Anti-Mullerian hormone and ovarian morphology in women with Hypothalamic Hypogonadism.

CONTEXT: Different phenotypical features of women with hypothalamic hypogonadism (HH), also known as WHO-1 anovulation, including ovarian morphology, have been scarcely described in large cohorts. Some studies have reported increased levels of Anti-Mullerian hormone (AMH) in women with HH. OBJECTIVE: To assess whether women with HH, compared to healthy controls, have increased serum levels of AMH and what proportion of these women erroneously meet the Rotterdam Criteria for Polycystic Ovarian Syndrome (PCOS). DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study in a Dutch academic medical center including 83 women with neither anovulation nor menstrual cycle disorders (healthy controls), 159 women with HH and 3640 women with PCOS. Age matching was used between the HH and PCOS group (1:2 ratio) to create a second group consisting of 318 age matched women with PCOS. INTERVENTION: None. MAIN OUTCOME MEASURES: AMH levels and ovarian morphology. RESULTS: Median AMH serum levels for the HH group were 3.8 (<0.1-19.8), compared to 7.5 (<0.1-81.0) in the PCOS group and 1.9 (<0.1-21.5) in the control group (p<0.001). In the HH group, 58 (36%) erroneously met the Rotterdam Criteria for PCOS (meeting 2 of 3 criteria). CONCLUSIONS: AMH levels are increased in women with HH. We hypothesize that this increase, whilst there was no increase in follicle count, may be explained by the presence of a relatively large pool of antral follicles smaller than 2 mm in diameter, that are undetectable by transvaginal ultrasound. This study highlights the importance of measuring gonadotropins and estradiol (E2) before diagnosing a patient with PCOS.