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CPE-010 · synthetic case PCOS-FX-09
Total testosterone 215 ng/dL and rapid virilization
Not explained by PCOS.
Purpose: Not explained by PCOS.
Inputs the engine received
Cycles and clinical signs
- Age
- 35 years
- Years since menarche
- 22 years
- Cycles per year
- 3
- Hirsutism, modified Ferriman–Gallwey score
- 14
- Rapid-onset severe hirsutism or virilization
- Yes
Laboratory and imaging
- Total testosterone
- 215 ng/dL
- DHEA-S
- 780 µg/dL
What the engine reports
Androgen values or features this marked are not explained by PCOS. PCOS is a diagnosis of exclusion; do not assign it until a tumor is excluded. Evaluation may include imaging of the adrenals and ovaries, per physician judgment.
Prolonged anovulation raises the risk of endometrial hyperplasia. The physician should consider endometrial assessment and protection. The engine names no regimen.
Detected clinical pattern
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first.
- Pattern: androgen tumor flag
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent evaluation for an androgen-secreting tumor.
- 2Consider endometrial assessment and protection.
Differentials, pitfalls and contradicting signals
- The features meet the criteria, but another cause is present or unexcluded; PCOS is a diagnosis of exclusion.
Evidence and rule trace · 4 rules
PC-SAFE-01Possible androgen-secreting tumor
Inputs: total testosterone 215 ng/dL · DHEA-S 780 µg/dL · rapid-onset severe hirsutism or virilization
Urgent evaluation: values or features this marked are not explained by PCOS.
PC-11Prolonged amenorrhea
Inputs: 3 cycles a year
Prolonged anovulation raises endometrial hyperplasia risk.
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-ACOG-PCOS-2018 · American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome. ACOG Practice Bulletin No. 194. Obstet Gynecol. 2018;131(6):e157-e171.
- 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
No stage is assigned for the values entered.
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-05
Criteria met, no exclusion tests
TSH, prolactin and 17-OHP missing.
PCOS-FX-06
Prolactin 68 ng/mL
Another cause of oligomenorrhea.
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