Serum levels of antimüllerian hormone in early maturing girls before, during, and after suppression with GnRH agonist
Circulating AMH declined significantly after gonadal suppression with long-acting GnRH agonist, and AMH recovered to pretreatment levels after discontinuation of GnRH agonist. This is an indication of partial gonadotropin-dependence of AMH.
Casper P. Hagen, M.D., Kaspar Sørensen, M.D., Ph.D., Richard A. Anderson, M.D., Ph.D., Anders Juul, M.D., Ph.D., D.M.Sc.
Volume 98, Issue 5, Pages 1326-1330, November 2012
To evaluate if serum AMH levels are affected in early maturing girls, and whether pituitary suppression by long-acting GnRH agonist (GnRHa) affects AMH.
Secondary analyses of a prospective clinical study.
Tertiary pediatric center.
Fifteen girls followed during GnRHa treatment. Evaluations before, 3 and 12 months after initiation, as well as 6 months after discontinuation of treatment. To evaluate if AMH levels were affected in early maturing girls, baseline levels were compared with levels in healthy girls (matched for age: n=129, matched for pubertal Tanner stage: n=119).
Patients were treated with SC injections of leuprolide acetate (LA; Procren 3.75 mg every 28th day).
Main outcome measures:
Basal serum levels of AMH, estradiol, inhibin B, FSH and LH, as well as GnRH stimulated levels of FSH and LH.
At baseline, the median (range) of AMH levels in the patients was 20.3 (2.0–30.0) pmol/L. After three months of GnRHa treatment, AMH declined to 10.4 (<2.0–27.0) pmol/L vs. pre-treatment levels, p=0.007. AMH suppression was maintained after 12 months of treatment; 14.4 (<2.0 –29.6) pmol/L vs. pretreatment levels, p=0.007. Six months after discontinuation of GnRHa treatment, AMH were similar to pretreatment levels, at 18.8 (5.8–46.9) vs. 20.3 (2.0–30.0) pmol/L, p=0.508. Prior to treatment, AMH levels in early maturing girls did not differ significantly from AMH in healthy age-matched girls (median 20 vs. 23 pmol/L, p=0.058) or Tanner-matched girls (20 vs. 19 pmol/L, p=0.335). Conclusion:
The partial suppression of AMH by GnRHa treatment is consistent with previous studies suggesting partial gonadotropin-dependence of AMH.