Abstract

Today the common therapy with PCOS is to administer contraceptive (Estrogen-Gestagen), anti-androgen, insulin sensitizer, vitamine D. The complexity of metabolic und hormone related dysfunction requires both an interdisciplinary and individualized therapy based on diagnostic.

In cases of wished pregnancy there are possibilities to inject hormones to start ovulation.

But there are still diagnostic (un)met needs identified in a group of PCOS-Patients which partially comes in focus of pharmaceutical industry:
• Basal Energy Rate (less within women with PCOS!)
• Status of inflammation
• Homocysteine (fat metabolism, blood/urine)
• Urinary free cortisol (UFC)
• Low dose dexamethasone suppression test
• Insulin-like Growth Factor (IGF)
• Oral Glucose Tolerance Test (OGTT)
• ACTH (Cosyntropin) stimulation test
• Diagnostic and related Clearing up
• Anti-Mullerian Hormone (AMH)
• Insulin Resistance (IR)and regional brain glucose hypometabolism
• Adrenal and thyroid function testing
• Ultrasonic testing /morphological
• Pituitary gland testing
• Cycle related testing

Visible characteristics as acne, alopecia, hirsutism, overweight/obesity and irregular or missing menses are important indicators, easy to detect to diagnose PCOS (e.g. hirsutism 90% and obesity 50%). Clinical parameters (Rotterdam Criteria) are not specified as insulin resistance, hypertension, high fat values. Specific is a higher AMH in women with PCOS which is investigated in several studies.

An early diagnose to start lifestyle modification which evidence based lead to lower IR level and less cardiovascular diseases especially in women with PCOS is mandatory. US recommended investigating: pubic hair before age eight (Hyper-Androgenism), OGTT from age 16 (IR), low grade inflammation (which stimulates androgen production). Better and faster diagnostic is the key!