Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls
IntroductionMenstrual irregularities are common in adolescents, often linked to anovulatory cycles. This study aims to establish diagnostic cut-off values for Polycystic Ovary Syndrome (PCOS) and differentiate it from anovulatory dysfunction in adolescents, while evaluating the diagnostic sensitivit...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1581060/full |
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| author | Emre Özer Demet Taş Demet Taş Seçil Çakır Gündoğan Mehmet Boyraz Mehmet Boyraz Fatih Gürbüz Fatih Gürbüz |
| author_facet | Emre Özer Demet Taş Demet Taş Seçil Çakır Gündoğan Mehmet Boyraz Mehmet Boyraz Fatih Gürbüz Fatih Gürbüz |
| author_sort | Emre Özer |
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| description | IntroductionMenstrual irregularities are common in adolescents, often linked to anovulatory cycles. This study aims to establish diagnostic cut-off values for Polycystic Ovary Syndrome (PCOS) and differentiate it from anovulatory dysfunction in adolescents, while evaluating the diagnostic sensitivity of the Free Androgen Index (FAI) and Sex Hormone Binding Globulin (SHBG).MethodsThe study included 305 adolescents with oligomenorrhea at a tertiary center. Statistical analyses were performed, and Receiver Operating Characteristic (ROC) curves were used to assess diagnostic performance.ResultsOf the 305 patients, 229 (75%) had anovulatory cycles, and 36 (11.8%) were diagnosed with PCOS. Mean FAI values were 3.5 ± 2 in anovulatory cycles, 8.0 ± 5 in PCOS, and 8.3 ± 4 in hyperinsulinism (p < 0.001). FAI showed significant positive correlations with HOMA-IR (r = 0.389, p < 0.001) and BMI z-score (r = 0.499, p < 0.001). ROC analysis identified an LH threshold of 9.7 U/L and an LH/FSH ratio of 2.62 as predictive markers for PCOS.DiscussionAnovulatory cycles are the leading cause of menstrual irregularities in adolescents. While hyperandrogenism is crucial for PCOS diagnosis, elevated FAI levels in PCOS are also observed in hyperinsulinemia and obesity. PCOS is more prevalent in obese adolescents, which limits the diagnostic reliability of FAI. Lower SHBG levels in hyperinsulinemic obese adolescents further complicate FAI interpretation, underscoring the significant impact of glucose and insulin metabolism on these markers. Therefore, a comprehensive diagnostic approach, including androgen levels, LH/FSH ratio, SHBG, FAI, and ovarian ultrasound, is essential for accurate PCOS diagnosis in adolescent girls. |
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| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-b2e5f89ed0f4449d8fa8b4feee7b7a742025-08-20T03:39:18ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-08-011310.3389/fped.2025.15810601581060Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girlsEmre Özer0Demet Taş1Demet Taş2Seçil Çakır Gündoğan3Mehmet Boyraz4Mehmet Boyraz5Fatih Gürbüz6Fatih Gürbüz7Department of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, TürkiyeDepartment of Pediatrics, Division of Adolescent Health, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, TürkiyeDivision of Adolescent Health, Department of Pediatrics, Ankara Bilkent City Hospital, Ankara, TürkiyeDepartment of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, TürkiyeDepartment of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, TürkiyeDepartment of Pediatric Endocrinology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, TürkiyeDepartment of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, TürkiyeDepartment of Pediatric Endocrinology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, TürkiyeIntroductionMenstrual irregularities are common in adolescents, often linked to anovulatory cycles. This study aims to establish diagnostic cut-off values for Polycystic Ovary Syndrome (PCOS) and differentiate it from anovulatory dysfunction in adolescents, while evaluating the diagnostic sensitivity of the Free Androgen Index (FAI) and Sex Hormone Binding Globulin (SHBG).MethodsThe study included 305 adolescents with oligomenorrhea at a tertiary center. Statistical analyses were performed, and Receiver Operating Characteristic (ROC) curves were used to assess diagnostic performance.ResultsOf the 305 patients, 229 (75%) had anovulatory cycles, and 36 (11.8%) were diagnosed with PCOS. Mean FAI values were 3.5 ± 2 in anovulatory cycles, 8.0 ± 5 in PCOS, and 8.3 ± 4 in hyperinsulinism (p < 0.001). FAI showed significant positive correlations with HOMA-IR (r = 0.389, p < 0.001) and BMI z-score (r = 0.499, p < 0.001). ROC analysis identified an LH threshold of 9.7 U/L and an LH/FSH ratio of 2.62 as predictive markers for PCOS.DiscussionAnovulatory cycles are the leading cause of menstrual irregularities in adolescents. While hyperandrogenism is crucial for PCOS diagnosis, elevated FAI levels in PCOS are also observed in hyperinsulinemia and obesity. PCOS is more prevalent in obese adolescents, which limits the diagnostic reliability of FAI. Lower SHBG levels in hyperinsulinemic obese adolescents further complicate FAI interpretation, underscoring the significant impact of glucose and insulin metabolism on these markers. Therefore, a comprehensive diagnostic approach, including androgen levels, LH/FSH ratio, SHBG, FAI, and ovarian ultrasound, is essential for accurate PCOS diagnosis in adolescent girls.https://www.frontiersin.org/articles/10.3389/fped.2025.1581060/fullfree androgen indexmenstrual irregularityLH-FSHoligomenorrheapolycystic ovary syndromesex hormone binding globuline |
| spellingShingle | Emre Özer Demet Taş Demet Taş Seçil Çakır Gündoğan Mehmet Boyraz Mehmet Boyraz Fatih Gürbüz Fatih Gürbüz Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls Frontiers in Pediatrics free androgen index menstrual irregularity LH-FSH oligomenorrhea polycystic ovary syndrome sex hormone binding globuline |
| title | Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls |
| title_full | Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls |
| title_fullStr | Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls |
| title_full_unstemmed | Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls |
| title_short | Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls |
| title_sort | clinical utility of fai and shbg in differentiating pcos from anovulatory cycles in adolescent girls |
| topic | free androgen index menstrual irregularity LH-FSH oligomenorrhea polycystic ovary syndrome sex hormone binding globuline |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1581060/full |
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