Abstract
Objective Decreased synthesis of sex hormone-binding globulin (SHBG) related to hyperinsulinemia is one of the disturbances characteristic of polycystic ovary syndrome (PCOS). Hyperinsulinemia is a compensatory mechanism for liver insulin resistance (IR); thus, SHBG may be considered as a surrogate marker of liver IR. Therefore, this study aimed to assess the prediction of IR and impaired fasting glucose (IFG) based on SHBG levels in women with PCOS. Methods This analysis included data retrieved from medical records of 854 patients with PCOS hospitalized in the Gynecological Endocrinology Clinic from 2012 to 2019. Data including anthropometric parameters, fasting plasma glucose, insulin, and SHBG levels were analyzed. BMI and HOMA-IR were calculated with standard formulas. Results IFG and IR assessed based on HOMA-IR values > 2.0 were found in 19.5% and 47.8% of the study group, respectively. Empirical optimal cutoff values for SHBG levels were ≤41.5 nmol/L typical for IR (AUC 0.711, sensitivity 61.1%, specificity 71.6%, positive predictive value (PPV) 70.7%, and negative predictive value (NPV) 62.1%). The probability of insulin resistance occurrence for SHBG concentration 26.1 nmol/L (the lower normal range) was 61.6% (95% CI: 57.4%–65.8%). The SHBG concentration of 36.4 nmol/L and 8.1 nmol/L was related to a 10% and 20% probability of IFG, respectively. Conclusion In conclusion, this is the first study estimating the probability of liver IR and IFG occurrence based on SHBG levels in women with PCOS. Despite the low sensitivity, SHBG level below 42 nmol/L should cause closer monitoring for the fatty liver and prediabetes.
Highlights
According to some recent studies, obesity, especially visceral obesity, is an important factor contributing to hormonal and metabolic disturbances in polycystic ovary syndrome (PCOS) [1,2]
To find a cutoff point discriminating the insulin resistance and impaired fasting glucose based on the sex hormone-binding globulin (SHBG) level, parametric and nonparametric ROC curves were calculated with the area under curve (AUC) and corresponding sensitivity, specificity, and positive and negative predictive values. e fractional polynomial curve with a 95% confidence interval was calculated to show the associations between SHBG levels and insulin levels. e logistic regression was used to assess the probability of IR and IFG based on the SHBG levels
Low circulating SHBG levels are associated with the development of type 2 and gestational diabetes [14,15,16,17,18,19, 25, 26]. e results of a 15-year follow-up study suggested that a decreased synthesis of SHBG in the liver is an early response to the increased insulin levels corresponding to IR in visceral fat [27]
Summary
Decreased synthesis of sex hormone-binding globulin (SHBG) related to hyperinsulinemia is one of the disturbances characteristic of polycystic ovary syndrome (PCOS). Erefore, this study aimed to assess the prediction of IR and impaired fasting glucose (IFG) based on SHBG levels in women with PCOS. Data including anthropometric parameters, fasting plasma glucose, insulin, and SHBG levels were analyzed. IFG and IR assessed based on HOMA-IR values > 2.0 were found in 19.5% and 47.8% of the study group, respectively. E probability of insulin resistance occurrence for SHBG concentration 26.1 nmol/L (the lower normal range) was 61.6% (95% CI: 57.4%–65.8%). E SHBG concentration of 36.4 nmol/L and 8.1 nmol/L was related to a 10% and 20% probability of IFG, respectively. This is the first study estimating the probability of liver IR and IFG occurrence based on SHBG levels in women with PCOS. SHBG level below 42 nmol/L should cause closer monitoring for the fatty liver and prediabetes
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