Should anti-Müllerian hormone be a diagnosis criterion for polycystic ovary syndrome? An in-depth review of pros and cons.

IF 5.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Emídio Vale-Fernandes, Duarte Pignatelli, Mariana P Monteiro
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引用次数: 0

Abstract

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology (PCOM). Despite the widespread use of the Rotterdam criteria, challenges in diagnostic accuracy persist. Anti-Müllerian hormone (AMH), a glycoprotein secreted by ovarian follicles, has emerged as a promising biomarker for refining diagnosis due to its strong correlation with follicular count and elevated levels in women with PCOS. This review critically evaluates the advantages and limitations of incorporating AMH into PCOS diagnostic criteria. Elevated AMH levels are indicative of PCOM and anovulation, offering a non-invasive diagnostic tool that minimizes interobserver variability in ultrasound-based assessments. Additionally, AMH remains stable throughout the menstrual cycle and aligns with phenotypic diversity in PCOS, potentially supporting individualized management strategies. However, significant challenges remain. Variability in AMH assay methods, the absence of comparable cut-off values, and influences of age, ethnicity, and obesity on AMH levels limit its universal applicability. Additionally, AMH cut-offs for PCOS diagnosis, ranging from 3.5 to 5 ng/mL, raises questions about its clinical relevance, as there is not clear evidence of its biological significance. The review also highlights AMH's clinical utility in reproductive medicine, particularly in predicting ovarian response to stimulation, tailoring gonadotropin dosages, and optimizing assisted reproductive technology outcomes. While AMH holds promise as a complementary diagnostic criterion for PCOS, its fully integration into clinical practice requires further validation through standardized assays, population-specific cut-offs, and robust studies to address existing limitations. In conclusion, AMH harbours the potential to enhance the specificity and sensitivity of PCOS diagnosis, particularly in dubious cases. However, the inclusion of AMH in the current criteria for diagnosing PCOS still requires addressing methodological challenges and balancing its benefits against inherent limitations.

勒氏激素应作为多囊卵巢综合征的诊断标准吗?对利弊的深入评论。
多囊卵巢综合征(PCOS)是一种常见的内分泌疾病,其特征是雄激素分泌过多、排卵功能障碍和多囊卵巢形态(PCOM)。尽管鹿特丹标准被广泛使用,但在诊断准确性方面仍然存在挑战。抗勒氏激素(AMH)是一种由卵巢卵泡分泌的糖蛋白,由于其与卵泡计数和PCOS患者水平升高有很强的相关性,已成为一种有希望用于精确诊断的生物标志物。这篇综述批判性地评估了将AMH纳入PCOS诊断标准的优点和局限性。AMH水平升高是PCOM和无排卵的指示,提供了一种无创诊断工具,可以最大限度地减少基于超声评估的观察者之间的差异。此外,AMH在整个月经周期保持稳定,并与PCOS的表型多样性一致,可能支持个体化管理策略。然而,重大挑战依然存在。AMH检测方法的可变性、缺乏可比较的临界值以及年龄、种族和肥胖对AMH水平的影响限制了其普遍适用性。此外,多囊卵巢综合征诊断的AMH临界值范围为3.5至5 ng/mL,这引起了对其临床相关性的质疑,因为没有明确的证据表明其生物学意义。该综述还强调了AMH在生殖医学中的临床应用,特别是在预测卵巢对刺激的反应、调整促性腺激素剂量和优化辅助生殖技术(ART)结果方面。虽然AMH有望成为多囊卵巢综合征的补充诊断标准,但其完全融入临床实践需要通过标准化分析、人群特异性切断和强有力的研究来进一步验证,以解决现有的局限性。总之,AMH有可能提高PCOS诊断的特异性和敏感性,特别是在可疑病例中。然而,将AMH纳入目前的多囊卵巢综合征诊断标准仍然需要解决方法上的挑战,并平衡其益处与固有局限性。
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来源期刊
European Journal of Endocrinology
European Journal of Endocrinology 医学-内分泌学与代谢
CiteScore
9.80
自引率
3.40%
发文量
354
审稿时长
1 months
期刊介绍: European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.
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