{
  "engine": {
    "id": "cpe-010",
    "code": "CPE-010",
    "name": "PCOS Pattern Engine",
    "version": "1.0.0",
    "url": "https://biod.ai/tools/pcos",
    "status": "Executable specification v1.0.0, authored by Biod from the narrative CPE-010 specification and current guidelines. Reviewed by Dr. Vinicius Amaral, D.O. Not for clinical production use."
  },
  "notice": "Clinical decision support for licensed clinicians. Synthetic-data demonstration. Not FDA cleared. Physician adjudication required.",
  "rules": [
    {
      "id": "PC-SCOPE-01",
      "name": "Patient outside the pathway",
      "group": "Scope and validity",
      "status": "active",
      "classification": "Priority 1",
      "summary": "Patient outside the pathway. Evaluates male OR pregnant OR postmenopausal.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "male OR pregnant OR postmenopausal"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Routing: PCOS criteria do not apply"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Cycles and androgens cannot be interpreted in pregnancy or after menopause."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-scope-01"
    },
    {
      "id": "PC-SCOPE-02",
      "name": "Adolescent criteria",
      "group": "Scope and validity",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Adolescent criteria. Evaluates age under 18, OR fewer than 8 years since menarche.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "age under 18, OR fewer than 8 years since menarche"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Adolescents need both irregular cycles and hyperandrogenism; ultrasound is not used, and nothing is diagnosed in the first year after menarche"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Normal pubertal variation overlaps with PCOS features."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-scope-02"
    },
    {
      "id": "PC-VAL-01",
      "name": "Hormonal contraception limits interpretation",
      "group": "Scope and validity",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Hormonal contraception limits interpretation. Evaluates combined hormonal contraception taken now or in the last 3 months.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "combined hormonal contraception taken now or in the last 3 months"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Cycles and androgen levels are altered: PCOS cannot be reliably assessed on the cycle or on testosterone"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "If the risks are acceptable, reassess after contraception is stopped for about 3 months; otherwise rely on clinical features and history"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "The decision to pause contraception belongs to the physician and patient."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-val-01"
    },
    {
      "id": "PC-01",
      "name": "Evaluation indicated",
      "group": "Screening",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Evaluation indicated. Evaluates irregular cycles OR hirsutism OR acne OR androgenic alopecia OR infertility with irregular cycles.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "irregular cycles OR hirsutism OR acne OR androgenic alopecia OR infertility with irregular cycles",
            "no PCOS work-up documented"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Screening opportunity: a PCOS work-up is reasonable"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Document cycle history; examine for hirsutism (modified Ferriman–Gallwey); measure total and free testosterone or the free androgen index with SHBG; add TSH, prolactin and early-follicular 17-hydroxyprogesterone"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Features are non-specific."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023",
        "EV-ACOG-PCOS-2018"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-01"
    },
    {
      "id": "PC-02",
      "name": "Criterion: irregular cycles",
      "group": "Criteria",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Criterion: irregular cycles. Evaluates cycle length below 21 or above 35 days, OR fewer than 8 cycles a year, OR amenorrhea for more than 3 months (adults).",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "cycle length < 21 or > 35 days, OR fewer than 8 cycles a year, OR amenorrhea for more than 3 months (adults)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Irregular cycles / ovulatory dysfunction"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Counts toward criteria only when other causes are excluded."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023",
        "EV-ROTTERDAM-2004"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-02"
    },
    {
      "id": "PC-03",
      "name": "Criterion: hyperandrogenism",
      "group": "Criteria",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Criterion: hyperandrogenism. Evaluates hirsutism (mFG ≥ 6, or ≥ 4 in some ethnicities) OR elevated total or free testosterone or free androgen index above 5 for the assay.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "hirsutism (mFG ≥ 6, or ≥ 4 in some ethnicities) OR elevated total or free testosterone or free androgen index > 5 for the assay",
            "acne and androgenic alopecia are weaker signs: they prompt biochemical testing and do not complete this criterion alone"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Clinical or biochemical hyperandrogenism"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Needs a high-quality testosterone assay (preferably LC-MS/MS)."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023",
        "EV-ES-HIRSUTISM-2018"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-03"
    },
    {
      "id": "PC-04",
      "name": "Criterion: polycystic ovarian morphology or raised AMH",
      "group": "Criteria",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Criterion: polycystic ovarian morphology or raised AMH. Evaluates ≥ 20 follicles in at least one ovary, OR ovarian volume ≥ 10 mL on endovaginal ultrasound, OR AMH raised for the assay.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "≥ 20 follicles in at least one ovary, OR ovarian volume ≥ 10 mL on endovaginal ultrasound, OR AMH raised for the assay",
            "adults only"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Polycystic ovarian morphology or raised AMH"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Not used in adolescents. In adults it matters only when one of the first two criteria is absent."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-04"
    },
    {
      "id": "PC-05",
      "name": "PCOS criteria met",
      "group": "Criteria",
      "status": "active",
      "classification": "Priority 3",
      "summary": "PCOS criteria met. Evaluates adults: at least 2 of the 3 criteria.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "adults: at least 2 of the 3 criteria",
            "adolescents: irregular cycles AND hyperandrogenism",
            "exclusions completed (PC-06 not fired)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Pattern meeting the 2023 international PCOS criteria"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Assess cardiometabolic risk, glycemic status, sleep and mood, and fertility goals"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A pattern for physician review; other causes must be excluded."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023",
        "EV-ROTTERDAM-2004"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-05"
    },
    {
      "id": "PC-06",
      "name": "Exclusions incomplete",
      "group": "Criteria",
      "status": "active",
      "classification": "Priority 3",
      "summary": "Exclusions incomplete. Evaluates criteria met.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "criteria met",
            "TSH, prolactin or early-follicular 17-hydroxyprogesterone missing"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Criteria are met on the available data, but other causes of the same picture have not all been excluded"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Names what is needed."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-06"
    },
    {
      "id": "PC-07",
      "name": "Raised prolactin",
      "group": "Exclusions",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Raised prolactin. Evaluates prolactin above the laboratory upper limit.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "prolactin above the laboratory upper limit"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Hyperprolactinemia can cause irregular cycles: PCOS cannot be assigned until it is addressed"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Does not name the cause."
          ]
        }
      ],
      "evidence": [
        "EV-ES-PRL-2011",
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-07"
    },
    {
      "id": "PC-08",
      "name": "Thyroid dysfunction",
      "group": "Exclusions",
      "status": "active",
      "classification": "Priority 3",
      "summary": "Thyroid dysfunction. Evaluates TSH outside 0.4 to 4.5 mIU/L.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "TSH outside 0.4 to 4.5 mIU/L"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Thyroid disease can cause irregular cycles: assess it before assigning PCOS"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Does not diagnose thyroid disease."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-08"
    },
    {
      "id": "PC-09",
      "name": "Non-classic congenital adrenal hyperplasia possible",
      "group": "Exclusions",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Non-classic congenital adrenal hyperplasia possible. Evaluates early-follicular-phase morning 17-hydroxyprogesterone ≥ 200 ng/dL.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "early-follicular-phase morning 17-hydroxyprogesterone ≥ 200 ng/dL"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "A raised 17-hydroxyprogesterone raises non-classic congenital adrenal hyperplasia"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Consider an ACTH-stimulation test to confirm or exclude non-classic CAH"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Not a diagnosis; confirmation needs stimulation testing."
          ]
        }
      ],
      "evidence": [
        "EV-ES-NCCAH-2018",
        "EV-ES-HIRSUTISM-2018"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-09"
    },
    {
      "id": "PC-SAFE-01",
      "name": "Possible androgen-secreting tumor",
      "group": "Safety",
      "status": "active",
      "classification": "Priority 1",
      "summary": "Possible androgen-secreting tumor. Evaluates total testosterone above 150 ng/dL OR DHEA-S above 700 µg/dL OR rapid-onset severe hirsutism or virilization (clitoromegaly, voice deepening).",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "total testosterone > 150 ng/dL OR DHEA-S > 700 µg/dL OR rapid-onset severe hirsutism or virilization (clitoromegaly, voice deepening)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Urgent evaluation: values or features this marked are not explained by PCOS"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Urgent evaluation, including imaging of the adrenals and ovaries per physician judgment"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "PCOS is a diagnosis of exclusion; do not assign it until a tumor is excluded."
          ]
        }
      ],
      "evidence": [
        "EV-ES-HIRSUTISM-2018"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-safe-01"
    },
    {
      "id": "PC-10",
      "name": "Features of Cushing syndrome",
      "group": "Exclusions",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Features of Cushing syndrome. Evaluates moon facies, wide violaceous striae, proximal muscle weakness or easy bruising.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "moon facies, wide violaceous striae, proximal muscle weakness or easy bruising"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Consider screening for Cushing syndrome"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A prompt."
          ]
        }
      ],
      "evidence": [
        "EV-ES-CUSHING-2008"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-10"
    },
    {
      "id": "PC-11",
      "name": "Prolonged amenorrhea",
      "group": "Safety",
      "status": "active",
      "classification": "Priority 3",
      "summary": "Prolonged amenorrhea. Evaluates amenorrhea for more than 3 months OR fewer than 4 cycles a year.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "amenorrhea for more than 3 months OR fewer than 4 cycles a year"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Prolonged anovulation raises the risk of endometrial hyperplasia: the physician should consider endometrial assessment and protection"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "The engine names no regimen."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023",
        "EV-ACOG-PCOS-2018"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-11"
    },
    {
      "id": "PC-12",
      "name": "Glycemic assessment",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Glycemic assessment. Evaluates PCOS criteria met or probable.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "PCOS criteria met or probable",
            "no glycemic assessment in the last 12 months (or in the last 36 months at low risk)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "The 2023 guideline recommends assessing glycemic status at diagnosis and every 1 to 3 years according to risk"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "A 75-g OGTT is the preferred test; HbA1c or fasting glucose are acceptable when it is not feasible"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A prompt."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-12"
    },
    {
      "id": "PC-13",
      "name": "Cardiometabolic assessment",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 5",
      "summary": "Cardiometabolic assessment. Evaluates PCOS criteria met or probable.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "PCOS criteria met or probable"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Assess BMI and waist, blood pressure and a lipid profile",
            "Metabolic syndrome criteria are counted when the values are entered"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Hands off to the metabolic engine."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-13"
    },
    {
      "id": "PC-14",
      "name": "Normal weight does not exclude metabolic risk",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 6",
      "summary": "Normal weight does not exclude metabolic risk. Evaluates PCOS criteria met or probable.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "PCOS criteria met or probable",
            "BMI under 25"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Insulin resistance is intrinsic to PCOS and is not limited to people with a high BMI"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A caution against false reassurance."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-14"
    },
    {
      "id": "PC-15",
      "name": "Mood screening",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 6",
      "summary": "Mood screening. Evaluates PCOS criteria met or probable.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "PCOS criteria met or probable",
            "depression and anxiety screening not documented"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "The 2023 guideline recommends screening for depression and anxiety in PCOS"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A prompt."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-15"
    },
    {
      "id": "PC-16",
      "name": "Trying to conceive",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Trying to conceive. Evaluates trying to conceive.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "trying to conceive",
            "irregular cycles"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Anovulation is a likely contributor; preconception counselling and fertility assessment are part of the plan"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "The engine names no ovulation-induction agent."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-16"
    },
    {
      "id": "PC-17",
      "name": "Free androgen index",
      "group": "Calculations",
      "status": "module",
      "classification": "Context",
      "summary": "Free androgen index. Evaluates total testosterone and SHBG available.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "total testosterone and SHBG available"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Free androgen index = total testosterone (nmol/L) ÷ SHBG (nmol/L) × 100",
            "A low SHBG can reveal hyperandrogenism despite a normal total testosterone"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Informational; cutoffs vary by assay."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-17"
    },
    {
      "id": "PC-18",
      "name": "Sleep-apnea screening",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 6",
      "summary": "Sleep-apnea screening. Evaluates PCOS criteria met or probable.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "PCOS criteria met or probable",
            "snoring, witnessed apneas, daytime sleepiness, or BMI ≥ 30"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Consider screening for obstructive sleep apnea"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "No prevalence figure is claimed."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-18"
    },
    {
      "id": "PC-MISS-01",
      "name": "Information needed",
      "group": "Missing data",
      "status": "active",
      "classification": "Priority 8",
      "summary": "Information needed. Evaluates irregular cycles or hyperandrogenism entered.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "irregular cycles or hyperandrogenism entered",
            "testosterone assay, TSH, prolactin or 17-hydroxyprogesterone missing"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "The work-up needed to complete the criteria and exclusions is not complete"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Names what is needed."
          ]
        }
      ],
      "evidence": [
        "EV-PCOS-2023"
      ],
      "url": "https://biod.ai/tools/pcos/rules/pc-miss-01"
    }
  ],
  "evidence": [
    {
      "id": "EV-PCOS-2023",
      "citation": "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.",
      "supports": [
        "Adult diagnosis: irregular cycles plus hyperandrogenism once other causes are excluded; ultrasound or AMH when one is missing",
        "Adolescent criteria require both irregular cycles and hyperandrogenism",
        "Glycemic, cardiometabolic, sleep and mood assessment; endometrial risk in prolonged anovulation"
      ]
    },
    {
      "id": "EV-ROTTERDAM-2004",
      "citation": "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.",
      "supports": [
        "Two of three criteria: oligo-anovulation, hyperandrogenism, polycystic ovaries, after excluding other disorders"
      ]
    },
    {
      "id": "EV-ACOG-PCOS-2018",
      "citation": "American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome. ACOG Practice Bulletin No. 194. Obstet Gynecol. 2018;131(6):e157-e171.",
      "supports": [
        "Clinical approach, exclusions and long-term risks"
      ]
    },
    {
      "id": "EV-ES-HIRSUTISM-2018",
      "citation": "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.",
      "supports": [
        "Hirsutism assessment (modified Ferriman–Gallwey), biochemical evaluation, and markedly raised androgens or rapid onset as tumor signals"
      ]
    },
    {
      "id": "EV-ES-PRL-2011",
      "citation": "Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96(2):273-288.",
      "supports": [
        "Hyperprolactinemia as a cause of oligo-amenorrhea"
      ]
    },
    {
      "id": "EV-ES-NCCAH-2018",
      "citation": "Speiser PW, Arlt W, Auchus RJ, et al. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(11):4043-4088.",
      "supports": [
        "Early-follicular-phase morning 17-hydroxyprogesterone as the screen for non-classic CAH, confirmed by ACTH stimulation"
      ]
    },
    {
      "id": "EV-ES-CUSHING-2008",
      "citation": "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.",
      "supports": [
        "Clinical features that prompt testing for Cushing syndrome"
      ]
    }
  ]
}