Peripubertal changes in circulating antimullerian hormone levels in girls

Capsule:
Rate of ovarian primordial follicle recruitment increases prepubertally then declines again following the onset of puberty, while ovarian follicle activity continues to increase. These changes seem to track with the age of menarche.

Authors:
Hany Lashen, F.R.C.O.G., David B. Dunger, M.D., Andy Ness, Ph.D., Ken K. Ong, Ph.D.

Volume 99, Issue 7, Pages 2071-2075, June 2013

Abstract:

Objective:
To identify correlates and longitudinal changes in circulating antimullerian hormone (AMH) levels as a marker of ovarian primordial follicle recruitment in normal peripubertal girls.

Design:
Observational study using mixed longitudinal and cross-sectional analyses.

Setting:
Not applicable.

Patients:
Unselected girls assessed at ages 7 to 11 years old.

Interventions:
None.

Main Outcome Measures:
AMH, inhibin B and FSH levels were analysed in blood samples collected at ages 7, 9 and 11 years for longitudinal analyses, and at age 8 years for cross-sectional analyses.

Results:
In the cross-sectional analysis, AMH levels at age 8 years were lower in pubertal girls (median 25.0 pmol/L, interquartile range [IQR] 16.0–33.9; n = 39) than in prepubertal girls (33.5 pmol/L, IQR 22.3–49.1; n = 342). In prepubertal girls, higher AMH levels were associated with higher inhibin B levels, lower FSH levels, and larger body mass index at age 8 years and subsequently with later age at menarche. AMH levels were unrelated to birth weight or birth length. In the longitudinal analysis, AMH levels increased between ages 7 (median 27.0 pmol/L, IQR 19.2–34) and 9 years (32.0 pmol/L, IQR 26.5–42.7), then declined between 9 and 11 years (26.5 pmol/L, IQR 19–42.25) with high intraindividual correlation in AMH levels between ages 7 and 9 years and 7 and 11 years.

Conclusions:
Measurement of circulating AMH and inhibin B levels suggests that the rate of ovarian primordial follicle recruitment increases in the pre-pubertal years then declines again following the onset of puberty as follicular activity pattern changes.

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