Anti-mullerian hormone (AMH) of >5.1 ng/mL may be an effective diagnostic marker for polycystic ovarian syndrome (PCOS) and a surrogate marker for hyperandrogenemia and polycystic ovarian morphology (PCOM) in women with acne, a study in Dermatologic Therapy suggests.
The study included 120 women aged ≥25 years who presented with acne to a dermatology outpatient department at a tertiary care hospital in India from November 2017 to March 2019. A total of 31 women had PCOS at presentation, whereas 89 women did not have PCOS.
Investigators assessed patients’ levels of total testosterone (TT), sex hormone binding globulin (SHBG), free androgen index (FAI), AMH, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), and luteinizing hormone (LH). The researchers also compared levels of AMH in patients with vs without PCOS to establish a diagnostic cut-off value of the hormone for PCOS.
Women with PCOS were significantly younger at presentation (mean age, 27.74±4.86 vs 30.43±4.95 years; P =.01) and had a younger age at acne onset (mean age, 23.06±7.08 vs 26.61±6.42 years; P =.001). In addition, women with PCOS more often had truncal acne (61.3% vs 23.6%; P =.0001), a past adolescent acne history (54.8% vs 32.6%; P =.028), menstrual irregularity (64.5% vs 12.4%; P <.0001), hirsutism (67.7% vs 30.3%; P =.0003), hyperseborrhea (77.4% vs 40.5%; P =.0004), and androgenetic alopecia (74.2% vs 50.6%; P =.022).
Overall, the mean AMH was 4.13±3.26 ng/mL. Women with PCOS had a significantly higher level of AMH compared with women without PCOS (mean, 6.91±3.85 vs 3.16±2.37 ng/mL, respectively; P .0001). Levels of AMH correlated positively with levels of 17OHP (correlation coefficient, 0.197; P =.03), TT (correlation coefficient, 0.428; P <.0001), LH/FSH ratio (correlation coefficient, 0.411; P <.0001), FAI (correlation coefficient, 0.29; P =.0013), and LH (correlation coefficient, 0.318; P =.0004) in the overall sample and significantly correlated with levels of TT (correlation coefficient, 0.345; P =.0009), LH/FSH ratio (correlation coefficient, 0.327; P =.0018), and LH (correlation coefficient, 0.214; P =.0439) in patients without PCOS.
In a receiver operating characteristics (ROC) analysis for the diagnosis of PCOS, the area under the ROC curve for AMH produced 0.814 for a cut-off value of >5.1 ng/mL. This value featured a sensitivity of 71% and a specificity of 82% for the diagnosis of PCOS.
A limitation of this study was the strict inclusion of only adult patients with acne, all of whom were recruited from a single outpatient dermatology department.
The investigators noted that the observed association between AMH and “androgens in the overall study population suggests that PCOM is often missed on transabdominal ultrasound and reiterates the sensitivity of AMH in depicting hyperandrogenemia.”
Bansal P, Sardana K, Arora P, et al. A prospective study of anti-mullerian hormone and other ovarian and adrenal hormones in adult female acne [published online July 05, 2020]. Dermatol Ther. doi: 10.1111/dth.13974