TABLE 1.
Discriminatory potential of parameters
| Parameter | Controls | FHA | PCOS | Area under the ROC curve to differentiate FHA from PCOS | Optimal threshold to differentiate FHA from PCOS | References |
|---|---|---|---|---|---|---|
| Body mass index (kg/m2) | 21.2 (20.3 22.4) | 19.2 (18.8, 20.0) | 25.0 (24.4, 27.3) | 98.3% |
100% sensitivity and 88.9% specificity at BMI 21.2 kg/m2 84.6% sensitivity and 100% specificity at BMI 23.7 kg/m2 |
22, 23, 65, 69, 105, 129, 130, 131, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142 |
| Resting energy expenditure (REE, kJ) | 5786 (5304, 6643) | 4300 (4300, 4300) | 6519 (5297, 6796) | 100% |
4798 kJ (same threshold when only including BMI < 25 kg/m2) |
28, 30, 32 |
| Luteinising hormone (LH, IU/L) | 5.14 (3.69, 6.40) | 2.10 (0.84, 3.22) | 9.58 (7.50, 10.68) | 100% | 5.36 IU/L | 60, 61, 65, 67, 68 |
| Anti‐Müllerian hormone (AMH, pmol/L) | 20.4 (14.7, 24.0) | 27.9 (27.0, 35.4) | 53.6 (47.1, 66.4) | 100% | 41.3 pmol/L | 65, 74, 83, 143, 144, 145 |
| Antral follicle count (AFC) | 10 (7.3, 17.8) | 16 (6.5 20.5) | 24 (16.6, 36.0) | 88.9% |
100% sensitivity and 66.7% Specificity at AFC > 16.3 66.7% sensitivity and 100% Specificity at AFC > 22.3 |
65, 68, 81, 144, 145 |
| Proportion with PCOM | 24% | 31.4% | 87.5% | n/a |
PCOM was associated with an increased odds of PCOS diagnosis by 9.6‐fold (95%CI 6.2‐14.8) compared to FHA |
65 |
| Inhibin B (pg/ml) | 88.5 (75.2, 96.5) | 46.5 (45.0, 48.0) | 105.5 (64.2, 140.1) | 100% | 50.1 pg/ml | 83, 85, 146, 147, 148, 149 |
| Fasting glucose (mmol/L) | 4.87 (4.50, 5.14) | 3.95 (3.80, 4.10) | 4.90 (4.74, 5.51) | 100% | 4.3 mmol/L | 24, 102, 104, 106 |
| Fasting insulin (pmol/L) | 54.3 (36.3, 93.3) | 86.1 (84.5, 193.7) | 48.7 (30.4, 63.5) | 100% | 74.5 pmol/L | 65, 69, 103, 105 |
| SHBG (nmol/L) | 67.4 (63.3, 71.4) | 61.4 (60.0, 62.9) | 45.3 (44.0, 46.7) | 100% | 53.3 nmol/L | 65, 107 |
| Total testosterone (nmol/L) | 1.11 (1.12, 1.20) | 0.92 (0.78, 1.06) | 1.81 (1.49, 2.94) | 100% | 1.26 nmol/L | 24, 25, 30, 65, 109 |
| Total testosterone (nmol/L) BMI < 25 kg/m2 only | 1.15 (1.13, 1.79) | 0.92 (0.78, 1.06) | 2.45 (1.50, 3.4) | 100% | 1.26 nmol/L | 24, 25, 30, 65, 109 |
| Basal morning cortisol (nmol/L) | 203 (144, 233) | 255 (210, 300) | 236 (227, 245) | 50% | 100% sensitivity & 50% specificity at cortisol 219 nmol/L | 24, 116, 118 |
Summary of clinical, biochemical and radiological parameters that could be used to differentiate FHA and PCOS. Aggregated summary statistics (median, IQR) are presented for healthy controls, women with functional hypothalamic amenorrhoea (FHA) and women with polycystic ovary syndrome (PCOS). The data presented were aggregated from the references indicated (see Tables [Link], [Link], [Link], [Link], [Link] for more details on the included studies). Sensitivities and specificities for thresholds to differentiate FHA and PCOS are provided; a single threshold indicates 100% sensitivity and specificity. However, these thresholds should be interpreted with caution, as they were calculated from summary statistics that is unable to fully capture the variability in individual patient data, thus over‐estimating their discriminatory capability. Therefore, these thresholds should be regarded as indicative pending further study in which these parameters are directly compared in women with amenorrhoea in the same study. Polycystic ovarian morphology (PCOM) was defined as having at least one ovary with 12 or more follicles per ovary and odds of PCOS diagnosis calculated by univariate logistic regression. 66
Abbreviations: AFC, total antral follicle count on ultrasound; AMH, anti‐Müllerian hormone; BMI, body mass index; LH, luteinizing hormone; SHBG, sex hormone–binding globulin.