Serum Anti-Müllerian Hormone Concentrations Are Elevated in Oligomenorrheic Girls Without Evidence of Hyperandrogenism

Abstract

Circulating levels of anti-Mullerian hormone (AMH) have significantly increased in adolescent girls with polycystic ovary syndrome (PCOS) compared with that of normal girls. This is consistent with findings in adult PCOS and normal women. Previous studies in both adolescent girls and women with PCOS have shown a close correlation of circulating AMH levels to the antral follicle count, and it has been proposed that serum AMH may be a useful biological marker for the presence of PCOS. Adolescent girls with oligomenorrhea (OLIGO) without evidence of hyperandrogenism may show increased pulsatile LH secretion similar to girls with PCOS. Without ovarian imaging studies and in the absence of hyperandrogenism, it is unclear whether girls with OLIGO fulfill the criteria for diagnosis of PCOS. A finding of elevated AMH serum levels in adolescent girls with OLIGO would be strongly suggestive of PCOS. No studies are available comparing serum AMH concentrations among adolescent girls with PCOS or OLIGO without evidence of hyperandrogenism. This prospective study compared serum AMH levels in adolescent girls with OLIGO, PCOS, or regular menstrual cycles (normal controls). The comparison groups were comprised of 24 girls with OLIGO who had no evidence of hyperandrogenism, 153 girls with PCOS, and 39 normal controls, as well as 73 women with PCOS, and 36 normal adult women. Baseline blood samples were drawn on an arbitrary day in girls with OLIGO and PCOS, and from the early to mid-follicular phase of the menstrual cycle in adolescent normal controls. Blood samples were obtained similarly in adult women. There was no significant difference in the basal serum AMH levels of adolescent girls with OLIGO (5.33 ± 0.47 ng/mL) or PCOS (5.28 ± 0.26 ng/mL) girls or PCOS adults (6.36 ± 0.47 ng/mL). Similarly, there was no significant difference between normal control adolescents (3.05 ± 0.31 ng/mL) and normal control adults (2.33 ± 0.22 ng/mL). AMH levels were significantly lower among obese adolescents and PCOS women compared with lean controls (P < 0.02 for each comparison). These findings suggest that adolescent girls with OLIGO have elevated antral follicle number similar to adolescents with PCOS, which is suggestive for diagnosis of PCOS.