STUDY QUESTION What are the characteristics of adolescents diagnosed with polycystic ovary syndrome (PCOS) based on the 2003 Rotterdam criteria, but who do not meet the diagnosis according to the international evidence-based guideline? SUMMARY ANSWER Adolescents who had features of PCOS but did not meet the evidence-based guideline adolescent criteria exhibited unfavorable metabolic profiles compared to controls and shared considerable metabolic and hormonal features with adolescents who did meet the adolescent criteria. WHAT IS KNOWN ALREADY The international evidence-based PCOS guideline recommended that ultrasound should not be used for the diagnosis of PCOS in girls with a gynecological age of <8 years. Thus far, few studies have evaluated the clinical characteristics of the girls diagnosed with PCOS based on the Rotterdam criteria but who do not meet the diagnosis according to the updated guideline. STUDY DESIGN, SIZE, DURATION This is a retrospective study, and subjects attended for care from 2004 to 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS Adolescent girls with PCOS diagnosed according to the 2003 Rotterdam criteria and healthy controls. All participants were between 2 and 8 years since menarche. MAIN RESULTS AND THE ROLE OF CHANCE Of the 315 girls diagnosed with PCOS according to the Rotterdam criteria, those with irregular menstruation (IM)/hyperandrogenism (HA)/polycystic ovary (PCO), IM/HA, HA/PCO, and IM/PCO phenotypes accounted for 206 (65.4%), 30 (9.5%), 12 (3.8%), and 67 (21.3%) participants, respectively. According to the evidence-based guideline, 79 girls (25.1%) with the HA/PCO or IM/PCO phenotypes were not diagnosed with PCOS, and aligned to the international guideline; they were designated as the ‘at-risk’ group. As expected, the girls meeting the evidence-based guideline adolescent criteria showed the worst metabolic profiles (degree of generalized or central obesity, frequency of insulin resistance, prediabetes or diabetes, and metabolic syndrome) and higher hirsutism scores than the at-risk group or controls. Approximately 90% of the at-risk group were not overweight or obese, which was similar to the controls. However, they showed worse metabolic profiles, with higher blood pressure, triglyceride, and insulin resistance parameters than controls; furthermore, these profiles were similar to those of the girls meeting the adolescent criteria. The at-risk group showed similarly elevated serum LH levels and LH/FSH ratio with the girls meeting adolescent criteria. LIMITATIONS, REASONS FOR CAUTION We could not evaluate hormonal or ultrasound parameters in controls. WIDER IMPLICATIONS OF THE FINDINGS Compared to the conventional Rotterdam criteria, the recent international evidence-based guideline—avoiding ultrasound in PCOS diagnosis in adolescents—still gives the opportunity to identify young girls at risk, aligned to the findings in this study. A practical approach to this adolescent population would involve establishing IM or HA (with ultrasound not indicated) and designating ‘at-risk’ PCOS status with regular check-ups for newly developed or worsening PCOS-related symptoms or metabolic abnormalities, with subsequent reassessment including ultrasound or anti-Müllerian hormone, once 8 years post-menarche. STUDY FUNDING/COMPETING INTEREST(S) No funding was received in support of this study. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER N/A.

中文翻译：

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根据鹿特丹标准诊断为多囊卵巢综合征但不符合更新指南诊断的青少年

研究问题 根据 2003 年鹿特丹标准诊断为多囊卵巢综合征 (PCOS) 但不符合国际循证指南诊断的青少年有哪些特征？摘要答案 具有 PCOS 特征但不符合循证指南青少年标准的青少年与对照组相比表现出不利的代谢特征，并且与符合青少年标准的青少年具有相当大的代谢和激素特征。已知信息 国际 PCOS 循证指南建议，不应使用超声来诊断妇科年龄 <8 岁的女孩的 PCOS。迄今为止，很少有研究评估根据鹿特丹标准诊断为 PCOS 的女孩的临床特征，但根据更新的指南不符合诊断。研究设计、规模、持续时间 这是一项回顾性研究，受试者从 2004 年到 2022 年接受护理。 参与者/材料、环境、方法 根据 2003 年鹿特丹标准和健康对照诊断患有 PCOS 的青春期女孩。所有参与者的初潮年龄均在 2 至 8 岁之间。主要结果和机会的作用 在根据鹿特丹标准诊断为 PCOS 的 315 名女孩中，月经不调 (IM)/雄激素过多症 (HA)/多囊卵巢 (PCO)、IM/HA、HA/PCO 和 IM/ PCO 表型分别占 206 名（65.4%）、30 名（9.5%）、12 名（3.8%）和 67 名（21.3%）参与者。根据循证指南，79 名具有 HA/PCO 或 IM/PCO 表型的女孩（25.1%）未被诊断为 PCOS，与国际指南一致；他们被指定为“高危”群体。正如预期的那样，符合循证指南青少年标准的女孩表现出最差的代谢特征（全身性或向心性肥胖的程度、胰岛素抵抗的频率、糖尿病前期或糖尿病以及代谢综合征），并且比高危人群或高危人群更高的多毛症评分控制。大约 90% 的高危人群没有超重或肥胖，这与对照组类似。然而，与对照组相比，他们的代谢特征更差，血压、甘油三酯和胰岛素抵抗参数更高；此外，这些情况与符合青少年标准的女孩的情况类似。高危组的血清 LH 水平和 LH/FSH 比值同样升高，女孩符合青少年标准。局限性、注意原因 我们无法评估对照中的激素或超声参数。研究结果的更广泛意义 与传统的鹿特丹标准相比，最近的国际循证指南（在青少年 PCOS 诊断中避免超声检查）仍然提供了识别处于危险中的年轻女孩的机会，与本研究的结果一致。针对这一青少年人群的实用方法是建立 IM 或 HA（未指示超声）并指定“高危”PCOS 状态，并定期检查新出现或恶化的 PCOS 相关症状或代谢异常，随后进行重新评估，包括超声检查或抗苗勒氏管激素，月经初潮后 8 年进行一次。研究资助/竞争利益 未收到支持本研究的资助。作者没有需要披露的利益冲突。试用注册号 不适用。