Öz
Amaç
Polikistik over sendromu (PKOS), kronik anovülasyon ve hiperandrojenizmle karakterize yaygın bir endokrin bozukluktur. Adolesanlarda, fizyolojik pubertal değişikliklerle örtüşmesi nedeniyle tanısı güçtür. Anti-Müllerian hormon (AMH) ve insülin like peptit-3 (INSL3), erişkin PKOS’ta potansiyel biyobelirteçler olarak önerilmiştir, ancak adolesan dönemdeki tanısal değerleri belirsizdir. Bu çalışmada, PKOS tanılı adolesanlarda ve sağlıklı kontrol grubunda serum AMH ve INSL3 düzeyleri araştırılmış, ultrasonografik ve biyokimyasal bulgularla ilişkileri değerlendirilmiştir.
Yöntem
Bu kesitsel çalışmaya, Rotterdam kriterlerine göre PKOS tanısı almış 50 adolesan ve 25 sağlıklı kontrol dahil edildi. Tüm katılımcılarda antropometrik ölçümler, hormonal/biyokimyasal analizler ve transabdominal ultrasonografi gerçekleştirildi. Biyobelirteçler, biyokimyasal hiperandrojenizm ve over morfolojisi arasındaki korelasyonlar değerlendirildi. AMH’nin tanısal performansı için alıcı işletim karakteristiği eğrisi (ROC) analizi yapıldı.
Bulgular
PKOS’lu adolesanlarda serum AMH düzeyleri kontrol grubuna göre anlamlı derecede yüksekti (11,1±5,4 vs. 3,8±1,8 ng/mL, p<0,001), INSL3 seviyeleri ise benzerdi (p=0,806). AMH, total testosteron, androstenedion, serbest androjen indeksi, Ferriman-Gallwey skoru, lüteinizan hormon/folikül uyarıcı hormon oranı, over hacmi ve antral folikül sayısı ile pozitif, seks hormonu bağlayıcı globulin ile negatif korelasyon gösterdi. PKOS grubunda AMH, INSL3 ile de anlamlı bir korelasyon gösterdi (r=0,35, p=0,012); özellikle fazla kilolu/obez alt gruplarında bu ilişki daha belirgindi. ROC analizi, %94 duyarlılık ve %80 özgüllük (eğri altındaki alan: 0,938, %95 güven aralığı: 0,88-0,99) ile 5,05 ng/mL’lik bir AMH kesme değeri belirledi.
Sonuç
Serum AMH, PKOS grubundaki adolesanlarda anlamlı düzeyde yüksektir ve hem klinik/biyokimyasal hiperandrojenizm hem de over morfolojisi ile güçlü bir korelasyon göstermektedir. Bu bulgu, AMH’nın tek başına tanısal bir biyobelirteç olmadığını, ancak PKOS tanısında destekleyici bir rol oynayabileceğini düşündürmektedir. Erişkin PKOS çalışmalarının aksine, adolesan dönemde INSL3 tanısal bir değer göstermemiştir. AMH’nın klinik değerlendirmeye katılması, farklı PKOS fenotiplerinin ve gelecekteki metabolik komplikasyonlar açısından risk altındaki adolesanların belirlenmesine katkı sağlayabilir.
Anahtar Kelimeler: Adolesan, PKOS, AMH, INSL3, polikistik morfoloji
Kaynakça
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