title: Anti-müllerian hormone: a valuable addition to the toolbox of the pediatric endocrinologist.
abstract: Anti-Müllerian hormone (AMH), secreted by immature Sertoli cells, provokes the regression of male fetal Müllerian ducts. FSH stimulates AMH production; during puberty, AMH is downregulated by intratesticular testosterone and meiotic germ cells. In boys, AMH determination is useful in the clinical setting. Serum AMH, which is low in infants with congenital central hypogonadism, increases with FSH treatment. AMH is also low in patients with primary hypogonadism, for instance in Down syndrome, from early postnatal life and in Klinefelter syndrome from midpuberty. In boys with nonpalpable gonads, AMH determination, without the need for a stimulation test, is useful to distinguish between bilaterally abdominal gonads and anorchism. In patients with disorders of sex development (DSD), serum AMH determination helps as a first line test to orientate the etiologic diagnosis: low AMH is indicative of dysgenetic DSD whereas normal AMH is suggestive of androgen synthesis or action defects. Finally, in patients with persistent Müllerian duct syndrome (PMDS), undetectable serum AMH drives the genetic search to mutations in the AMH gene, whereas normal or high AMH is indicative of an end organ defect due to AMH receptor gene defects.
authors.affiliation: INSERM U782, Université Paris-Sud, UMR-S0782, 92140 Clamart, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Josso
authors.affiliation: Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños "R. Gutiérrez", C1425EFD Buenos Aires, Argentina ; Departamento de Histología, Embriología, Biología Celular y Genética, Facultad de Medicina, Universidad de Buenos Aires, C1121ABG Buenos Aires, Argentina.
authors.forename: Rodolfo A
authors.initials: RA
authors.lastname: Rey
authors.affiliation: INSERM U782, Université Paris-Sud, UMR-S0782, 92140 Clamart, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Picard