Anti-Mullerian hormone (AMH) is produced by the ovarian granulosa cells in immature follicles from around week 36 of gestation to the menopause. Expression is highest in pre-antral and early antral follicles. AMH has a generally inhibitory effect on early follicle development and possibly on the responsiveness of growing follicles to FSH. Serum AMH is markedly elevated in women with PCOS and increased concentrations have also been reported in the healthy prepubertal daughters of PCOS mothers, suggesting that AMH may be a marker of developing ovarian follicles from an early age. In view of the reported association between adrenarche and functional ovarian hyperandrogenism, we measured serum AMH in girls with exaggerated adrenarche and compared them with normative data.
Serum AMH (pmol/L) was measured by immunoassay (DSL Elisa) in 25 girls with clinical signs of exaggerated adrenarche [median (range) age 8.1 (6.08.9) years] recruited into a Scottish multicentre adrenarche study. Values were compared with a cross-sectional age-related reference range for AMH established in Glasgow.
Median AMH in the girls with exaggerated adrenarche was 15.1 pmol/L, significantly higher than found in 58 year-old girls who did not exhibit symptoms (n=18; median AMH 5.0 pmol/L; P=0.003; 95% CI 3.90,13.20). A weak negative correlation was found between AMH and FSH.
(r=−0.264) and between AMH and DHAS (r=−0.372) in the girls with adrenarche. Interestingly, the AMH concentration in the adrenarche group was similar to that found in the early pubertal age group (912 yr) in the reference range (n=32; median AMH 15.7 pmol/L; P=0.859; 95% CI 9.00, 5.00).
The early rise in AMH in girls with exaggerated adrenarche implies that follicular development has proceeded to more advanced developmental stages than normal. While the nature of the relationship with the increased androgen environment remains to be determined, these early events might be related to later development of PCOS.