Endocrine Abstracts

Background: Higher anti-Müllerian hormone (AMH) values are associated with polycystic ovary syndrome (PCOS) and AMH is proposed as a marker of PCOS, however, the optimal diagnostic threshold is not yet defined.

Aim: To study the significant correlations of AMH in PCOS and the accuracy and threshold of AMH for the PCOS diagnosis in Romania.

Subjects and methods: Serum AMH, TT, LH, FSH, fasting glucose and insulin (Ins), HOMA-IR and BMI were analyzed in a cohort of 157 patients with PCOS selected by Rotterdam 2003 criteria and 166 controls, aged 18-35 years, recruited at the National Institute of Endocrinology, Bucharest, Romania. Receiver operator characteristic (ROC) curves were constructed to determine the diagnostic utility of different parameters.

Results: Serum AMH was positively correlated with oligo/amenorrhea (P=0.0034), TT (P=0.0178), LH (P=0.0123), LH/FSH (P=0.0015) and number of antral follicles per ovary (P=0.0011) in PCOS, while BMI (P< -0.0001), fasting-Ins (P= -0.0209) and HOMA-IR (P= -0.0138) were negatively correlated with AMH in these patients. In stepwise linear regressions including as effects LH/FSH, TT, BMI, fasting-Ins or HOMA-IR and age, LH/FSH and BMI remained significant independent predictors of AMH values in PCOS (P=0.0002 and P< -0.0001 respectively). In ROC curve analysis using all population of the study (PCOS and controls), the area under the curve (AUC) for AMH in the diagnosis of PCOS was 0.893 [95% confidence interval (CI): 0.834-0.953; P< 0.0001], with the best compromise between sensitivity and specificity at a cut-off of 32.41 pmol/l (i.e.4.53 ng/ml) (Se=85.06%, Spe=80.65%). The AUCs for TT, LH, LH/FSH, fasting-Ins, HOMA-IR and BMI were 0.773 [95% CI: 0.717-0.830; P< 0.001], 0.736[95% CI: 0.664-0.809; P< 0.0001], 0.788 [95% CI: 0.715-0.862; P< 0.001], 0.669 [95% CI: 0.598-0.741; P=0.0004], 0.615 [95% CI: 0.537-0.694; P=0.005] and 0.612 [95% CI: 0.546-0.678; P=0.001] respectively.

Conclusions: AMH values reflect both reproductive and metabolic dysfunction in PCOS. The optimal AMH threshold for PCOS diagnosis was 32.41 pmol/l (4.53 ng/ml) in the Romanian population of this study. The accuracy of serum AMH in PCOS diagnosis is greater than that of TT, gonadotropins or isulin-resistance quantified by HOMA-IR.