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Antonio La Marca, Stefania Marzotti, Annalisa Brozzetti, Gaspare Stabile, Alfredo Carducci Artenisio, Vittorio Bini, Roberta Giordano, Annamaria De Bellis, Annibale Volpe, Alberto Falorni, on behalf of the Italian Addison Network, Primary Ovarian Insufficiency due to Steroidogenic Cell Autoimmunity Is Associated with a Preserved Pool of Functioning Follicles, The Journal of Clinical Endocrinology & Metabolism, Volume 94, Issue 10, 1 October 2009, Pages 3816–3823, https://doi.org/10.1210/jc.2009-0817
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Context: Primary ovarian insufficiency (POI) is defined as hypergonadotropic amenorrhea before the age of 40 yr. In 4–5% of patients with POI, an ovarian autoimmune process is present.
Design: Serum concentrations of antimüllerian hormone (AMH) have been determined in 26 women with POI due to steroidogenic cell autoimmunity (SCA-POI), 66 with nonautoimmune idiopathic POI (iPOI), 40 postmenopausal women (PMW), and 44 healthy fertile women (HW). SCA-POI was diagnosed according to presence of steroidogenic enzyme autoantibodies (17α-hydroxylase, side chain cleavage, and 21-hydroxylase autoantibodies).
Results: AMH concentrations were significantly higher in women with SCA-POI than women with iPOI (P = 0.018) or PMW (P = 0.03) but significantly lower than HW (P < 0.0001). AMH was detected in 11 of 26 women with SCA-POI (42%) and seven of 66 with iPOI (11%) (P = 0.002). Serum concentrations above the fifth percentile of the normal range (0.6 ng/ml) were detected in nine of 26 women with SCA-POI (35%) and four of 66 with iPOI (6%) (P = 0.001). Eight of 12 women with SCA-POI with less than 5 yr (67%) and one of 14 with longer disease duration (7%) had AMH concentrations within the normal range (P = 0.003). AMH concentrations correlated inversely with disease duration in women with SCA-POI (rho = −0.563, P = 0.003) but not women with iPOI. AMH correlated inversely with FSH serum concentrations in HW (rho = −0.584, P < 0.001) but not PMW or women with POI.
Conclusions: Two thirds of women with recent-onset SCA-POI had normal AMH concentrations. Women with SCA-POI, differently from those with iPOI, present a preserved ovarian follicle pool for several years after diagnosis of ovarian insufficiency.
Most women with autoimmune primary ovarian insufficiency (positive for 21-hydroxylase autoantibodies) have normal serum concentrations of anti-müllerian hormone, and a preserved pool of functioning follicles.
