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Anti-Müllerian hormone predictive of PCOS

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December 4, 2017


Elevated levels of anti-Müllerian hormone were four times more predictive of polycystic ovary syndrome than serum testosterone or free androgen index in white women, according to findings published in Clinical Endocrinology.

“Currently, PCOS is diagnosed using the Rotterdam, or Androgen Excess Society or NIH criteria, but it still remains a diagnosis to be made only after the exclusion of other conditions,” Stephen L. Atkin, PhD, professor of medicine at Weill Cornell Medicine, Doha, Qatar, and colleagues wrote. “A diagnostic test that would positively identify a patient with PCOS and add value to the current diagnostic criteria would be of great benefit, and anti-Müllerian hormone measurement has been suggested to add value to the Rotterdam criteria.”

The researchers conducted a cross-sectional study of 110 women with PCOS who fulfilled all Rotterdam diagnostic criteria, as well as 65 women without PCOS. The primary outcome was the feasibility of anti-Müllerian hormone for diagnosing PCOS and the relationship of the hormone to metabolic parameters.

Patients with PCOS had increased levels of anti-Müllerian hormone compared with controls (P < .001), the researchers reported. Additionally, anti-Müllerian hormone was predictive of PCOS. A cutoff of 46 pmol/L derived from the 95th percentile of controls demonstrated sensitivity of 41% and specificity of 86%, Atkin and colleagues wrote, while a cutoff of 35 pmol/L showed a sensitivity of 55% and specificity of 79%.

After multiple logistic regression accounting for age and BMI, the researchers reported that anti-Müllerian hormone was more predictive of PCOS than either serum testosterone level (OR = 4.04; 95% CI, 1.42-11.11) or free androgen index (OR = 3.9; 95% CI, 1.4-10.83).

The researchers concluded that though anti-Müllerian hormone has poor sensitivity, it identified an additional 16% or 22% of patients with PCOS using cutoffs of 35 pmol/L or 46 pmol/L, respectively, even when androgen concentrations were not elevated.

“This means there may be merit in considering [anti-Müllerian hormone] as a marker, which complements androgen measurement in the biochemical assessment of PCOS.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.

itj+ Perspective

Corrine Welt, MD

Polycystic ovary syndrome is diagnosed based on two of three criteria: irregular menstrual cycles, hyperandrogenism and polycystic ovary morphology. The third diagnostic criteria requires ultrasound measurement, which can be inconvenient or contraindicated for some women. The use of AMH as a proxy for polycystic ovary morphology documented by ultrasound has been considered, but is not yet accepted.

The study by Sathyapalan and colleagues illustrates the problems. AMH measurements using various cutoffs have only fair diagnostic accuracy and poor sensitivity to predict PCOS, as demonstrated in this study. The overlap in AMH levels between PCOS and control groups remains large. The choice of the control group affects the accuracy of the AMH threshold. As illustrated in this study, using controls with regular menstrual cycles and no hyperandrogenism will result in greater overlap in AMH levels between PCOS and control subjects compared with studies using controls without polycystic ovary morphology on ultrasound.

Although AMH appeared to be an independent predictor of PCOS in this study, AMH would not be used as a sole marker for PCOS; it is one of three criteria and would not be used alone to identify PCOS. Thus, the use of AMH in place of ultrasound-defined polycystic ovary morphology awaits international assay standards and consensus regarding acceptable case and control groups used to define the polycystic ovary morphology -proxy cutoff.

Corrine K. Welt, MD

Professor of Medicine, Division of Endocrinology and Metabolism

Utah Diabetes Center

Disclosure: Welt reports no relevant financial disclosures.