOS by specialists across Europe. METHODS: The questionnaire consisted of 23 questions grouped to achieve information on i) the general characteristics of the respondents, ii) patients with PCOS seen by endocrinologists, iii) the main diagnostic criteria, iv) biochemical parameters used in the differential diagnosis of hyperandrogenism, v) long-term concerns, and, finally vi) treatment choices. A total of 357 questionnaires representing 13.3% of the members of European Society of Endocrinology (ESE) were available for final analysis; 93% of the respondents were endocrinologists RESULTS: In relation to the diagnostic criteria, respondents were most likely to select menstrual irregularity as the most frequent criteria used for the diagnosis of PCOS although very high rates were achieved for the use of hirsutism and biochemical hyperandrogenism. It therefore appears that the NIH criteria were followed by the majority of respondents. The most frequent biochemical parameters in the differential diagnosis of hyperandrogenism were total testosterone or free androgen index. Obesity and type 2 diabetes were regarded as the principal long-term concerns for PCOS. The most common treatments for patients with PCOS were metformin (33%), lifestyle modification (25%), and oral contraceptives (22%). More direct treatments of infertility include clomiphene citrate alone or in combination with metformin, prescribed by 9 and 23%, respectively, whereas only 6% used other methods for induction of ovulation. CONCLUSION: The survey produced by ESE is a good start for evaluating the perspective in the diagnosis and treatment of PCOS by endocrinologists in Europe.
BACKGROUND: There is evidence for differences between endocrinologists and other specialists in their approach to diagnosis and management of the polycystic ovary syndrome (PCOS). OBJECTIVE: A mailed survey consisting of a simple questionnaire aiming to understand current practice for diagnosis and management of the PCOS by specialists across Europe. METHODS: The questionnaire consisted of 23 questions grouped to achieve information on i) the general characteristics of the respondents, ii) patients with PCOS seen by endocrinologists, iii) the main diagnostic criteria, iv) biochemical parameters used in the differential diagnosis of hyperandrogenism, v) long-term concerns, and, finally vi) treatment choices. A total of 357 questionnaires representing 13.3% of the members of European Society of Endocrinology (ESE) were available for final analysis; 93% of the respondents were endocrinologists RESULTS: In relation to the diagnostic criteria, respondents were most likely to select menstrual irregularity as the most frequent criteria used for the diagnosis of PCOS although very high rates were achieved for the use of hirsutism and biochemical hyperandrogenism. It therefore appears that the NIH criteria were followed by the majority of respondents. The most frequent biochemical parameters in the differential diagnosis of hyperandrogenism were total testosterone or free androgen index. Obesity and type 2 diabetes were regarded as the principal long-term concerns for PCOS. The most common treatments for patients with PCOS were metformin (33%), lifestyle modification (25%), and oral contraceptives (22%). More direct treatments of infertility include clomiphene citrate alone or in combination with metformin, prescribed by 9 and 23%, respectively, whereas only 6% used other methods for induction of ovulation. CONCLUSION: The survey produced by ESE is a good start for evaluating the perspective in the diagnosis and treatment of PCOS by endocrinologists in Europe.