Cussons Andrea J, Stuckey Bronwyn G A, Walsh John P, Burke Valerie, Norman Robert J
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Clin Endocrinol (Oxf). 2005 Mar;62(3):289-95. doi: 10.1111/j.1365-2265.2004.02208.x.
Women with polycystic ovarian syndrome (PCOS) commonly consult endocrinologists or gynaecologists and it is not known whether these specialty groups differ in their approach to management.
To compare the investigation, diagnosis and treatment practices of endocrinologists and gynaecologists who treat PCOS.
A mailed questionnaire containing a hypothetical patient's case history with varying presentations--oligomenorrhoea, hirsutism, infertility and obesity--was sent to Australian clinical endocrinologists and gynaecologists in teaching hospitals and private practice.
Evaluable responses were obtained from 138 endocrinologists and 172 gynaecologists. The two specialty groups differed in their choice of essential diagnostic criteria and investigations. Endocrinologists regarded androgenization (81%) and menstrual irregularity (70%) as essential diagnostic criteria, whereas gynaecologists required polycystic ovaries (61%), androgenization (59%), menstrual irregularity (47%) and an elevated LH/FSH ratio (47%) (all P-values < 0.001). In investigation, gynaecologists were more likely to request ovarian ultrasound (91%vs. 44%, P < 0.001) and endocrinologists more likely to measure adrenal androgens (80%vs. 58%, P < 0.001) and lipids (67%vs. 34%, P < 0.001). Gynaecologists were less likely to assess glucose homeostasis but more likely to use a glucose tolerance test to do so. Diet and exercise were chosen by most respondents as first-line treatment for all presentations. However, endocrinologists were more likely to use insulin sensitizers, particularly metformin, for these indications. In particular, for infertility, endocrinologists favoured metformin treatment whereas gynaecologists recommended clomiphene.
There is a lack of consensus between endocrinologists and gynaecologists in the definition, diagnosis and treatment of PCOS. As a consequence, women may receive a different diagnosis or treatment depending on the type of specialist consulted.
多囊卵巢综合征（PCOS）女性通常会咨询内分泌科医生或妇科医生，目前尚不清楚这些专科群体在治疗方法上是否存在差异。
比较治疗PCOS的内分泌科医生和妇科医生的检查、诊断及治疗方法。
向澳大利亚教学医院和私人诊所的临床内分泌科医生和妇科医生发送了一份包含假设患者不同临床表现（月经过少、多毛、不孕和肥胖）病史的邮寄问卷。
获得了138名内分泌科医生和172名妇科医生的可评估回复。两个专科群体在基本诊断标准和检查的选择上存在差异。内分泌科医生将雄激素化（81%）和月经不规律（70%）视为基本诊断标准，而妇科医生则要求多囊卵巢（61%）、雄激素化（59%）、月经不规律（47%）以及LH/FSH比值升高（47%）（所有P值<0.001）。在检查方面，妇科医生更倾向于要求进行卵巢超声检查（91%对44%，P<0.001），而内分泌科医生更倾向于检测肾上腺雄激素（80%对58%，P<0.001）和血脂（67%对34%，P<0.001）。妇科医生评估葡萄糖稳态的可能性较小，但更倾向于使用葡萄糖耐量试验进行评估。大多数受访者选择饮食和运动作为所有临床表现的一线治疗方法。然而，内分泌科医生更倾向于使用胰岛素增敏剂，尤其是二甲双胍来治疗这些病症。特别是对于不孕，内分泌科医生更倾向于使用二甲双胍治疗，而妇科医生则推荐使用克罗米芬。
内分泌科医生和妇科医生在PCOS的定义、诊断和治疗方面缺乏共识。因此，女性根据咨询的专科医生类型可能会得到不同的诊断或治疗。
