The Relevant Hormonal Levels and Diagnostic Features of Polycystic Ovary Syndrome in Adolescents

Relevance: The clinical picture of polycystic ovary syndrome (PCOS) is extremely polymorphic, especially in adolescence. At the same time, the diagnostic criteria of PCOS in adolescence are still under discussion, and the hormonal parameters, including anti-Mullerian hormone range and hyperandrogenism, are not determined. The aim of the present study was to characterize the pivotal clinical and hormonal features of PCOS in adolescents and to establish the age-specific thresholds of the most essential hormonal parameters.

Design: A case-control study.

Methods: The study included 130 girls with PCOS according to the complete Rotterdam criteria, aged 15 to 17 years. The control group consisted of 30 healthy girls with a regular menstrual cycle of the same age. A complete clinical and laboratory examination, hormonal assays, and ultrasound of the pelvic organs were performed. The serums anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, prolactin, estradiol, 17α-OH progesterone (17α-OHP), androstenedione, testosterone (T), dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), leptin, and free androgen index (FAI) were analyzed. The diagnostic accuracy of AMH, FAI, LH/FSH, T, and androstenedione levels in predicting PCOS in adolescents was established using a logistic regression model and calculating area under the receiver operator characteristic (ROC) curve (AUC).

Results: The serum levels of LH (9.0 (5.4-13.8) vs. 3.7 (2.5-4.7) IU/L; p < 0.0001), LH/FSH (1.6 (1.0-2.3) vs. 0.7 (0.5-1.1); p < 0.0001), 17α-OHP (4.1 (3.2-5.1) vs. 3.4 (2.7-3.8) nmol/L; p = 0.0071), cortisol (464.0 ± 147.6 vs. 284.0 ± 129.7 nmol/L; p < 0.0001), prolactin (266.0 (175.0-405.0) vs. 189.0 (142.0-269.0) mIU/L; p = 0.0141), T (1.9 (1.2-2.5) vs. 0.8 (0.7-1.1) nmol/L; p < 0.0001), androstenedione (15.8 (11.6-23.2) vs. 8.3 (6.5-10.8) ng/mL; p < 0.0001), AMH (9.5 (7.5-14.9) vs. 5.8 (3.8-6.9) ng/mL; p < 0.0001), FAI (5.5 (2.8-7.0) vs. 1.6 (1.1-2.3); p < 0.0001), SHBG (37.0 (24.7-55.5) vs. 52.9 (39.0-67.6) nmol/L; p = 0.0136), DHEAS (6.8 ± 3.2 vs. 5.1 ± 1.5 μmol/L; p = 0.0039), and leptin (38.7 ± 27.1 vs. 23.7 ± 14.0 ng/mL; p = 0.0178) were significantly altered in the PCOS patients compared to the controls. Multivariate analysis of all studied hormonal and instrumental parameters of PCOS in adolescents revealed as the most essential: AMH level > 7.20 ng/mL, FAI > 2.75, androstenedione > 11.45 ng/mL, total T > 1.15 nmol/L, LH/FSH ratio > 1.23, and the volume of each ovary > 10.70 cm³ (for each criterion sensitivity ≥ 75.0-93.0%, specificity ≥ 83.0-93.0%). The diagnostic accuracy of PCOS determination was 90.2-91.6% with the combined use of either four detected indexes, which was significantly higher than the use of each index separately. The accuracy of PCOS diagnostics reached 92% using AMH and leptin concentrations when the value of the logistic regression function [85.73 - (1.73 × AMH) - (0.12 × Leptin)] was less than 70.72.

Conclusions: The results of the study estimate the threshold for AMH, FAI, androstenedione, testosterone, LH/FSH, and ovarian volume, which could be suggested for use in the PCOS diagnostics in adolescents with a high sensitivity and specificity. Moreover, the combination of either four determined indexes improved the diagnostic accuracy for the PCOS detection in adolescents.