title: Anti-Müllerian hormone: correlation with testosterone and oligo- or amenorrhoea in female adolescence in a population-based cohort study.
abstract: OBJECTIVE
  Can serum anti-Müllerian hormone (AMH) levels measured in female adolescents predict polycystic ovary syndrome (PCOS)-associated features in adolescence and early adulthood?
  
  
  CONCLUSIONS
  AMH levels associated well with PCOS-associated features (such as testosterone levels and oligoamenorrhoea) in adolescence, but was not an ideal marker to predict PCOS-associated features in early adulthood.
  
  
  BACKGROUND
  Several studies have reported that there is a strong correlation between antral follicle count and serum AMH levels and that women with PCOS/PCO have significantly higher serum AMH levels than women with normal ovaries. Other studies have reported an association between AMH serum levels and hyperandrogenism in adolescence, but none has prospectively assessed AMH as a risk predictor for developing features of PCOS during adulthood.
  
  
  METHODS
  A subset of 400 girls was selected from the prospective population-based Northern Finland Birth Cohort 1986 (n = 4567 at age 16 and n = 4503 at age 26). The population has been followed from 1986 to the present.
  
  
  METHODS
  At age 16, 400 girls (100 from each testosterone quartile: 50 with oligo- or amenorrhoea and 50 with a normal menstrual cycle) were selected at random from the cohort for AMH measurement. Metabolic parameters were also assessed at age 16 in all participants. Postal questionnaires enquired about oligo- or amenorrhoea, hirsutism, contraceptive use and reproductive health at ages 16 and 26.
  
  
  RESULTS
  There was a significant correlation between AMH and testosterone at age 16 (r = 0.36, P < 0.001). AMH levels at age 16 were significantly higher among girls with oligo- or amenorrhoea compared with girls with normal menstrual cycles (35.9 pmol/l [95% CI: 33.2;38.6] versus 27.7 pmol/l [95% CI: 25.0;30.4], P < 0.001). AMH at age 16 was higher in girls who developed hirsutism at age 26 compared with the non-hirsute group (31.4 pmol/l [95% CI 27.1;36.5] versus 25.8 pmol/l [95% CI 23.3;28.6], P = 0.036). AMH at age 16 was also higher in women with PCOS at age 26 compared with the non-PCOS subjects (38.1 pmol/l [95% CI 29.1;48.4] versus 30.2 pmol/l [95% CI 27.9;32.4], P = 0.044). The sensitivity and specificity of the AMH (cut-off 22.5 pmol/l) for predicting PCOS at age 26 was 85.7 and 37.5%, respectively. The addition of testosterone did not significantly improve the accuracy of the test. There was no significant correlation between AMH levels and metabolic indices at age 16.
  AMH is related to oligo- or amenorrhoea in adolescence, but it is not a good marker for metabolic factors. The relatively low rate of participation in the questionnaire at age 26 may also have affected the results. AMH was measured in a subset of the whole cohort. AMH measurement is lacking international standardization and therefore the concentrations and cut-off points are method dependent.
  
  
  CONCLUSIONS
  Using a high enough cut-off value of AMH to predict which adolescents are likely to develop PCOS in adulthood could help to manage the condition from an early age due to a good sensitivity. However, because of its low specificity, it is not an ideal diagnostic marker, and its routine use in clinical practice cannot, at present, be recommended.
  The study was funded by a grant from Wellcome Trust (089549/Z/09/Z) to H.L., S.F. and M.-R.J. Study funding was also received from Oulu University Hospital Research Funds, Sigrid Juselius Foundation and the Academy of Finland. None of the authors have any competing interest to declare.
authors: Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, Oulu, Finland.
authors: P
authors: P
authors: Pinola
authors: Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, Oulu, Finland lmp@cc.oulu.fi.
authors: L C
authors: LC
authors: Morin-Papunen
authors: Department of Children and Young People and Families, National Institute for Health and Welfare, Aapistie 1, Box 310, FI-90101 Oulu, Finland.
authors: A
authors: A
authors: Bloigu
authors: NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland.
authors: K
authors: K
authors: Puukka
authors: NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland.
authors: A
authors: A
authors: Ruokonen
authors: Department of Children and Young People and Families, National Institute for Health and Welfare, Aapistie 1, Box 310, FI-90101 Oulu, Finland Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Institute of Health Sciences, University of Oulu, PO Box 5000, FI-90014 Oulu, Finland Biocenter Oulu, University of Oulu, Aapistie 5A, PO Box 5000, FI-90014 Oulu, Finland Unit of Primary Care, Oulu University Hospital, Kajaanintie 50, PO Box 20, FI-90220 Oulu, 90029 OYS, Finland.
authors: M-R
authors: MR
authors: Järvelin
authors: Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.
authors: S
authors: S
authors: Franks
authors: Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, Oulu, Finland Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
authors: J S
authors: JS
authors: Tapanainen
authors: Department of Human Metabolism, University of Sheffield, Jessop Wing, Sheffield, UK.
authors: H
authors: H
authors: Lashen
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D000328:Adult; D000568:Amenorrhea / Q000097:blood*; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005387:Finland; D006801:Humans; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis* / Q000378:metabolism; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood*
chemical_list: D015415:Biomarkers; D013739:Testosterone; D054304:Anti-Mullerian Hormone
keywords: AMH; PCOS; female adolescence; oligo- or amenorrhoea; testosterone