The role of antimullerian hormone in central precocious puberty (CCP) and premature thelarche (PT) in girls

The Role of Antimullerian Hormone in Central Precocious Puberty (CPP) and Premature Thelarche (PT) in Girls. Baskent University Medicine Faculty, Division of Pediatric Endocrinology, thesis of pediatric endocrinology, 2014. Objective: Although it is known that Antimullerian Hormone (AMH) is effective in initialization of folliculogenesis and selection of dominant follicle, the role of AMH in PT and CPP is not known. The aim of this study is investigating the level of AMH in girls with PT and CPP, and research the relationship between AMH level and PT and CPP. Material and Method: Total 65 girls, younger than 8 years old, who complaint with breast development but do not have organic pathology causing precocious puberty, acute or chronic disease or any drug usage history were taken as patient group. Additionally, control group was recruited from 25 prepubertal, 24 pubertal and 25 post menarche healthy girls. The AMH levels of patient and control groups were measured. Medical history and physical examination findings, bone age, pelvic USG, free T4, TSH, FSH, LH, estradiol levels of patients were recorded in their first visits. According to LHRH test results patients were divided to subgroups such as PT and CPP. After 4-6 months, AMH levels of the subgroups were measured. Results: The average AMH of CPP group is found to be significantly lower than the PT group, when peak LH response limit is taken as 4,2 and 3,3 mIU/mL in LHRH test (p:0,022 and p:0,028). AMH cut-off value is found to be 1,265 ng/ml with 67,9% sensitivity and 83,8% specifity when peak LH response limit is taken as 4,2 mIU/mL in LHRH test, but it is found to be 0,795 mg/dl with 96,8% sensitivity and 76,5% spesifity if the limit is taken as 3,3 mIU/mL (p:0,010, p:0,007). There is no significant difference determined between the average AMH of prepubertal, pubertal and post-menarche control groups, and moreover the average AMH level of prepubertal control group does not differ from patient group. In the patient group, AMH levels and mean, maximum and minimum ovarian volumes were significantly correlated (p:0.001, p:0.0001, p:0.008, respectively). Conclusion: herein we have shown that, the AMH level was decreasing during the pubertal HHG axis activation period. It was thought that, the finding of lower AMH in girls with early breast development migth be an impressive marker for the progressive clinic. AMH measurements migth be a usefull indicator in diagnosing and management of CPP. Key Words: Precocious Puberty, Premature Thelarche, AMH.