Elevated serum anti-Müllerian hormone in adolescents with polycystic ovary syndrome: relationship to ultrasound features

Abstract

Context Serum Anti-Müllerian Hormone (AMH) is linked to the ovarian follicle pool. Little is known about the relationship between serum AMH and ovarian ultrasound (US) features in adolescents with Polycystic Ovary Syndrome (PCOS). Objectives To confirm that serum AMH is elevated in adolescents with PCOS and to correlate serum AMH with ovarian ultrasound features in this population. Design A retrospective chart review of clinical, biochemical, and ultrasonographic data in adolescents with PCOS and normal controls. Serum AMH was measured and compared between groups and correlated with ovarian ultrasound findings. Setting Two urban tertiary academic medical centers. Participants Study groups included 23 adolescent females with PCOS and 12 age and BMI matched female controls. Main Outcome Measures We hypothesized that serum AMH would be elevated in the PCOS group compared with controls and would positively correlate with follicle number, distribution, and ovarian volume. Results Serum AMH was 6.78 +−3.55 ng/mL in the PCOS group versus 3.38 +−1.48 ng/mL in controls (P=0.0004). AMH positively correlated with ovarian volume (left ovary r=0.65, P=0.0007, right ovary r=0.55, P=0.0065) and peripheral follicle distribution (P=0.0027). Ten or more follicles were observed in 83% of ultrasounds. Conclusions There is a positive relationship between serum AMH and ovarian volume as well as peripheral follicular distribution in adolescents with PCOS. Our findings support the use of serum AMH as a useful marker to reflect ovarian ultrasound features typical of PCOS in cases where accurate ultrasounds are not available and for follow up.

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

“…It is not only used to measure ovarian reserve but also reflects the greater number of follicles present in the ovaries with polycystic morphology (PCOm). Serum concentrations of AMH correlate with the antral follicle count and degree of menstrual disturbances (86,87,88). The strong association between AMH and follicle count has led some authors to compare the performance of one against the other for the diagnosis of PCOS.…”

Is ultrasound useful in the diagnosis of adolescents with polycystic ovary syndrome?

“…Four of the seven studies done in adolescents revealed statistically significant differences in ovarian volume between PCOS patients and controls (8, 9, 12, 13). Shah et al and Pawelczak et al revealed that in a cohort of 74 overweight/obese PCOS adolescents, 40% of adolescents had an enlarged ovarian volume (10,14). Ovarian volume was also found to be similar in patients with PCOS and patients with polycystic ovaries but with no clinical manifestations of PCOS (12).…”

“…Overall, nine studies conducted between 2003 and 2013 were identified, and seven were used in this review (8)(9)(10)(11)(12)(13)(14). Two studies were excluded from our analysis because there was a lack of ultrasonographic quantitative data (15,16).…”

“…Silfen et al reported that 100% obese PCOS and 75% non-obese PCOS patients had multiple peripherally oriented ovarian follicles, compared with 31% of controls (11). Shah et al and Pawelczak et al reported that more than 80% of obese adolescent PCOS patients had > 10 follicles located peripherally (10,14). Figure 1 shows the peripherally located follicles in obese and non-obese PCOS adolescents, compared with a normal ovary.…”

“…This was calculated using studies that had both PCOS and control patients (9,11,13). The morphology of ovarian follicles was reported in three of the studies, which showed peripheral and multiple follicles ( > 10) in 83% of cases (10,11,14). Greater levels of androgens, including total and free testosterone, were found in the obese PCOS patients, compared with the controls in four studies (9,11,13,14).…”