The ovarian markers of the FSH insufficiency in functional hypothalamic amenorrhoea
The ovarian markers of the FSH insufficiency in functional hypothalamic amenorrhoea
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DOI：
10.1093/humrep/deh560
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发表时间：
2005-01-01
影响因子：
6.1
通讯作者：
Dewailly, D
中科院分区：
文献类型：
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作者：
Jonard, S;Pigny, P;Dewailly, D
背景：本研究的目的是利用相关的卵巢标记物重新探讨功能性下丘脑闭经(FHA)的促性腺激素不足。方法：对31例FHA患者和30例卵泡早期健康妇女进行血清抗苗勒氏激素(AMH)、雌二醇(E-2)、抑制素B、黄体生成素(LH)和卵泡刺激素(FSH)免疫检测。在采血当天，用超声实时测定2~5 mm和6~9 mm两个不同直径范围内的卵巢腔卵泡数(FN)。结果：两组间2~5 mm Fn相近，而6~9 mm Fn明显低于对照组，与血清FSH水平降低有关(r=0.428；P<；0.024)。9例(29%)FHA患者基础血清FSH水平较低(P<0.05)，为对照组的5个百分位数。在FSH明显正常的22例(71%)患者中，FN平均为6-9 mm，与对照组相似。然而，在这个亚组中，AMH血清平均水平和AMH：2-5 mM FN比值显著高于对照组，而平均抑制素B水平显著低于对照组。血清黄体生成素水平与FN、AMH、抑制素B值无明显相关性。结论：只有少数FHA患者血清基础FSH水平较低，我们认为这与卵巢水平上6-9 mm卵泡的减少有关。尽管大多数FHA患者血清FSH水平正常，FN为6-9 mm，但功能性卵泡标志物均异常。这表明FSH对卵巢的作用是不完整的，并且不能正确地反映其血清水平和超声下的FN。
BACKGROUND: The purpose of this work was to revisit the gonadotrophin insufficiency of functional hypothalamic amenorrhoea (FHA) with the use of relevant ovarian markers. METHODS: Serum anti-Mullerian hormone (AMH), estradiol (E-2), inhibin B, LH and FSH were immunoassayed in 31 women with FHA and in 30 healthy women in early follicular phase. The ovarian antral follicle number (FN) was determined within two distinct diameter ranges (2-5 and 6-9mm) by ultrasound in real time, the same day as the blood sampling. RESULTS: The 2-5mm FN was similar between the two groups, while the 6-9mm FN was significantly less in FHA than in controls, in relation with lower serum FSH levels (r = 0.428; P < 0.024). Nine (29%) FHA patients had a low serum basal FSH level (i.e. < 4.51IU/l, 5th percentile of control values). In the 22 (71%) patients with apparently normal FSH, the mean 6-9mm FN was similar to controls. However, in this sub-group, the mean AMH serum level and the AMH:2-5mm FN ratio were significantly higher and the mean inhibin B serum level was significantly lower than in controls. No significant relationship was found between the serum LH levels and the FN, AMH or inhibin B values. CONCLUSION: Only a minority of patients with FHA have a low serum basal FSH level, and we show that this is associated with fewer 6-9mm follicles at the ovarian level. Despite a normal serum FSH level and 6-9mm FN in the majority of patients with FHA, the functional follicle markers are abnormal. This suggests that the FSH action on the ovary is incomplete and is not properly reflected by its serum level nor by FN at ultrasound.