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CPE-010 · synthetic case PCOS-FX-25
Irregular cycles and acne, no work-up yet
A prompt for evaluation.
Purpose: A prompt for evaluation.
Inputs the engine received
Cycles and clinical signs
- Age
- 24 years
- Years since menarche
- 11 years
- Cycles per year
- 6
- Acne
- Yes
What the engine reports
Detected clinical pattern
PCOS Evaluation Indicated
The features justify a PCOS work-up. They do not establish anything alone.
- Criteria met: 1 of 3 criteria
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Document cycle history, score hirsutism (modified Ferriman–Gallwey), measure testosterone with SHBG, and add TSH, prolactin and early-follicular 17-hydroxyprogesterone.
Differentials, pitfalls and contradicting signals
- Acne and androgenic alopecia are weaker signs of hyperandrogenism: they prompt biochemical testing and do not complete the criterion on their own.
Missing information
- Total testosterone with SHBG (high-quality assay).
- TSH.
- Prolactin.
- Early-follicular-phase 17-hydroxyprogesterone.
Evidence and rule trace · 3 rules
PC-01Evaluation indicated
Inputs: irregular cycles · acne or androgenic alopecia
A PCOS work-up is reasonable.
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-ACOG-PCOS-2018 · American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome. ACOG Practice Bulletin No. 194. Obstet Gynecol. 2018;131(6):e157-e171.
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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