AMH as Predictor of Premature Ovarian Insufficiency: A Longitudinal Study of 120 Turner Syndrome Patients

Lunding, Stine Aagaard; Aksglæde, Lise; Anderson, Richard A.; Main, Katharina M.; Juul, Anders; Hagen, Casper P; Pedersen, Anette Tønnes

doi:10.1210/jc.2015-1621

Cited by 93 publications

(88 citation statements)

References 44 publications

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“…AMH appears to be a reliable marker in this field, and is associated with karyotype as well as with ovarian function, the lowest AMH levels being found in 45,X monosomy patients and in those with no signs of spontaneous puberty [22,23]. AMH has been found to predict disturbance at puberty onset in young TS girls and premature ovarian failure in adolescent and adult TS patients [22][23][24]. Nevertheless, none of the cited studies proved the superiority of AMH over FSH in predicting spontaneous puberty.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, none of the cited studies proved the superiority of AMH over FSH in predicting spontaneous puberty. Based on an analysis of 15 girls, Lunding et al [24] confirmed that an AMH level below -2 SD (4 pmol/L) predicted failure to enter puberty. However, a strong negative correlation between AMH and FSH was found in a multicentre study, but due to its cross-sectional design the authors stressed the need for a longitudinal study to determine if AMH at a younger age is predictive and whether multiple measurements are needed over time [23].…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Spontaneous Puberty in Turner Syndrome Based on Mid-Childhood Gonadotropin Concentrations, Karyotype, and Ovary Visualization: A Longitudinal Study

et al. 2017

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Aims: To investigate whether karyotype, mid-childhood (6–10 years) follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, and ultrasound ovary visualization results can be used as indicators of spontaneous puberty in Turner syndrome (TS). Methods: The analysis was based on clinical and biochemical data from 110 TS girls aged >13 years at the end of the study (1,140 visits between 1996 and 2015). The study population was divided according to karyotype: 45,X and non-45,X. Results: The mean age ± standard deviation at diagnosis was 10.7 ± 4.0 years, and the follow-up duration was 5.9 ± 3.3 years. Spontaneous puberty was confirmed in 48% and menarche in 20% of the subjects, less frequently in 45,X girls. The mean age at Tanner stage B2 was 13.7 ± 2.4 years and that at menarche 14.2 ± 1.7 years, regardless of the karyotype. The median FSH level at 6–10 years was 8.16 IU/L, which was significantly lower than <6 years and >10 years. The median LH level at 6–10 years was 0.35 IU/L, which was lower than >10 years. The chance of spontaneous menarche was decreased in girls with FSH ≥6.7 IU/L between 6 and 10 years. Conclusions: Although spontaneous puberty and menarche occur more frequently in non-45,X girls, the karyotype cannot be used to predict them. However, the chance of spontaneous menarche can be predicted based on gonadotropin cut-off values. There was no correlation between ultrasound ovary visualization results and spontaneous puberty.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prediction of Spontaneous Puberty in Turner Syndrome Based on Mid-Childhood Gonadotropin Concentrations, Karyotype, and Ovary Visualization: A Longitudinal Study

et al. 2017

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“…If gonadotropins are normal for age, observation for spontaneous puberty is appropriate, with future replacement therapy if gonadal failure occurs. Low anti-Müllerian hormone (AMH) and undetectable inhibin B can also be used to predict ovarian failure in TS (153,154,155). Using low doses of estrogen is crucial to preserve height potential whether or not GH treatment has already been initiated, because very-low-dose ethinylestradiol (EE), TD E2, oral E2 and systemic (depot) E2 do not interfere with the growth response to GH therapy (87,94,152,156,157).…”

Section: Sex Hormone Replacementmentioning

confidence: 99%

Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

Gravholt¹,

Andersen

Conway

et al. 2017

European Journal of Endocrinology

825

1,259

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Turner syndrome affects 25-50 per 100,000 females and can involve multiple organs through all stages of life, necessitating multidisciplinary approach to care. Previous guidelines have highlighted this, but numerous important advances have been noted recently. These advances cover all specialty fields involved in the care of girls and women with TS. This paper is based on an international effort that started with exploratory meetings in 2014 in both Europe and the USA, and culminated with a Consensus Meeting held in Cincinnati, Ohio, USA in July 2016. Prior to this meeting, five groups each addressed important areas in TS care: 1) diagnostic and genetic issues, 2) growth and development during childhood and adolescence, 3) congenital and acquired cardiovascular disease, 4) transition and adult care, and 5) other comorbidities and neurocognitive issues. These groups produced proposals for the present guidelines. Additionally, four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with a separate systematic review of the literature. These four questions related to the efficacy and most optimal treatment of short stature, infertility, hypertension, and hormonal replacement therapy. The guidelines project was initiated by the European Society of Endocrinology and the Pediatric Endocrine Society, in collaboration with the European Society for Paediatric Endocrinology, the Endocrine Society, the European Society of Human Reproduction and Embryology, the American Heart Association, the Society for Endocrinology, and the European Society of Cardiology. The guideline has been formally endorsed by the European Society of Endocrinology, the Pediatric Endocrine Society, the European Society for Paediatric Endocrinology, the European Society of Human Reproduction and Embryology and Summary of recommendationsThe recommendations (R) are worded as recommend (strong recommendation) and suggest (weak recommendation). We formally graded only the evidence underlying recommendations for therapeutic choices. The quality of evidence behind the recommendations is classified as very low (⨁◯◯◯), low (⨁⨁◯◯), moderate (⨁⨁⨁◯) and strong (⨁⨁⨁⨁). See further section 'Summary of methods used for guideline development'. Diagnosis and geneticsR 1.1. We recommend considering a diagnosis of TS in phenotypic females with a karyotype containing one X chromosome and complete or partial absence of the second sex chromosome, associated with one or more typical clinical manifestations of TS (⨁⨁⨁⨁). R 1.2. We recommend against considering a diagnosis of TS in females with one X chromosome and a deletion distal to Xq24 on the other X chromosome, and in women over the age of 50 years with less than 5% 45,X mosaicism (⨁⨁◯◯). R 1.3. We suggest that the new general surveillance management guideline applies to TS patients with any karyotype (⨁⨁◯◯). R 1.4. We recommend to consider testing for Turner syndrome (TS) in a female with typical signs (Table 2) (⨁⨁⨁⨁). R 1.5. We ...

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“…The typical progression of an AMH value is to decline over a woman's lifetime until undetectable [12]. This study demonstrates that there can be a dynamic shift in AMH and AFC with growth hormone therapy.…”

Section: Discussionmentioning

confidence: 69%

“…Patients with premature ovarian insufficiency or diminished ovarian reserve are noted to also have very low AMH and AFC that typically does not improve with any treatment option [12].…”

Section: Introductionmentioning

confidence: 99%

Normalization of anti-mullerian hormone level after growth hormone replacement in a patient with congenital growth hormone deficiency: A case study

Purdy¹,

Leonard²,

Rhodes³

et al. 2018

Clin Obstet Gynecol Reprod Med

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Objective: To describe a case of congenital growth hormone deficiency in a patient that had return of ovarian function after growth hormone replacement following undetectable levels of anti-mullerian hormone (AMH) level. Design: Case Study.Setting: Mayo Clinic. Patient(s):A 32-year-old woman with congenital growth hormone deficiency (CGHD) was evaluated at Mayo Clinic and noted to have an undetectable AMH level. Intervention(s):The patient was started on Humatrope at a dose of 0.4mg daily. Patient was escalated on growth hormone therapy until her IGF-1 levels were within normal range. Main Outcome Measure(s):Return of cyclical menses and increase in AMH level to normal range. Results:After 12 months of GH replacement, the patient's menses had returned to regular 28-day cycles and her hypoestrogenic symptoms had resolved. Her GH was adequately replaced with an IGF-1 level of 151ng/mL. Her AFC had increased to 16 from a previous ultrasound depicting 1 antral follicle and her laboratory tests had returned to normal levels; FSH 7.7IU/L, estradiol 33 pg/mL and AMH 1.9 ng/mL. Conclusion:This documents a patient with CGHD and suppressed AMH levels. In this case, GH correction played a significant role in restoring ovarian function. Assessing ovarian reserve status in adolescent patients with CGHD is a key component in their evaluation and may allow for oocyte cryopreservation in young girls that have normalization of ovarian function after treatment. This is important, as there is unclear data on the long term fertility potential of patients with CGHD. AMH has been shown to be a marker of ovarian reserve in a patient with CGHD which demonstrated a dynamic shift in AMH that was related to the patient's GH status.

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AMH as Predictor of Premature Ovarian Insufficiency: A Longitudinal Study of 120 Turner Syndrome Patients

Abstract: The majority of women with mosaic karyotype 45,X/46,XX had ongoing ovarian function in early adulthood. AMH < -2 SD predicted failure to enter puberty in young TS girls and imminent POI in adolescent and adult TS patients.

Cited by 93 publications

References 44 publications

Prediction of Spontaneous Puberty in Turner Syndrome Based on Mid-Childhood Gonadotropin Concentrations, Karyotype, and Ovary Visualization: A Longitudinal Study

Prediction of Spontaneous Puberty in Turner Syndrome Based on Mid-Childhood Gonadotropin Concentrations, Karyotype, and Ovary Visualization: A Longitudinal Study

Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

Normalization of anti-mullerian hormone level after growth hormone replacement in a patient with congenital growth hormone deficiency: A case study

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