Abstract
Background: PCOS affects 5-15% of females of reproductive age and frequently manifests in adolescence. One of its diagnostic criteria is presence of polycystic ovary morphology (PCOM); however, this criterion is based on adult data obtained by transvaginal ultrasound thus may not be relevant to younger patients. AMH represents an alternative marker for PCOM as it is produced by preantral ovarian granulosa cells, which are increased in this condition. This study uses MRI, a noninvasive and accurate method, to determine FC and OV in young patients with PCOS and controls. Aims: 1. To determine if AMH is different in PCOS compared to controls; 2. To examine the relationship between AMH and FC and OV by MRI in PCOS and controls; 3. To determine the relationship between AMH and androgens and insulin resistance in PCOS and controls. Methods: Healthy nonobese adolescents and young adults with PCOS (n=12) and controls (n=12), (mean age 19.7 ± 3.2 years, BMI 23.1 ± 3.2 kg/m2) participated. Labs after an overnight fast included AMH, LH, FSH, estradiol, total and free testosterone, androstenedione, DHEAS, and a 2h OGTT with glucose and insulin levels. HOMA-IR and insulin area under the curve (iAUC) were calculated. Whole body dual-energy x-ray absorptiometry (DXA) scan for percentage body fat (%BF) and ovarian MRI for OV and FC were obtained. Results: Compared to controls, PCOS had higher AMH (10.7 ± 5.8 vs 5.0 ± 2.5 ng/mL. Reference range: 1.05-12.86 ng/mL), total and free testosterone, androstenedione and DHEAS (P<0.003 for all). HOMA-IR, iAUC , BMI and %BF were similar between the groups. AMH correlated with total testosterone (r=0.66, p<0.03) and to FC (r=0.88, p=0.0002), but not with free testosterone, androstenedione, DHEA-S, LH, HOMA-IR, iAUC or OV by MRI. Conclusions: In this small study of young and nonobese patients, AMH was higher in PCOS than controls and highly correlated with FC using ovarian MRI and to testosterone levels. These findings support the use of AMH as a minimally invasively additional marker to assist in the diagnosis of PCOS.
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