Clinical utility of FAI and SHBG in differentiating PCOS from anovulatory cycles in adolescent girls

Anovulatory 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.