Clinical Utility of Anti-Mullerian Hormone in Pediatrics

Abstract

Context Anti-Mullerian Hormone (AMH) was originally described in the context of sexual differentiation in the male fetus but has gained prominence now as a marker of ovarian reserve and fertility in females. In this mini review, we offer an updated synopsis on AMH and its clinical utility in pediatric patients. Design and Results A systematic search was undertaken for studies related to the physiology of AMH, normative data and clinical role in pediatrics. In males, AMH, secreted by Sertoli cells, is found at high levels prenatally and throughout childhood and declines with progression through puberty to overlap with levels in females. Thus, serum AMH has clinical utility as a marker of testicular tissue in males with differences in sexual development, cryptorchidism and in the evaluation of persistent Mullerian duct syndrome. In females, serum AMH has been used as a predictive marker of ovarian reserve and fertility, but pre-pubertal and adolescent AMH assessments need to be interpreted cautiously. AMH is also a marker of tumor burden, progression, and recurrence in germ cell tumors of the ovary. Conclusions AMH has widespread clinical diagnostic utility in pediatrics but interpretation is often challenging and should be undertaken in the context of not only age and sex, but also developmental and pubertal stage of the child. Non-standardized assays necessitate the need for assay-specific normative data. The recognition of the role of AMH beyond gonadal development and maturation may usher in novel diagnostic and therapeutic applications that would further expand its utility in pediatric care.

Reference intervals of anti‐Müllerian hormone in Korean women

“…Anti‐Müllerian hormone (AMH) is originally described in the context of sexual differentiation in the male fetus, in which AMH is secreted as a 140 kDa dimeric glycoprotein hormone structurally related to transforming growth factor β and inhibin. 1 , 2 Anti‐Müllerian hormone in women is produced by granulosa cells of small, growing follicles in the ovary, in which serum AMH level strongly correlates with the number of growing follicles. 1 Serum AMH in women has received increasing attention as an indicator for ovarian reserve.…”

“…Its clinical use has increased in obstetrics and gynecology clinics for fertility treatment and to manage diseases of the reproductive system. 1 , 2 …”

“…Its clinical use has increased in obstetrics and gynecology clinics for fertility treatment and to manage diseases of the reproductive system. 1,2 Serum AMH level is determined in clinical laboratories by manual assays using enzyme-linked immunosorbent assays (ELISA) with Gen II (Beckman Coulter), Ultra-sensitive AMH/MIS (Ansh Laboratories), or MenoCheck picoAMH (Ansh Laboratories) assay and by automated assays, such as Access AMH (Beckman Coulter), Elecsys AMH (Roche), and AFIAS AMH (Boditech Med). 1,3,4 Because these assays detect different AMH isoforms using different antibody pairs, direct comparison of AMH values obtained by these assays remains problematic.…”

“…Serum AMH in women has received increasing attention as an indicator for ovarian reserve. Its clinical use has increased in obstetrics and gynecology clinics for fertility treatment and to manage diseases of the reproductive system 1,2 …”

AMH Regulation by Steroids in the Mammalian Testis: Underlying Mechanisms and Clinical Implications

“…Independently of its physiological role(s), AMH is a proven biomarker of the immature Sertoli cell population in normal and pathological conditions [reviewed in ref ( 36 – 39 )]. Serum AMH reflects the mass of immature Sertoli cells, i.e.…”