Sex hormone binding globulin - an important biomarker for predicting pcos risk: A systematic review and meta-analysis
Open accessAbstract
Sex hormone-binding globulin (SHBG) is a glycoprotein which regulates bioavailability of sex steroid hormones. Interest in SHBG has escalated in recent years because of its inverse association with polycystic ovary syndrome (PCOS), obesity, insulin resistance, metabolic syndrome, and diabetes type II. This meta-analysis was performed to examine the associations of SHBG with PCOS and to correlate serum SHBG levels with various PCOS associated endocrine and metabolic dysregulation as well as to determine the effects of various therapeutic agents on serum SHBG levels in PCOS patients in order to assess the true accuracy of SHBG in the prediction of PCOS. A literature search was performed using Pub-Med, Science direct, google scholar, EMBASE, and Cochrane library. A total of 675 relevant records were identified, of which 62 articles were included. Meta-analysis using a random-effects model was performed using STATA version 13 to calculate standardized mean difference (SMD) with 95% confidence intervals (95 % CIs). SHBG levels in controls were significantly higher than that of PCOS patients (SMD= -0.83, 95%CI = -1.01, –0.64), with significant heterogeneity across studies (I2= 93.9% and p=0.000). Our results suggest that the lower serum SHBG levels are associated with the risk of PCOS. SHBG may also play an important role in various metabolic disturbances in PCOS patients. Therapeutic interventions improved SHBG levels in PCOS women which further reduced PCOS associated complications. Therefore, SHBG levels may prove to be a useful biomarker for the diagnosis and treatment of PCOS.Systematic review registration: PROSPERO CRD42017057972Abbreviations: PCOS: polycystic ovary syndrome; SHBG: sex hormone-binding globulin
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Obesity and obesity-related low-grade inflammation both contribute to the onset of insulin resistance by amplifying metabolic and reproductive outcomes.
“In particular, obesity and obesity-related low-grade inflammation both contribute to the onset of IR, by amplifying the metabolic and reproductive outcomes [7].”
From Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS) (2019) · cites this paper as [7]
The Discussion (page not provided) describes obesity and insulin resistance as commonly occurring in PCOS, and the Introduction lists metabolic and reproductive morbidities associated with PCOS. Neither passage establishes that obesity causes the onset of insulin resistance, and the searched passages do not address obesity-related low-grade inflammation or the claimed amplification of outcomes. (LLM, conf=0.76)
Experimental — accuracy not yet measuredLevels of SHBG are reduced in PCOS, permitting higher levels of bioavailable androgens.
“Levels of SHBG, a protein that transports steroids in biologically inactive form, are reduced in PCOS, permitting higher levels of bioavailable androgens (Deswal et al., 2018).”
From Endometriosis and polycystic ovary syndrome are diametric disorders (2021) · cites this paper as Deswal et al., 2018
Obesity and hyperandrogenism are associated with lower concentrations of SHBG.
“Additionally, obesity and hyperandrogenism are associated with lower concentrations of SHBG (Deswal et al., 2018), which binds circulating androgens biologically rendering them inactive (Azziz et al., 2016).”
From Improvements in PCOS characteristics and phenotype severity during a randomized controlled lifestyle intervention (2021) · cites this paper as Deswal et al., 2018
SHBG can be useful as a marker for a higher risk of PCOS.
“Studies indicate that SHBG can be useful as a marker for a higher risk of PCOS [66].”
From The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome (2022) · cites this paper as [66]
Low SHBG levels are a feature of PCOS and associated comorbidities including type 2 diabetes, insulin resistance, and obesity.
“Low SHBG levels are a feature of PCOS and associated co-morbidities including type 2 diabetes, insulin resistance, and obesity.59”
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- Authors
- Deswal, R., Yadav, A., & Dang, A. S.
- Affiliations
- Maharshi Dayanand University (IN)
- All India Institute of Medical Sciences (IN)
- Corresponding author
- Dang, Amita Suneja
- Venue
- Systems Biology in Reproductive Medicine
- Publisher
- Informa UK Limited
- Published
- 2017-12-11
- Volume
- 64
- Issue
- 1
- Pages
- 12-24
- ISSN
- 1939-6368 (ISSN-L)
- 1939-6376
- OpenAlex
- W2772256493
- Cited by
- 159
- References
- 84
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 18 · 2023: 26 · 2022: 28 · 2021: 28 · 2020: 14 · 2019: 10 · 2018: 2
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Systems Biology in Reproductive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- sex hormone-binding globulin, polycystic ovary syndrome, biomarkers, insulin resistance, metabolic syndrome, type 2 diabetes, obesity
- MeSH terms
- Female, Humans, Polycystic Ovary Syndrome, Predictive Value of Tests, Prognosis, Risk Factors, Sex Hormone-Binding Globulin, Biomarkers, Down-Regulation
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