Antimullerian hormone in patients with hypogonadotropic hypogonadism

Antimullerian hormone (AMH) is produced by immature Sertoli cells until pubertal maturation. At puberty, elevation of serum testosterone correlates with a decrease in serum AMH. To further investigate the hormonal control of AMH secretion, serum AMH levels were measured in 20 normal men (20-60 yr) in 12 patients (19-30 yr) with congenital hypogonadotropic hypogonadism (CHH), and in 18 patients (19-65 yr) with acquired hypogonadotropic hypogonadism (AHH) either untreated or during testosterone or human chorionic gonadotropin (hCG) therapy. Mean serum AMH levels in normal adult men were low (20 +/- 4.9 pmol/L). In untreated CHH patients, mean serum AMH levels were significantly higher than in normal men (292 +/- 86 pmol/L, P < 0.001) and were similar to those previously reported in prepubertal boys. In men with AHH, mean serum AMH levels were also significantly increased (107 +/- 50 pmol/L; P < 0.01) when compared with healthy men but were less than in men with CHH. In addition, in 10 patients treated for prostate cancer, a modest but significant increase of serum AMH (from 11.4 +/- 5.7 pmol/L to 49 +/- 9.9 pmol/L; P < 0.01)was observed 12 months after suppression of the gonadal axis with the GnRH agonist Triptorelin (3.75 mg IM once a month). Plasma testosterone (T) and serum AMH levels were measured at baseline and at 3 and 6 months in 10 HH patients (6 CHH and 4 AHH) treated with bCG (1500 IU/twice weekly for 6 months) and in 8 HH (4 CHH and 4 AHH) patients treated with T (T enanthate 250 mg/3 weeks for 6 months). hCG treatment induced an increase of plasma T (from 1.0 +/- 0.7 to 11 +/- 2.4 and 19 +/- 4.8 nmol/L, at 3 and 6 months respectively) associated with a dramatic decrease of serum AMH (from 314 +/- 93 to 56 +/- 30 and 17 +/- 4,3 pmol/L). The similar increase in plasma T levels (from 1.4 +/- 1.0 to 15.6 +/- 4.2 and 23 +/- 6.2 ng/mL) obtained with exogenous T induced a lesser decrease of serum AMH (from 221 +/- 107 pmol/L to 114 +/- 50 and 66 +/- 17 pmol/L, at 3 and 6 months respectively). In conclusion, high plasma AMH levels in CHH patients are related to the absence of pubertal maturation of Sertoli cells. The high AMH levels in AHH and its increase after Triptorelin-induced gonadotropin deficiency suggest that the suppression of AMH is a reversible phenomenon. Finally, the inhibition of AMH production by Sertoli cells is induced by intratesticular T.