AMH as Predictor of Premature Ovarian Insufficiency: A Longitudinal Study of 120 Turner Syndrome Patients

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Stine Aa Lunding, Lise Aksglæde, Richard A Anderson, Katharina M Main, Anders Juul, Casper P Hagen, Anette T Pedersen

CONTEXT: The majority of Turner syndrome (TS) patients suffer from accelerated loss of primordial follicles. Low circulating levels of anti-Müllerian hormone (AMH) may predict the lack of spontaneous puberty in prepubertal girls and imminent premature ovarian insufficiency (POI) in TS women with preserved ovarian function.

OBJECTIVES: To evaluate the association between circulating AMH and ovarian status in TS patients.

DESIGN: Longitudinal observational cohort study.

SETTING: Tertiary referral center for pediatric and gynecologic endocrinology.

PARTICIPANTS: A total of 120 TS patients, aged 0 to 48 years.

MAIN OUTCOME MEASURES: Longitudinal measurements of AMH, FSH, LH, estradiol, and inhibin B according to age, karyotype (45,X; 45,X/46,XX mosaicism; miscellaneous karyotypes), and ovarian status (group 0, prepubertal; group 1, never ovarian function; group 2, ongoing ovarian function; and group 3, loss of ovarian function).

RESULTS: Ovarian status was highly associated with the TS karyotype: spontaneous puberty—45,X (three of 44 patients), 45,X/46,XX (15 of 17), miscellaneous (17 of 42); and POI—45,X (three of three), 45,X/46,XX (one of 15), and miscellaneous (eight of 17). AMH was associated with ovarian status (eg, group 1, <2 pmol/L; vs group 2, 19 pmol/L; P < .001). AMH < 4 pmol/L (corresponding to <-2 SD) predicted absent puberty in prepubertal girls and POI in adolescent and adult patients.

CONCLUSION: The majority of women with mosaic karyotype 45,X/46,XX had ongoing ovarian function in early adulthood. AMH < -2 SD predicted failure to enter puberty in young TS girls and imminent POI in adolescent and adult TS patients.

Original languageEnglish
JournalJournal of Clinical Endocrinology and Metabolism
Volume100
Issue number7
Pages (from-to)E1030-8
Number of pages9
ISSN0021-972X
DOIs
Publication statusPublished - Jul 2015

    Research areas

  • Adolescent, Adult, Anti-Mullerian Hormone, Biomarkers, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Longitudinal Studies, Middle Aged, Primary Ovarian Insufficiency, Prognosis, Turner Syndrome, Young Adult

ID: 160446658