Abstract
BackgroundHigh anti-Müllerian hormone (AMH) levels and 25-hydroxyvitamin D [25(OH)D] deficiency have been associated with polycystic ovarian syndrome (PCOS) in adult women, and implicated in its pathogenesis. Herein we determined if the level of both AMH and 25(OH)D are altered in adolescent females with clinical features of PCOS.MethodsThis is a cross-sectional study utilizing a retrospective chart review of 128 patients aged 12–20 referred to an academic adolescent gynecology and endocrinology clinic for an evaluation of suspected PCOS. Unadjusted comparisons of AMH and 25(OH)D distributions between subjects with and without PCOS were performed using the Wilcoxon Rank Sum test. Quantile regression was used to compare the median AMH and 25(OH)D between subject groups; adjusting for race, ethnicity, BMI, insurance type, age, and season when bloodwork was performed.ResultsSeventy-four subjects were classified as having PCOS by meeting ≥2 of the three Rotterdam diagnostic criteria, and 47 subjects met only one Rotterdam diagnostic criteria, and were used as the comparative non-PCOS group. There were statistically significant unadjusted differences in median levels of AMH and 25(OH)D. In the adjusted analyses, median AMH was significantly higher in the PCOS group compared to the non-PCOS group (+ 2.39 ng/mL, 95% CI 0.43, 4.35, p = 0.018); 25(OH)D was significantly lower in the PCOS group (− 9.01 ng/mL, 95% CI -14.49, − 3.53 p = 0.001). In our sample, adolescents in both groups had insufficient 25(OH)D level (22 ng/mL) and elevated BMI (32.2 kg/m2).ConclusionsAdolescents with PCOS display high levels of AMH and low 25(OH)D levels. Since traditional clinical markers of PCOS may be physiologic in adolescents, AMH and 25(OH)D may be used as surrogate markers of PCOS risk in adolescents.
Highlights
High anti-Müllerian hormone (AMH) levels and 25-hydroxyvitamin D [25(OH)D] deficiency have been associated with polycystic ovarian syndrome (PCOS) in adult women, and implicated in its pathogenesis
Study population Out of 128 patients who were referred to Adolescent gynecology and endocrinology clinic (AGEC) with concern for PCOS, 7 patients presented within 2 years of menarche and were excluded [46]
Patient demographic information was compared between the PCOS and non-PCOS groups as a whole, and between patients who had AMH and 25(OH)D results and those who did not, to check for systematic selection bias due to missing data in the primary outcomes (Table 1)
Summary
High anti-Müllerian hormone (AMH) levels and 25-hydroxyvitamin D [25(OH)D] deficiency have been associated with polycystic ovarian syndrome (PCOS) in adult women, and implicated in its pathogenesis. Diagnosis of polycystic ovarian syndrome (PCOS) in the adolescent population remains imprecise. The Rotterdam criteria use ovarian volume greater than 10 mL or more than 12 follicles on an ovary using a vaginal transducer, adolescents have been noted to have greater ovarian volumes and follicular counts than adult women, and it is not recommended to perform vaginal ultrasound on this population [6, 10, 11]. 35% of an unselected adolescent population had polycystic ovarian appearance [6]. Recent guidelines recommend against using ultrasound at all in adolescents for diagnosis of PCOS until 8 years post-menarche [5]. Similar to adult women, we know that larger ovaries and higher antral follicle counts in adolescents are associated with elevated androgens [13]
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