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Progressive decline of residual follicle pool after clinical diagnosis of autoimmune ovarian insufficiency
Author(s) -
Falorni Alberto,
Brozzetti Annalisa,
Aglietti Maria Chiara,
Esposito Raffaella,
Minarelli Viviana,
Morelli Silvia,
Sbroma Tomaro Emilia,
Marzotti Stefania
Publication year - 2012
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2012.04387.x
Subject(s) - autoantibody , medicine , anti müllerian hormone , follicular phase , follicle stimulating hormone , endocrinology , hormone , immunology , antibody , luteinizing hormone
Summary Context In approximately 5–8% patients with primary ovarian insufficiency ( POI ), the disease is caused by an autoimmune process made evident by the appearance of autoantibodies against steroidogenic enzymes ( SCA ‐ POI ). Anti‐müllerian hormone ( AMH ) is the best marker of the residual follicular pool. Objective To evaluate the rate of loss of the residual follicle pool in women with SCA ‐ POI after clinical diagnosis. Design and methods One hundred and thirty‐two women with POI were tested for 21‐hydroxylase autoantibodies, 17α‐hydroxylase autoantibodies and P450scc autoantibodies, and 35 patients with SCA ‐ POI were identified. AMH was analysed at the time of the first visit in all women with POI , and in follow‐up, serum samples were taken 1–3 years after in 11 women with SCA ‐ POI and detectable AMH . Results 12/35 (35%) women with SCA ‐ POI had AMH levels within the normal range at the time of first sampling, as compared to 6/97 (6%) with idiopathic POI ( P < 0·001). 11/17 (65%) women with SCA ‐ POI with <6 years disease duration had normal serum AMH concentration. A progressive decline in AMH concentration was observed at longitudinal follow‐up in all 11 AMH ‐positive women with SCA ‐ POI , at an estimated average rate of 1·6 μg/l AMH /year (corresponding to an average 57% of preserved follicle pool/previous year) ( R 2 = 0·219, P = 0·028). After 6 years of disease duration, only 1/18 (6%) women with SCA ‐ POI had detectable levels of AMH , similar to women with idiopathic POI (5/78, 6%). Conclusion Most women with SCA ‐ POI present at clinical diagnosis with a preserved follicle pool that is progressively lost within a few years.