title: Polycystic Ovary-Like Abnormalities (PCO-L) in women with functional hypothalamic amenorrhea.
abstract: BACKGROUND
  In the general population, about 30% of asymptomatic women have polycystic ovary-like abnormalities (PCO-L), i.e. polycystic ovarian morphology (PCOM) at ultrasound and/or increased anti-Müllerian hormone (AMH) serum level. PCOM has also been reported in 30-50% of women with functional hypothalamic amenorrhea (FHA).
  
  
  OBJECTIVE
  The aim of this study was to verify whether both PCOM and excessive AMH level indicate PCO-L in FHA and to elucidate its significance.
  
  
  METHODS
  We conducted a retrospective analysis using a database and comparison with a control population.
  
  
  METHODS
  Subjects received ambulatory care in an academic hospital.
  
  
  METHODS
  Fifty-eight patients with FHA were compared to 217 control women with nonendocrine infertility and body mass index of less than 25 kg/m(2).
  
  
  METHODS
  There were no interventions.
  
  
  METHODS
  We measured serum testosterone, androstenedione, FSH, LH, AMH, and ovarian area values. The antral follicle count (AFC) was used as a binary variable (i.e. negative or positive) because of the evolution of its sensitivity over the time of this study. The ability of these variables (except AFC) to detect PCO-L in both populations was tested by cluster analysis.
  
  
  RESULTS
  One cluster (cluster 2) suggesting PCO-L was detected in the control population (n = 52; 24%), whereas two such clusters were observed in the FHA population (n = 22 and n = 6; 38 and 10%; clusters 2 and 3, respectively). Cluster 2 in FHA had similar features of PCO-L as cluster 2 in controls, with higher prevalence of positive AFC (70%) and PCOM (70%), higher values of ovarian area and higher serum AMH (P < 0.0001 for all), and testosterone levels (P < 0.01) than in cluster 1. Cluster 3 in FHA was peculiar, with frankly elevated AMH levels. In the whole population (controls + FHA), PCO-L was significantly associated with lower FSH values (P < 0.0001).
  
  
  CONCLUSIONS
  PCO-L in FHA is a frequent and usually incidental finding of unclear significance, as in controls. The association of PCO-L with hypothalamic amenorrhea should not lead to a mistaken diagnosis of PCOS.
authors.affiliation: Department of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, 59037 Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Robin
authors.forename: C
authors.initials: C
authors.lastname: Gallo
authors.forename: S
authors.initials: S
authors.lastname: Catteau-Jonard
authors.forename: C
authors.initials: C
authors.lastname: Lefebvre-Maunoury
authors.forename: P
authors.initials: P
authors.lastname: Pigny
authors.forename: A
authors.initials: A
authors.lastname: Duhamel
authors.forename: D
authors.initials: D
authors.lastname: Dewailly
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000097:blood* / Q000000981:diagnostic imaging; D000735:Androstenedione / Q000097:blood; D054304:Anti-Mullerian Hormone / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007027:Hypothalamic Diseases / Q000097:blood* / Q000000981:diagnostic imaging; D007986:Luteinizing Hormone / Q000097:blood; D010053:Ovary / Q000000981:diagnostic imaging*; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000000981:diagnostic imaging; D013739:Testosterone / Q000097:blood; D014463:Ultrasonography
chemical_list: D013739:Testosterone; D000735:Androstenedione; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone