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Nat. Rev. Endocrinol. doi:10.1038/nrendo.2018.24 Figure 5 Algorithm for the aetiological diagnosis of women thought to have PCOS Figure 5 | Algorithm for the aetiological diagnosis of women thought to have PCOS. An unusual clinical presentation should immediately be suspected to be an androgen-secreting neoplasm that must be ruled out by appropriate adrenal and ovarian imaging techniques and might even require venous sampling (left arm of diagram). A typical peripubertal, slow and progressive presentation requires careful assessment of clinical hyperandrogenism, hyperandrogenaemia, ovulatory function and ovarian morphology and exclusion of secondary aetiologies such as non-classic congenital adrenal hyperplasia (NCCAH) or hyperprolactinaemia. (Please note that the Androgen Excess and Polycystic Ovary Syndrome Society (AE–PCOS) definition of PCOS preferred by the author has been used for this algorithm, but the reader might combine individual criteria according to other diagnostic classifications as appropriate.) 1–24 ACTH, cosyntropin; 17OHP, 17-hydroxyprogesterone. Adapted with permission from Ref. 115, Oxford University Press. Adapted with permission from Escobar-Morreale, H. F. et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum. Reprod. Update 18, 146–170 (2012). Escobar-Morreale, H. F. (2018) Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment Nat. Rev. Endocrinol. doi:10.1038/nrendo.2018.24