The Rotterdam criteria (2003) for PCOS diagnosis require the presence of at least 2 of 3 features. A 22-year-old has regular cycles, clinical acne, serum total testosterone 0.8 ng/mL (ULN 0.6), and an ultrasound showing 14 follicles per ovary, each 4–9 mm. Which FIGO criteria designation applies?
- A Phenotype C: hyperandrogenism + PCOM, without oligo-anovulation — non-classic ✓
- B Phenotype A: oligo-anovulation + clinical/biochemical hyperandrogenism + PCOM — classic PCOS
- C Phenotype D: oligo-anovulation + PCOM, without hyperandrogenism — ovulatory PCOS
- D Does not meet Rotterdam criteria — at least 20 follicles per ovary required
Explanation
Rotterdam 2003 phenotypes: A = all 3 (OA + HA + PCOM); B = OA + HA; C = HA + PCOM (no OA); D = OA + PCOM (no HA). This patient has regular cycles (no oligo-anovulation) but has biochemical hyperandrogenism (elevated testosterone) and PCOM (≥12 follicles per ovary, each 2–9 mm, on 2D ultrasound — note: 2023 ESHRE update raised threshold to ≥20 follicles per ovary on current-generation high-frequency probes). With 14 follicles and elevated androgens, she meets Phenotype C. The 20-follicle threshold is the updated criterion from ESHRE 2023, but 12 follicles was the original threshold.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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