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CPE-010 · synthetic case PCOS-FX-05
Criteria met, no exclusion tests
TSH, prolactin and 17-OHP missing.
Purpose: TSH, prolactin and 17-OHP missing.
Inputs the engine received
Cycles and clinical signs
- Age
- 25 years
- Years since menarche
- 12 years
- Cycles per year
- 6
- Hirsutism, modified Ferriman–Gallwey score
- 10
Laboratory and imaging
- Total testosterone
- 52 ng/dL
What the engine reports
Detected clinical pattern
Criteria Met on Available Data — Exclusions Incomplete
TSH, prolactin and 17-hydroxyprogesterone are needed before other causes are excluded.
- Criteria met: 2 of 3 criteria
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Assess glycemic status: the 2023 guideline recommends it at diagnosis and every 1 to 3 years by risk. A 75-g OGTT is preferred; HbA1c or fasting glucose are acceptable when it is not feasible.
- 2Assess BMI and waist, blood pressure and a lipid profile; the metabolic engine applies the metabolic-syndrome criteria.
- 3Screen for depression and anxiety (for example PHQ-9 and GAD-7).
Missing information
- TSH, prolactin and early-follicular 17-hydroxyprogesterone, to exclude other causes.
Evidence and rule trace · 6 rules
PC-06Exclusions incomplete
Inputs: criteria met · TSH, prolactin, 17-hydroxyprogesterone missing
Criteria are met on the available data; other causes are not all excluded.
PC-15Mood screening
Inputs: mood screening not documented
The 2023 guideline recommends screening for depression and anxiety.
Evidence
- EV-PCOS-2023 · Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469.
- EV-ROTTERDAM-2004 · Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-47.
- EV-ES-HIRSUTISM-2018 · Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257.
Physician adjudication required. Clinical decision support for physician review. This output applies published criteria to the values entered. It does not diagnose, exclude other causes by itself, or choose contraception, ovulation induction or any treatment. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Criteria met (adults need 2 of 3)
✓ 0 of 3
No criterion met
✓ 1 of 3
Not enough
● 2 of 3
Criteria met if causes are excluded
○ 3 of 3
All three present
Cycles and clinical signs
6 or more (4 or more in some ethnicities).
Laboratory and imaging
25 ng/mL is assumed when empty.
Endovaginal ultrasound. Not used in adolescents.
Cardiometabolic, sleep, mood and fertility
More pcos cases
PCOS-FX-01
Irregular cycles and hirsutism, exclusions complete
A 26-year-old with 8 cycles a year and an mFG of 9.
PCOS-FX-02
Irregular cycles and polycystic ovaries
No hyperandrogenism, 22 follicles per ovary.
PCOS-FX-03
Hyperandrogenism and polycystic ovaries with regular cycles
Ovulatory phenotype.
PCOS-FX-04
Irregular cycles only
One criterion is not enough.
PCOS-FX-06
Prolactin 68 ng/mL
Another cause of oligomenorrhea.
PCOS-FX-07
TSH 9.2 mIU/L
Thyroid disease explains irregular cycles.
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