Nursel MURATOĞLU ŞAHİN, Hatice NURSUN ÖZCAN, Aslıhan ARASLI YILMAZ, Semra ÇETİNKAYA, Şenay ERDEVE, Koza MURAT, Zehra AYCAN

Puberte prekokslu kızlarda ant -Müller an hormon(AMH) düzey n n fol kül sayısı ve büyüklügü le l sk s

Amaç: Yetişkinlerde AMH ile antral folikül sayısı arasında pozitif korelasyon vardır. Peripubertal sağlıklı kızlarda da AMH iletoplam folikül sayısı ve folikül büyüklüğü arasında ilişki saptanmıştır. Çalışmamızda; santral puberte prekoks (SPP) tanısıalmış kızlarda AMH düzeyi ile folikül sayı ve büyüklüğünün ilişkisi araştırıldı.Gereç ve Yöntemler: Santral puberte prekoks tanılı 32 kız olgu çalışmaya alındı. Hastalardan AMH için kan örneği alınarakpelvik ultrasonografi ile overde folikül sayımı yapıldı. Foliküller büyüklüklerine göre; küçük (1-4,4 mm), orta (4,5-9,4 mm)ve büyük (≥9,5mm) olarak sınıflandırıldı. Hastalar puberte evrelerine ve antral folikül sayısına göre gruplandırıldı.Bulgular: Hastaların AMH düzeyi ile küçük, orta, büyük folikül sayısı, küçük/orta folikül oranı, en büyük folikül boyutu vetoplam folikül sayısı arasında anlamlı bir ilişki saptanmadı (p > 0,05). Hastalar meme evrelerine göre sınıflandırıldığında dagrupların AMH düzeyleri, küçük, orta ve büyük folikül sayısı, küçük/orta folikül oranı, en büyük folikül boyutu ve toplamfolikül sayısı farklı değildi (p>0,05). Birden fazla antral folikülü olanların AMH düzeyi [median:0,23 ng/ml, (0,06-0,56)], enfazla bir antral folikülü olanların AMH düzeyinden [median:0,17ng/ml (0,05-0,48)] anlamlı olarak daha yüksekti (p:0,035).Sonuç: Puberte prekokslu kızlarda AMH düzeyi ile folikül sayı ve boyutu arasındaki ilişkinin ilk defa incelendiğiçalışmamızda; AMH düzeyi ile over hacmi, folikül sayı ve büyüklüğü arasında anlamlı bir ilişki saptanamamış olmasıhastalarımızın erken pubertal evrede olmasından kaynaklanıyor olabilir. Bununla birlikte; puberte prekoksta folikülgelişim paterninin normal puberteden farklı olabileceği ya da folikül sayısı dışında AMH’ya etkili başka faktörlerin deolabileceği ihtimali de dışlanamaz.

The relationship between size and number of over follicles and anti- Müllerian hormone (AMH) levels in girls with precocious puberty

Aim: AMH has a positive correlation with antral follicles number in adults. It has been proved that there is a relation between AMH and size and number of follicles in girls with healthy puberty. In this study the relationship between AMH levels and number and size of follicles in girls with central precocious puberty (SPP) diagnosis was investigated. Material and Methods: 32 girls with SPP diagnosis were included in the study. Blood samples from the patients for AMH assay and the number of follicles was counted by by pelvic ultrasonography. The follicles were classified according to their size: small (1-4,4 mm), medium (4,5-9,4 mm) and large (≥9,5mm). Results: No significant correlation was recorded between AMH level and the largest follicle size, total number of follicles and small, medium and large follicles count, and small/medium follicle ratio (p>0,05). The AMH level and follicles number and size were not different according to breast stages (p>0,05). The AMH level of patients with more than one antral follicles [median:0,23 ng/ml, (0,06-0,56)] was significantly higher than the AMH level of patents with maximum one antral follicle [median:0,17ng/ml (0,05-0,48)] (p:0,035). Conclusion: In our study, which researched the relation between AMH level and follicles size and number for the first time, a significant relationship between AMH level and ovarian volume, size and number of follicle was not recorded and this could result from patients being in early pubertal stage. Furthermore the possibility of the difference development pattern between of precocious puberty and normal puberty, and factors other than follicles count affecting AMH level must be considered.

PDF

___

1. Peters H. The human ovary in childhood and early maturity. Eur J Obstet Gynecol Reprod Biol 1979; 9: 137-40.
2. Kraus FT, Neubecker RD. Luteinization of the ovarian theca in infants and children. Am J Clin Pathol 1962; 37: 389-97.
3. Peters H, Byskov AG, Grinsted J. Follicular growth in fetal and prepubertal ovaries of humans and other primates. Clin Endocrinol Metab 1978; 7: 469-85.
4. Bridges NA, Cooke A, Healy MJ, Hindmarsh PC, Brook CG. Standards for ovarian volume in childhood and puberty. Fertil Steril 1993; 60: 456-60.
5. Ross GT. Gonadotropins and preantral follicular maturation in women. Fertil Steril 1974; 25: 522-43.
6. McGee EA, Smith R, Spears N, Nachtigal MW, Ingraham H, Hsueh AJ. Müllerian inhibitory substance induces growth of rat preantral ovarian follicles. Biology of Reproduction 2001; 64: 293–98.
7. Merke DP, Cutler GB Jr. Evaluation and management of precocious puberty. Arch Dis Child 1996; 75: 269-71.
8. Lee MM, Donahoe PK, Hasegawa T et al. Müllerian inhibiting substance in humans: normal levels from infancy to adulthood Journal of Clinical Endocrinology and Metabolism 1996; 81: 571–76.
9. Durlinger AL, Visser JA, Themmen AP. Regulation of ovarian function: the role of anti-Müllerian hormone. Reproduction 2002; 124: 601-9.
10. Durlinger AL, Gruijters MJ, Kramer P et al. Anti-Mullerian hormone inhibits initiation of primordial follicle growth in the mouse ovary. Endocrinology 2002; 143: 1076–84.
11. Visser JA, Themmen AP. Anti-Mullerian hormone and folliculogenesis. Mol Cell Endocrinol 2005; 234: 81–86.
12. Hagen CP, Aksglaede L, Sørensen K et al. Individual serum levels of anti-Müllerian hormone in healthy girls persist through childhood and adolescence: a longitudinal cohort study. Hum Reprod 2012; 27: 861–66.
13. Sahin NM, Kinik ST, Tekindal MA, Bayraktar N. AMH levels at central precocious puberty and premature thelarche: is it a parameter? J Pediatr Endocrinol Metab 2015; 28: 1351-56.
14. de Vet A, Laven JS, de Jong FH, Themmen AP, Fauser BC. Anti- Müllerian hormone serum levels: a putative marker for ovarian aging. Fertility and Sterility 2002; 77: 357–62.
15. Kaya C, Pabuccu R, Satiroglu H. Serum antimüllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle are predictive of the fertilization, implantation, and pregnancy in polycystic ovary syndrome patients undergoing assisted reproduction. Fertil Steril 2010; 94: 2202-2207.
16. Scheffer GJ, Broekmans FJ, Dorland M, Habbema JD, Looman CW, te Velde ER. Antral follicle counts by transvaginal ultrasonography are related to age in women with proven natural fertility. Fertil Steril 1999; 72: 845–51.
17. Hagen CP, Mouritsen A, Mieritz MG et al. Circulating AMH reflects ovarian morphology by magnetic resonance imaging and 3D ultrasound in 121 healthy girls. J Clin Endocrinol Metab 2015; 100: 880-90.
18. Resende EA, Lara BH, Reis JD, Ferreira BP, Pereira GA, Borges MF. Assessment of basal and gonadotropin-releasing hormonestimulated gonadotropins by immunochemiluminometric and immunofluorometric assays in normal children. J Clin Endocrinol Metab 2007; 92: 1424–29
19. Jayaprakasan K, Deb S, Batcha M, Hopkisson J, Johnson I, Campbell B, Raine-Fenning N. The cohort of antral follicles measuring 2–6 mm reflects the quantitative status of ovarian reserve as assessed by serum levels of anti-Müllerian hormone and response to controlled ovarian stimulation. Fertil Steril 2010; 94: 1775–81.
20. Alebic MŠ, Stojanovic N, Dewailly D. Discordance between serum anti-Müllerian hormone concentrations and antral follicle counts: not only technical issues. Hum Reprod 2018; 33: 1141-48.
21. Chen T, Wu H, Xie R, Wang F, Chen X, Sun H, Chen L. Serum AntiMüllerian Hormone and Inhibin B as Potential Markers for Progressive Central Precocious Puberty in Girls. J Pediatr Adolesc Gynecol 2017; 30: 362-66.