Codner Ethel, Iñíguez Germán, Villarroel Claudio, Lopez Patricia, Soto Néstor, Sir-Petermann Teresa, Cassorla Fernando, Rey Rodolfo A
Institute of Maternal and Child Research, School of Medicine, University of Chile, Casilla 226-3, Santiago, Chile.
J Clin Endocrinol Metab. 2007 Dec;92(12):4742-6. doi: 10.1210/jc.2007-1252. Epub 2007 Sep 25.
Anti-Müllerian hormone (AMH) levels are increased in polycystic ovarian syndrome (PCOS), but it is not known whether other forms of hyperandrogenism, such as PCOS observed in women with type 1 diabetes mellitus (DM1), are also associated with elevated AMH levels.
Our objective was to compare AMH and steroid levels in women with PCOS with and without DM1.
We compared the clinical, hormonal, and ultrasonographic characteristics of 17 women with PCOS and DM1 (DM1+PCOS), 20 women with PCOS without DM1 (PCOS), and 35 normal women (control) in a cross-sectional study.
The Ferriman-Gallwey score, serum testosterone, free androgen index, 17OH-progesterone, and ovarian volume were elevated in both groups of PCOS women compared with controls. Serum androstenedione, LH/FSH ratio, and follicle number, however, were higher and SHBG was lower in PCOS compared with DM1+PCOS and controls. AMH levels were higher in PCOS (76.0 +/- 36.3 pmol/liter) than in DM1+PCOS (18.8 +/- 7.4 pmol/liter) and controls (13.9 +/- 8.3 pmol/liter). AMH levels correlated with follicle number in the three groups. Serum AMH/follicle number ratio was higher in PCOS than in DM1+PCOS and controls.
Women with DM1+PCOS have normal levels of AMH, inhibin B, estradiol, SHBG, and LH/FSH, suggesting that the pathophysiology of hyperandrogenism in PCOS patients with DM1 appears to be different from that in PCOS without DM1. However, hirsutism score and androgen levels were similar in both groups of women with PCOS. We postulate that insulin treatment acts as a co-gonadotropin increasing follicle recruitment, hence not increasing AMH levels.
多囊卵巢综合征（PCOS）患者的抗苗勒管激素（AMH）水平升高，但尚不清楚其他形式的高雄激素血症，如1型糖尿病（DM1）女性中观察到的PCOS，是否也与AMH水平升高有关。
我们的目的是比较合并或不合并DM1的PCOS女性的AMH和类固醇水平。
在一项横断面研究中，我们比较了17例合并DM1的PCOS女性（DM1+PCOS）、20例不合并DM1的PCOS女性（PCOS）和35例正常女性（对照组）的临床、激素和超声特征。
与对照组相比，两组PCOS女性的费里曼-盖尔韦评分、血清睾酮、游离雄激素指数、17-羟孕酮和卵巢体积均升高。然而，与DM1+PCOS组和对照组相比，PCOS组的血清雄烯二酮、LH/FSH比值和卵泡数量更高，而SHBG更低。PCOS组的AMH水平（76.0±36.3 pmol/升）高于DM1+PCOS组（18.8±7.4 pmol/升）和对照组（13.9±8.3 pmol/升）。三组中AMH水平均与卵泡数量相关。PCOS组的血清AMH/卵泡数量比值高于DM1+PCOS组和对照组。
合并DM1的PCOS女性的AMH、抑制素B、雌二醇、SHBG和LH/FSH水平正常，这表明合并DM1的PCOS患者高雄激素血症的病理生理学似乎与不合并DM1的PCOS患者不同。然而，两组PCOS女性的多毛评分和雄激素水平相似。我们推测胰岛素治疗起到了协同促性腺激素的作用，增加了卵泡募集，因此没有增加AMH水平。
