Serum levels of antimüllerian hormone in early maturing girls before, during, and after suppression with GnRH agonist

Capsule:
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.

Authors:
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

Abstract:

Objective:
To evaluate if serum AMH levels are affected in early maturing girls, and whether pituitary suppression by long-acting GnRH agonist (GnRHa) affects AMH.

Design:
Secondary analyses of a prospective clinical study.

Setting:
Tertiary pediatric center.

Patients:
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).

Interventions:
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.

Results:
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.

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