Adölesanlarda Polikistik Over Sendromu Tanısında AMH, SHBG ve LH/FSH Oranının Rolü

Abstract

Amaç: Adölesanlarda polikistik over sendromu (PKOS) tanısı tartışmalıdır. Bu nedenle PKOS tanısı için yardımcı belirteçlere ihtiyaç vardır. PKOS’lu adölesanları taramak ve PKOS tanısında hangisinin tanısal değerinin daha fazla olduğunu araştırmak için Luteinizan hormon (LH)/folikül uyarıcı hormon (FSH) oranı, serbest androjen indeksi (SAI), anti-müllerian hormon (AMH) ve seks hormon bağlayıcı globulin (SHBG) düzeylerinin yararlı ve değerli bir test olup olmadığını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışmaya PKOS tanılı 56 ve sağlıklı 70 kız dahil edildi. PKOS’u teşhis etmek için Pediatrik Endokrin Derneği kriterleri kullanıldı. Klinik muayeneleri ve hormon tahlilleri yapıldı. Bulgular: PKOS grubunda kontrol grubuna göre LH/FSH oranı ve SAI düzeyleri anlamlı olarak yüksek, SHBG düzeyleri anlamlı olarak düşük saptandı (p<0.001). PKOS tanısı için en iyi belirteç AMH olarak bulundu. PKOS’lu tüm adölesanlarda, obezite/fazla kilodan bağımsız olarak, kontrol grubu ile karşılaştırıldığında anlamlı olarak daha yüksek AMH seviyeleri gözlendi (p<0.001). PKOS’lu vakaları sağlıklı kontrollerden ayırt etmek için LH/FSH oranı eşik değeri %77 duyarlılık ve %77 özgüllük ile 1.48 ng/ml ölçüldü. Sonuç: AMH, SAI ve LH/FSH oranı, PKOS kriterlerinin varlığında PKOS tanısında yararlı ve değerli testler olabilir. AMH PKOS’lu hastalarda en güçlü tanısal belirteç olarak bulundu.

Keywords

• Anti müllerian hormon
• Seks hormon bağlayıcı globülin
• LH/FSH oranı
• Polikistik over sendromu
• Serbest androjen indeks

The Role of the AMH, SHBG, Free Androgen Index and LH/FSH Ratio in the Diagnosis of Polycystic Ovary Syndrome in Adolescent

Abstract

Objective: Polycystic ovary syndrome (PCOS) diagnosis is controversial in adolescents. Therefore, auxiliary markers are required for the diagnosis of PCOS. We aimed to evaluate whether luteinizing hormone (LH)/ follicle-stimulating hormone (FSH) ratio, free androgen index (FAI), anti-Mullerian hormone (AMH), and sex hormone-binding globulin (SHBG) levels are a useful test to screen adolescents with PCOS and to investigate which of them has more diagnostic value in the PCOS diagnosis. Material and Methods: A total of 56 girls with PCOS and 70 healthy girls consisted in this study. Pediatric Endocrine Society criteria were used to diagnose PCOS. Clinical examinations and hormonal assays were performed. Results: The LH/FSH ratio, and FAI levels were detected significantly higher, and SHBG levels were detected significantly lower in the PCOS group than in the control group (p<0.001). The best marker for PCOS diagnosis was found as AMH. In all adolescents with PCOS, irrespective of obesity/overweight, significantly higher AMH levels were observed compared to the control subjects (p<0.001). Also, we measured a LH/FSH ratio cut-off value of 1.48 ng/ml with 77% sensitivity and 77% specificity to differentiate cases with PCOS from healthy controls. Conclusion: AMH, FAI, and LH/FSH ratio could be usefull and valuable tests for the PCOS diagnosis in the presence of the PCOS criteria. AMH was found to be the strongest diagnostic marker in patients with PCOS.

Keywords

• Anti-Mullerian hormone
• Free androgen index
• LH/FSH ratio
• Polycystic ovary syndrome
• Sex hormone-binding globulin

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