Anti-Müllerian hormone measurement for the diagnosis of polycystic ovary syndrome

Objective: Anti-Müllerian hormone (AMH) is derived from the small antral follicles, and an elevated level has been suggested to add value to the Rotterdam criteria for the diagnosis of PCOS in cases of diagnostic uncertainty. Therefore, the role of AMH in the classical phenotype of PCOS was defined within a Caucasian population. Design: This was a cross-sectional study. Patients: Sixty Five women without PCOS and 110 women with PCOS fulfilling all 3 diagnostic Rotterdam criteria. Measurements: The main outcomes were the utility of serum AMH for the diagnosis of PCOS and its relationship to the metabolic parameters. Results: Anti-Müllerian hormone was increased in PCOS compared to controls (P  < .001). Areas under the receiver operator curve showed AMH to be predictive of PCOS (0.76) using a cut-off AMH of 46 pmol/L, which is derived from the 95 th percentile of the controls that gave a 41% sensitivity and 86% specificity; an AMH cut-off of 35 pmol/L gave a 55% sensitivity and 79% specificity. Age- and BMI-adjusted multiple logistic regression showed that AMH was more predictive of PCOS independently of either serum testosterone (T) (OR = 4.04; 95% CI 1.42-11.11; P =.007) or free androgen index (FAI) (OR = 3.90; 95% CI 1.40-10.83; P =.009). Conclusion: Whilst an elevated AMH has poor sensitivity, it is fourfold more likely to be associated with a diagnosis of PCOS, and supplementary to biochemical parameters will make a positive diagnosis of PCOS in 22% of patients when neither serum testosterone nor FAI is elevated

The Polycystic Ovary Syndrome Quality of Life scale (PCOSQOL): Development and preliminary validation

Polycystic ovary syndrome is an endocrine disorder amongst women, which can negatively impact quality of life. Research proposes that a more sensitive PCOS quality of life measure is needed. This study aims to develop and initially validate a quality of life scale for women with the condition in the United Kingdom. Women with PCOS (n = 714) took part in the development and initial validation of the 35-item polycystic ovary syndrome quality of life scale (PCOSQOL)(α = .95). Subscales include Impact of PCOS (α = .95), Infertility (α = .95), Hirsutism (α = .97) and Mood (α = .89). The PCOSQOL scale represents aspects of quality of life important to women with PCOS and may be more sensitive for use in the clinical and research settings

PCOS remains a diagnosis of exclusion:a concise review of key endocrinopathies to exclude

Polycystic ovarian syndrome (PCOS) is a heterogenous disorder associated with clinical, endocrine and ultrasonographic features that can also be encountered in a number of other diseases. It has traditionally been suggested that prolactin excess, enzymatic steroidogenic abnormalities and thyroid disorders need to be excluded before a diagnosis of PCOS is made. However, there is paucity of data regarding the prevalence of PCOS phenotype in some of these disorders, whereas other endocrine diseases that exhibit PCOS-like features may elude diagnosis and proper management if not considered. This article reviews the data of currently included entities that exhibit a PCOS phenotype and those that potentially need to be looked for, and attempts to identify specific features that distinguish them from idiopathic PCOS

Adiponectin in Women with Polycystic Ovary Syndrome

BACKGROUND: Though adiponectin has been associated with insulin resistance and cardiovascular risk factors, the relationship between adiponectin and polycystic ovary syndrome (PCOS) remains controversial. The aim of this study was to compare adiponectin level in women with PCOS and without PCOS, and to investigate the relationship between adiponectin level and metabolic variables including insulin resistance. METHODS: 60 women with PCOS were enrolled along with a control group of 80 healthy women, matched for age and body mass index (BMI). We measured hormonal and metabolic parameters, as well as the plasma adiponectin concentration of each participant. We estimated the insulin sensitivity according to the quantitative insulin sensitivity check index (QUICKI). RESULTS: The PCOS group displayed significantly lower level of adiponectin (P < 0.001) after adjustment for age, BMI, mean blood pressure, fasting glucose, fasting insulin, and several metabolic parameters. Adiponectin levels were positively correlated with QUICKI in the PCOS group (P < 0.001) and the control group (P = 0.03). Following step-wise multiple regression analysis, however, adiponectin level was positively correlated with QUICKI in the control group only (P = 0.03). In addition, adiponectin level was found to be independently associated with HDL-cholesterol level (P < 0.001) and BMI (P = 0.02) in the PCOS group and independently associated with HDL-cholesterol (P = 0.02) in the control group. CONCLUSION: We report decreased adiponectin level in PCOS patients in relation to controls independently of insulin resistance or other metabolic factors. And adiponectin is associated with both lipid metabolism and obesity, which, in turn, is related to insulin resistance in PCOS. Further studies are needed to clarify the mechanism of adiponectin in PCOS.ope

Anti-Mullerian hormone: correlation with testosterone and oligo- or amenorrhoea in female adolescence in a population-based cohort study

Study questions: Can serum anti-Müllerian hormone (AMH) levels measured in female adolescents predict polycystic ovary syndrome (PCOS)-associated features in adolescence and early adulthood? Summary answer: AMH levels associated well with PCOS-associated features (such as testosterone levels and oligoamenorrhoea) in adolescence, but was not an ideal marker to predict PCOS-associated features in early adulthood. What is known already: Several studies have reported that there is a strong correlation between antral follicle count and serum AMH levels and that women with PCOS/PCO have significantly higher serum AMH levels than women with normal ovaries. Other studies have reported an association between AMH serum levels and hyperandrogenism in adolescence, but none has prospectively assessed AMH as a risk predictor for developing features of PCOS during adulthood. Study design, size, duration: A subset of 400 girls was selected from the prospective population-based Northern Finland Birth Cohort 1986 (n = 4567 at age 16 and n = 4503 at age 26). The population has been followed from 1986 to the present. Participants/material, setting, methods: At age 16, 400 girls (100 from each testosterone quartile: 50 with oligo- or amenorrhoea and 50 with a normal menstrual cycle) were selected at random from the cohort for AMH measurement. Metabolic parameters were also assessed at age 16 in all participants. Postal questionnaires enquired about oligo- or amenorrhoea, hirsutism, contraceptive use and reproductive health at ages 16 and 26. Main results and role of chance: There was a significant correlation between AMH and testosterone at age 16 (r = 0.36, P < 0.001). AMH levels at age 16 were significantly higher among girls with oligo- or amenorrhoea compared with girls with normal menstrual cycles (35.9 pmol/l [95% CI: 33.2;38.6] versus 27.7 pmol/l [95% CI: 25.0;30.4], P < 0.001). AMH at age 16 was higher in girls who developed hirsutism at age 26 compared with the non-hirsute group (31.4 pmol/l [95% CI 27.1;36.5] versus 25.8 pmol/l [95% CI 23.3;28.6], P = 0.036). AMH at age 16 was also higher in women with PCOS at age 26 compared with the non-PCOS subjects (38.1 pmol/l [95% CI 29.1;48.4] versus 30.2 pmol/l [95% CI 27.9;32.4], P = 0.044). The sensitivity and specificity of the AMH (cut-off 22.5 pmol/l) for predicting PCOS at age 26 was 85.7 and 37.5%, respectively. The addition of testosterone did not significantly improve the accuracy of the test. There was no significant correlation between AMH levels and metabolic indices at age 16. Implications, reasons for cauntion: AMH is related to oligo- or amenorrhoea in adolescence, but it is not a good marker for metabolic factors. The relatively low rate of participation in the questionnaire at age 26 may also have affected the results. AMH was measured in a subset of the whole cohort. AMH measurement is lacking international standardization and therefore the concentrations and cut-off points are method dependent. Wider implications for the findings: Using a high enough cut-off value of AMH to predict which adolescents are likely to develop PCOS in adulthood could help to manage the condition from an early age due to a good sensitivity. However, because of its low specificity, it is not an ideal diagnostic marker, and its routine use in clinical practice cannot, at present, be recommended