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CPE-010 · synthetic case PCOS-FX-10
Features of Cushing syndrome
Striae and proximal weakness.
Purpose: Striae and proximal weakness.
Inputs the engine received
Cycles and clinical signs
- Age
- 34 years
- Years since menarche
- 19 years
- Cycles per year
- 6
- Hirsutism, modified Ferriman–Gallwey score
- 8
- Moon facies, striae, proximal weakness or easy bruising
- Yes
Laboratory and imaging
- TSH
- 2 mIU/L
- Prolactin
- 11 ng/mL
- 17-hydroxyprogesterone (early follicular, morning)
- 55 ng/dL
What the engine reports
Detected clinical pattern
Another Cause Is Present or Unexcluded
The features resemble PCOS, but a cause that must be addressed first is present. PCOS is a diagnosis of exclusion.
- Criteria met: 2 of 3 criteria
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Consider screening for Cushing syndrome.
Differentials, pitfalls and contradicting signals
- The features meet the criteria, but another cause is present or unexcluded; PCOS is a diagnosis of exclusion.
Missing information
- Total testosterone with SHBG (high-quality assay).
Evidence and rule trace · 4 rules
PC-10Features of Cushing syndrome
Inputs: features of Cushing syndrome
Consider screening for Cushing syndrome.
PC-MISS-01Information needed
Inputs: work-up incomplete
The tests needed to complete criteria and exclusions are not all entered.
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.
- EV-ES-CUSHING-2008 · Nieman LK, Biller BMK, Findling JW, et al. The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540.
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-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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