title: Anti-Müllerian Hormone and Inhibin-A, but not Inhibin-B or Insulin-Like Peptide-3, may be Used as Surrogates in the Diagnosis of Polycystic Ovary Syndrome in Adolescents: Preliminary Results.
abstract: OBJECTIVE
  Polycystic ovary syndrome (PCOS) is a common endocrine problem in adolescents with an increasing prevalence of 30%. Pursuing new biomarkers with high specificity and sensitivity in the diagnosis of PCOS in adolescents is currently an active area of research. We aimed to investigate the diagnostic value of anti-Müllerian hormone (AMH), insulin-like peptide-3 (INSL3), inhibin-A (INH-A), and inhibin-B (INH-B) in adolescents with PCOS and also to determine the association, if any, between these hormones and clinical/laboratory findings related with hyperandrogenism.
  
  
  METHODS
  The study group comprised 53 adolescent girls aged between 14.5 and 20 years who were admitted to our outpatient clinic with symptoms of hirsutism and/or irregular menses and diagnosed as having PCOS in accordance with the Rotterdam criteria. Twenty-six healthy peers, eumenorrheic for at least two years and body mass index-matched, constituted the controls. Fasting blood samples for hormones [luteinizing hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone-sulfate (DHEAS), androstenedione (D4-A), total/free testosterone (T/fT), sex hormone binding globulin (SHBG), AMH, INSL3, INH-A, INH-B] were drawn after an overnight fast.
  
  
  RESULTS
  In the PCOS group, 83% of the subjects were oligomenorrheic/amenorrheic and 87% had hirsutism. The LH, LH/FSH ratio, total T, fT, free androgen-index (FAI), DHEAS levels were significantly higher (p=0.005, p=0.042, p=0.047, p<0.001, p=0.007, p=0.014, respectively) and SHBG was significantly lower (p=0.004) in PCOS patients as compared to the controls. Although the INSL-3 and INH-B levels showed no difference between the groups (p>0.05), AMH and INH-A levels were found to be significantly higher in the PCOS group compared to the controls (p<0.001, p<0.001, respectively). In multiple linear regression analysis, WC SDS (p=0.028), logD4-A (p=0.033), logSHBG (p=0.031), and total ovarian volume (p=0.045) had significant effects on AMH levels, and LH (p=0.003) on INH-A levels. In receiver-operating characteristic analysis, the cut-off values for AMH and INH-A were 6.1 ng/mL (sensitivity 81.1%) and 12.8 pg/mL (sensitivity 86.8%), respectively, to diagnose PCOS. When AMH and INH-A were used in combination, the sensitivity (96.2%) increased.
  
  
  CONCLUSIONS
  INSL3 and INH-B were not found to have diagnostic value in adolescents with PCOS. On the other hand, it was shown that INH-A could be used as a new diagnostic biomarker in addition to AMH.
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Division of Adolescent Medicine, İstanbul, Turkey, Phone: +90 505 369 00 35 E-mail: aylin.yetim@istanbul.edu.tr.
authors.forename: Aylin
authors.initials: A
authors.lastname: Yetim
authors.forename: Çağcıl
authors.initials: Ç
authors.lastname: Yetim
authors.forename: Firdevs
authors.initials: F
authors.lastname: Baş
authors.forename: Oğuz Bülent
authors.initials: OB
authors.lastname: Erol
authors.forename: Gülnaz
authors.initials: G
authors.lastname: Çığ
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uçar
authors.forename: Feyza
authors.initials: F
authors.lastname: Darendeliler
mesh_terms: D000293:Adolescent; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005215:Fasting / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007265:Inhibins / Q000097:blood*; D007328:Insulin / Q000097:blood; D016014:Linear Models; D007986:Luteinizing Hormone / Q000097:blood; D010045:Outpatients / Q000706:statistics & numerical data; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000175:diagnosis; D011506:Proteins; D012372:ROC Curve; D013739:Testosterone / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; C084797:Leydig insulin-like protein; D011506:Proteins; C422362:inhibin A; C422364:inhibin B; D013739:Testosterone; D007265:Inhibins; D019314:Dehydroepiandrosterone Sulfate; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone