Mechanism of elevated LH/FSH ratio in lean PCOS revisited: a path analysis.
Level 4 - case-series / case-control
Cross-sectional study without a non-PCOS control group
PubMed 38589425 · doi:10.1038/s41598-024-58064-0
What was done
A cross-sectional study was conducted in 110 lean women with polycystic ovary syndrome (PCOS) at Dr. Cipto Mangunkusumo Kencana Hospital and the IMERI UI HRIFP cluster in Indonesia. Fasting blood samples were analyzed for LH, FSH, kisspeptin, neurokinin B, dynorphin, leptin, adiponectin, anti-Müllerian hormone (AMH), fasting glucose, fasting insulin, HOMA-IR, testosterone, and sex hormone-binding globulin. Bivariate and path analyses were performed to evaluate direct and indirect pathways influencing the LH/FSH ratio.
What was found
The abstract reports directional relationships but does not provide any numerical values, correlation coefficients, or p-values. Dynorphin was negatively associated with kisspeptin, while neurokinin B showed no association with kisspeptin. Dynorphin and AMH were both directly and positively associated with the LH/FSH ratio in bivariate and path analyses. Kisspeptin had no direct association with the LH/FSH ratio. AMH acted as an intermediary variable linking HOMA-IR and free androgen index to the LH/FSH ratio. HOMA-IR was negatively associated with adiponectin and positively associated with leptin and free androgen index.
Why it matters
This study suggests that dynorphin and AMH, rather than kisspeptin directly, may mediate the elevated LH/FSH ratio in lean PCOS, offering potential targets for mechanism-based therapy.
Limits
The cross-sectional design precludes establishing causality, and the study did not include a healthy control group. The abstract provides no quantitative data, effect sizes, or confidence intervals. In addition, peripheral circulating neuropeptide levels may not accurately reflect central hypothalamic activity.