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Adolescent PCOS — RACP Paediatrics MCQ

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HardAdolescent MedicineAdolescent PCOSRACP Paediatrics

A 15-year-old is 30 months post-menarche and has cycles every 55–70 days, progressive hirsutism and repeatedly raised calculated free testosterone. Pregnancy, thyroid disease, hyperprolactinaemia and non-classic CAH have been excluded. Pelvic ultrasound shows multifollicular ovaries. Which interpretation is best?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Diagnose adolescent PCOS from ovulatory dysfunction and hyperandrogenism; ultrasound adds no criterion

Explanation lettering: E = shown as B · B = shown as E

B is correct because adolescent diagnosis requires both persistent ovulatory dysfunction and clinical or biochemical hyperandrogenism after excluding mimics; ultrasound and AMH are not recommended diagnostic criteria. C imports adult Rotterdam logic. D ignores cycle intervals that are abnormal more than one year post-menarche. E uses a test with inadequate adolescent specificity. A correctly notes that ovarian morphology is non-specific but wrongly treats it as evidence against otherwise fulfilled criteria.

Reference: Monash University, 2023 International Evidence-based PCOS Guideline: https://www.monash.edu/medicine/mchri/pcos/guideline