Primary ovarian insufficiency due to steroidogenic cell autoimmunity is associated with a preserved pool of functioning follicles.
BACKGROUND
Primary ovarian insufficiency (POI) is defined as hypergonadotropic amenorrhea before the age of 40 yr. In 4-5% of patients with POI, an ovarian autoimmune process is present.


METHODS
Serum concentrations of antimüllerian hormone (AMH) have been determined in 26 women with POI due to steroidogenic cell autoimmunity (SCA-POI), 66 with nonautoimmune idiopathic POI (iPOI), 40 postmenopausal women (PMW), and 44 healthy fertile women (HW). SCA-POI was diagnosed according to presence of steroidogenic enzyme autoantibodies (17alpha-hydroxylase, side chain cleavage, and 21-hydroxylase autoantibodies).


RESULTS
AMH concentrations were significantly higher in women with SCA-POI than women with iPOI (P = 0.018) or PMW (P = 0.03) but significantly lower than HW (P < 0.0001). AMH was detected in 11 of 26 women with SCA-POI (42%) and seven of 66 with iPOI (11%) (P = 0.002). Serum concentrations above the fifth percentile of the normal range (0.6 ng/ml) were detected in nine of 26 women with SCA-POI (35%) and four of 66 with iPOI (6%) (P = 0.001). Eight of 12 women with SCA-POI with less than 5 yr (67%) and one of 14 with longer disease duration (7%) had AMH concentrations within the normal range (P = 0.003). AMH concentrations correlated inversely with disease duration in women with SCA-POI (rho = -0.563, P = 0.003) but not women with iPOI. AMH correlated inversely with FSH serum concentrations in HW (rho = -0.584, P < 0.001) but not PMW or women with POI.


CONCLUSIONS
Two thirds of women with recent-onset SCA-POI had normal AMH concentrations. Women with SCA-POI, differently from those with iPOI, present a preserved ovarian follicle pool for several years after diagnosis of ovarian insufficiency.
La Marca
Antonio
A
Mother-Infant Department, Section of Obstetrics and Gynecology, University of Modena and Reggio Emilia, 41100 Modena, Italy.
Marzotti
Stefania
S
Brozzetti
Annalisa
A
Stabile
Gaspare
G
Artenisio
Alfredo Carducci
AC
Bini
Vittorio
V
Giordano
Roberta
R
De Bellis
Annamaria
A
Volpe
Annibale
A
Falorni
Alberto
A
D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000276:immunology; D000704:Analysis of Variance; D054304:Anti-Mullerian Hormone / Q000097:blood; D001323:Autoantibodies / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D012739:Gonadal Steroid Hormones / Q000097:blood* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D007265:Inhibins / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D008875:Middle Aged; D006080:Ovarian Follicle / Q000276:immunology / Q000378:metabolism*; D016649:Primary Ovarian Insufficiency / Q000276:immunology*; D011863:Radioimmunoassay; D055815:Young Adult
D001323:Autoantibodies; D012739:Gonadal Steroid Hormones; C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone