title: Progressive decline of residual follicle pool after clinical diagnosis of autoimmune ovarian insufficiency.
abstract: BACKGROUND
  In approximately 5-8% patients with primary ovarian insufficiency (POI), the disease is caused by an autoimmune process made evident by the appearance of autoantibodies against steroidogenic enzymes (SCA-POI). Anti-müllerian hormone (AMH) is the best marker of the residual follicular pool.
  
  
  OBJECTIVE
  To evaluate the rate of loss of the residual follicle pool in women with SCA-POI after clinical diagnosis.
  
  
  METHODS
  One hundred and thirty-two women with POI were tested for 21-hydroxylase autoantibodies, 17α-hydroxylase autoantibodies and P450scc autoantibodies, and 35 patients with SCA-POI were identified. AMH was analysed at the time of the first visit in all women with POI, and in follow-up, serum samples were taken 1-3 years after in 11 women with SCA-POI and detectable AMH.
  
  
  RESULTS
  12/35 (35%) women with SCA-POI had AMH levels within the normal range at the time of first sampling, as compared to 6/97 (6%) with idiopathic POI (P < 0·001). 11/17 (65%) women with SCA-POI with <6 years disease duration had normal serum AMH concentration. A progressive decline in AMH concentration was observed at longitudinal follow-up in all 11 AMH-positive women with SCA-POI, at an estimated average rate of 1·6 μg/l AMH/year (corresponding to an average 57% of preserved follicle pool/previous year) (R(2)  = 0·219, P = 0·028). After 6 years of disease duration, only 1/18 (6%) women with SCA-POI had detectable levels of AMH, similar to women with idiopathic POI (5/78, 6%).
  
  
  CONCLUSIONS
  Most women with SCA-POI present at clinical diagnosis with a preserved follicle pool that is progressively lost within a few years.
authors.affiliation: Department of Internal Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Falorni
authors.forename: Annalisa
authors.initials: A
authors.lastname: Brozzetti
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Aglietti
authors.forename: Raffaella
authors.initials: R
authors.lastname: Esposito
authors.forename: Viviana
authors.initials: V
authors.lastname: Minarelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Morelli
authors.forename: Emilia
authors.initials: E
authors.lastname: Sbroma Tomaro
authors.forename: Stefania
authors.initials: S
authors.lastname: Marzotti
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000097:blood / Q000276:immunology* / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D012739:Gonadal Steroid Hormones / Q000276:immunology; D006801:Humans; D007265:Inhibins / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D006080:Ovarian Follicle / Q000276:immunology / Q000473:pathology; D016649:Primary Ovarian Insufficiency / Q000097:blood / Q000276:immunology* / Q000473:pathology*; D013997:Time Factors; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D012739:Gonadal Steroid Hormones; C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone