Anti-Müllerian hormone confirms the novel classification of female functional androgenization including polycystic ovary syndrome

Abstract

Objective: Functional androgenization (FA) can be divided into five groups corresponding to the predominant organ pathology as recently shown by our group: functional cutaneous androgenization (FCA, skin) and FA syndrome (FAS) I (ovary, lean individual), II (adrenal gland), III (ovary, fat tissue, pancreas, and hyperinsulinemia), and IV (residual FA dysfunctions). Group-specific clusters are based on primary variables such as LH, testosterone, DHEAS, sex hormone-binding globulin (SHBG), body mass index (BMI), glucose, insulin, and enlarged polyfollicular ovaries. Because anti-Mü llerian hormone (AMH) positively correlates with the antral follicle count, its relevance as an additional primary variable for classifying FA was investigated. Design: In this study, 178 patients with FA were consecutively enrolled and classified into the five FA groups as described earlier and 30 women with regular menstrual cycles served as control. Methods: Primary variables and serum AMH were analyzed in the early follicular phase. Results: FA patients showed significantly elevated AMH levels (11.1G6.7 ng/ml) versus control (3.0G2.0 ng/ml; P!.0001). AMH was significantly increased in groups FAS I (15.6G5.8 ng/ml) and FAS III (11.6G6.6 ng/ml) compared with groups FCA (7.0G3.8 ng/ml), FAS II (5.05G3.0 ng/ml), and FAS IV (6.9G4.6 ng/ml) and correlated positively (P!.0001) with LH (rZ0.538) and testosterone (rZ0.368). In regression and multivariate analyses, AMH was not dependent on SHBG, DHEAS, BMI, glucose, or insulin. In receiver operating characteristic analysis, 9.21 ng/ml AMH showed 90% specificity with 71.2% sensitivity for the diagnosis of the two ovarian FA groups, FAS I and III. Conclusion: AMH confirms the novel stratification system and constitutes a useful primary variable in the algorithm of FA classification.

An 1 h-OGLT is an Appropriate Approach for the Determination of Glucose and Insulin Dynamics in Female Functional Androgenization (Including “Polycystic Ovary Syndrome”)

“…Anthropometric and basic endocrinological parameters of FA patients and controls necessary for FAS classification are shown in table 1 and were already described earlier [1,2]. Levels of 17-OH-P were not in The different prevalences of values above the respective cut-off levels (s. "Definitions") of insulin and glucose regarding HOMA-IR [11,13], OGLT [13], AUC 2h insulin [14], and ISI [12,20] in groups FAS II-IV are shown in figure 1.…”

“…In the FAS classification system presented, group FAS I comprises lean patients with ovarian hypertestosteronemia caused by EPOs without metabolic dysfunctions (Tables 1 and 2); this group corresponds in principle to the first RC group "PCOS without MetS" [4]. On the opposite, group FAS III is characterized by anthropometric, ovarian, pituitarian, fat-tissue-allocated, pancreatic and hepatic pathologies; the ovarian dysfunction which appears to be equivalent to that of FAS I [1,2] is merely a part of the overall pathogenesis resembling the second RC-group "PCOS with MetS" [4]. The majority of FAS IV patients depict a feature markedly overlapping with that of FAS III, however, the ovaries is in the normal range or even small and oligofollicular; consequently, circulating T shows normal levels [3].…”

“…Ultrasonography of the ovaries using a vaginal ultrasound probe (Sonoline SI 200, Siemens, München/Germany; Logiq 200 Pro Series, General Electrics, Solingen/Germany; Sonoace SA 8000, Marl/ Germany) was performed at the time of blood sampling and was described before [1,2]. Briefly, an EPO corresponds to the so called "polycystic ovary" ("PCO") [4,5] and was defined by a maximum (max.)…”

“…As described previously [1,2], functional androgenization (FA) consists of 5 groups corresponding to their predominant organ pathology: functional cutaneous androgenization (FCA; skin), functional androgenization syndrome (FAS) I (ovary), II (adrenal gland), III (ovary, obese tissue, pancreas, liver) and IV (residual FA dysfunctions). This systematic classification of FCA and FAS I -III is based on different, strictly determined, group specific variable clusters consisting of primary variables like cutaneous androgenization, body mass index (BMI), luteinizing hormone (LH), testosterone (T), sex hormone-binding globulin (SHBG), free androgen index (FAI), anti-Müllerian hormone (AMH), enlarged polyfollicular ovaries (EPO), dehydroepiandrosterone-sulphate (DHEAS), 17-hydroxyprogesterone (17-OH-P) and an oral glucose loading test (OGLT) including the determination of both glucose and insulin [1].…”

The relation between serum anti-Mullerian hormone levels and follicle count in polycystic ovary syndrome

“…In the metaanalysis conducted by Pepe et al [16], an AMH cutoff value of 4.7 ng/ml was determined to distinguish healthy women from PCOS patients. Additionally, AMH shows different PCOS phenotypes of varied severity [12,13,17,18]. Koninger et al [19] compared the diagnostic potency of AMH with sonographic views of ovaries, ovarian volume, testosterone, androstenedione, luteinizing hormone (LH), and the LH/FSH ratio for the purpose of establishing the age-dependency of AMH.…”