Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome
| Autor: | Tiphaine Lefebvre, Geoffroy Robin, Pascal Pigny, Alice Fraissinet, Sophie Catteau-Jonard, Didier Dewailly |
|---|---|
| Přispěvatelé: | Gamétogenèse et Qualité du Gamète - ULR 4308 (GQG), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Mucines Epitheliales : du Gene a la Fonction, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Laboratoire d'Ecologie Alpine (LECA ), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Hôpital Jeanne de Flandre [Lille], Service d'endocrinologie, gynécologie et médecine de la reproduction |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Anti-Mullerian Hormone
0301 basic medicine endocrine system diseases diagnosis hyperandrogenism 0302 clinical medicine AMH PCOS Medicine Ultrasonography education.field_of_study 030219 obstetrics & reproductive medicine biology ultrasound Rehabilitation Obstetrics and Gynecology Anti-Müllerian hormone oligo-anovulation Polycystic ovary Phenotype female genital diseases and pregnancy complications 3. Good health Female Adult medicine.medical_specialty Population polycystic ovarian morphology Young Adult 03 medical and health sciences Follicle Internal medicine Humans education Retrospective Studies Gynecology business.industry Ovary Hyperandrogenism Retrospective cohort study [SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology medicine.disease PCOM 030104 developmental biology Endocrinology anti-Müllerian hormone Reproductive Medicine polycystic ovary syndrome biology.protein business Hormone |
| Zdroj: | Human Reproduction Human Reproduction, 2017, 32 (8), pp.1716-1722. ⟨10.1093/humrep/dex239⟩ Human Reproduction, Oxford University Press (OUP), 2017, 32 (8), pp.1716-1722. ⟨10.1093/humrep/dex239⟩ |
| ISSN: | 0268-1161 1460-2350 |
| Popis: | STUDY QUESTION Does the use of the serum anti-Mullerian hormone (AMH) assay to replace or complement ultrasound (U/S) affect the diagnosis or phenotypic distribution of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Combining U/S and the serum AMH assay to define polycystic ovarian morphology (PCOM) diagnoses PCOS (according to the Rotterdam classification) in more patients than definitions using one or the other of these indicators exclusively. WHAT IS KNOWN ALREADY Since 2003, PCOM, as defined by U/S, is one of the three diagnostic criteria for PCOS. As it is closely correlated with follicle excess seen at U/S, an excessive serum AMH level could be used as a surrogate for PCOM. STUDY DESIGN, SIZE, DURATION Single-center retrospective study from a database of prospectively collected clinical, laboratory and ultrasound data from patients referred for oligo-anovulation (OA) and/or hyperandrogenism (HA) between January 2009 and January 2016. PARTICIPANTS/MATERIALS, SETTING, METHOD The standard Rotterdam classification for PCOS was tested against two modified versions that defined PCOM by either excessive serum AMH level alone (AMH-only) or a combination (i.e. 'and/or') of the latter and U/S. The PCOS phenotypes were defined as A (full phenotype, OA+HA+PCOM), B (OA+HA), C (HA+PCOM) and D (OA+PCOM). MAIN RESULTS AND THE ROLE OF CHANCE PCOS was more frequently diagnosed when PCOM was defined as the combination 'positive U/S' and/or 'positive AMH' (n = 639) than by either only U/S-only (standard definition, n = 612) or by AMH-only (n = 601). With this combination, PCOM was recognized in 637 of the 639 cases that met the Rotterdam classification, and phenotype B practically disappeared. In this population, U/S and AMH markers were discordant for PCOM in 103 (16.1%) cases (9% U/S-only, 7.1% AMH-only, P = 0.159). The markers used had no other significant impact on the phenotypic distribution (except for phenotype B). However, the percentage of cases positive by U/S-only was significantly higher in phenotype D than in phenotype A (14.1% vs. 5.8%, P < 0.05). Furthermore, in the discordant cases, plasma LH levels were significantly higher in the AMH-only group than in the concordant cases, and fasting insulin serum levels tended to be higher in the U/S-only group. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study. A referral bias explains the relatively high proportion of patients with phenotype D (28%). PCOM was defined by in-house thresholds. The AMH assay used is no longer commercially available. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that ideally both U/S data and serum AMH level should be integrated to define PCOM in the Rotterdam classification. In a cost-effectiveness approach, the choice of one or the other has little impact on the diagnosis and the phenotyping of PCOS. STUDY FUNDING/COMPETING INTEREST(S) No external funding. The authors have no conflict of interest to declare. |
| Databáze: | OpenAIRE |
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