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

Abstract

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.