Elevated anti-Mullerian hormone (AMH) and inhibin B levels in prepubertal girls with type 1 diabetes mellitus

Objective Elevated anti-Mullerian hormone (AMH) and adrenal androgen levels have been observed during childhood in girls at risk of developing polycystic ovarian syndrome (PCOS). The aim of this study was to evaluate ovarian function and adrenal steroid levels in prepubertal girls with type 1 diabetes mellitus (T1D). Design Cross-sectional study. Patients/Measurements We evaluated hormonal and ultrasonographic characteristics in girls with T1D (N = 73) and compared them to characteristics found in a control group of healthy girls (N = 86). Data are reported as geometric means (95% CI). Results Prepubertal girls with T1D had higher levels of AMH (29.1 pmol/l (23.2-36.3) vs 20.9 pmol/l (16.6-26.1), P = 0.038), inhibin B (arithmetic mean: 16 7 pg/ml (11.6-21.7) vs 11.7 pg/ml (10.0-13.5), P = 0.044) and dehydroepiandrosterone sulphate (DHEAS) (0.3 nmol/l (0.2-0.6) vs 0.2 nmol/l (0.1-0.3)) than controls (P = 0.045). During puberty, decreasing AMH levels were observed in girls with T1D only (P < 0.0001). Girls with T1D in Tanner stages 4-5 had lower AMH levels than their paired healthy controls (10.1 pmol/l (7.4-13.9) vs 15.7 pmol/l (11.6-21.3), respectively, P = 0.047). Conclusions Our observations indicate that prepubertal girls with T1D may exhibit similar endocrine findings to those of other girls at risk of developing PCOS. The elevated levels of AMH and inhibin B suggest that higher numbers of follicles are present in the ovary during childhood in these patients and that insulin treatment may act as a local growth factor. In addition, AMH levels differed in prepubertal and pubertal girls, suggesting that the effect of T1D on ovarian folliculogenesis changes once gonadotrophin levels rise during puberty.