Anti-Müllerian hormone
| Anti-Müllerian hormone | ||
|---|---|---|
| Properties of human protein | ||
| Mass / length primary structure | 535 amino acids | |
| Secondary to quaternary structure | Homodimer | |
| Identifier | ||
| Gene names | AMH ; MIS | |
| External IDs | ||
| Occurrence | ||
| Homology family | Muellerian inhibiting factor | |
| Parent taxon | Amniotes | |
The anti- Müllerian hormone (AMH), English anti-Müllerian hormone (AMH) is a proteohormone or glycoprotein that plays a role in sexual differentiation during embryonic development . Mutations in AMH - gene are for the course Persistenzsyndrom Müller responsible.
The name is reminiscent of Johannes Peter Müller , who described the Müller courses. In the English-language literature, the AMH is also called Müllerian inhibiting hormone (MIH), Müllerian inhibiting factor (MIF) and Müllerian inhibiting substance (MIS).
function
The anti-Müllerian hormone consists of 535 amino acids and is produced in the Sertoli cells of the embryonic testicle . It causes the regression of the Müller ducts up to the 8th week of embryogenesis , so that they only remain as so-called testicular appendages ( appendix testis ) between the epididymis and testes.
AMH belongs to the inhibin into the family of transforming growth factors (TGF), and there in the subgroup of the TGF-β and is very early detected in the differentiation phase of the testicles. The maximum concentration is measured during the regression of the Müllerian corridors.
Since no AMH is formed in female fetuses, the uterus , fallopian tubes and vaginal vault can develop in these from the Müller ducts .
In sexually mature women, AMH is produced in the granulosa cells of growing follicles in the ovary . There is a direct relationship between the AMH level and the number of egg cells that can mature.
Clinical significance
In Müllerian gang persistence syndrome , a man who has otherwise normal internal and external genitalia remains Müllerian ganglion due to a structural abnormality or a lack of AMH or its receptor . With the onset of puberty , the amount of AMH produced is greatly reduced, as the increased testosterone produced now inhibits the gene expression of the anti- Müllerian hormone.
Variations in the anti-Müllerian hormone gene - which is located on chromosome 19 - are possibly the cause of the development of Mayer-Rokitansky-Küster-Hauser syndrome .
The anti-Müllerian hormone can be used for fertility diagnostics. It correlates with the functioning of the ovaries. It is the marker that correlates earliest with age, has the smallest variability within and between the cycles and can thus be determined at any point in time. Values above 6.95 ng / ml pose a high risk of developing ovarian hyperstimulation syndrome . With increasing age, the AMH level in women falls in line with the loss of ovarian functional reserve. A decrease in AMH can be seen before a clear increase in FSH .
In bitches, the anti-Müllerian hormone can be used to detect incomplete castration .
Normal range
Between the ages of 18 and 30, the AMH concentration hardly changes in women. After the age of 30, however, the serum level falls steadily to levels that can no longer be measured during the menopause . Values> 1 µg / l indicate adequate residual ovarian function.
- Women in the fertile phase of life: 1–10 µg / l
- Restricted ovarian function: 0.4–1.0 µg / l
- Menopause: <0.4 µg / l
- adult men: 1.5–4.3 µg / l
Decreased values are found with restricted ovarian functional reserve and poor response to ovarian stimulation . Patients with low AMH levels require higher doses of FSH for ovarian stimulation than women with high / normal levels.
Elevated values are an indication of PCO syndrome. During therapy with metformin , the AMH levels decrease in the long term. The AMH level in the blood and in the follicular fluid can be used as a predictor of the therapeutic success of an off-label metformin therapy.
Litigation
The Hamm Higher Regional Court had to decide a case in which a woman with an AMH value of 0.1, after an informative discussion with her gynecologist, in which she pointed out the limited informative value of this value, stopped taking the birth control pill and subsequently became pregnant unintentionally. The woman sued the doctor for malpractice for pain and suffering in the amount of 50,000 euros and compensation for maintenance damages up to the age of the child. The lawsuit was dismissed in the first and second instance because, in the opinion of the courts, the doctor had given the patient sufficient information. The judgment is not yet final, the plaintiff has lodged a non-admission complaint with the Federal Court of Justice .
literature
- N. Josso, C. Belville, N. di Clemente, JY Picard: AMH and AMH receptor defects in persistent Müllerian duct syndrome. In: Hum Reprod Update. 11 (4), Jul-Aug 2005, pp. 351-356. Epub 2005 May 5th Review. PMID 15878900
- R. Rey: Anti-Müllerian hormone in disorders of sex determination and differentiation. In: Arq Bras Endocrinol Metabol. 49 (1), Feb 2005, pp. 26-36. Review. PMID 16544032
- A. de Vet et al .: Antimüllerian hormone serum levels: a putative marker for ovarian aging. In: Fertil Steril. 77, 2002, pp. 357-362.
- A. La Marca et al .: Serum anti-Mullerian hormone throughout the human menstrual cycle. In: Hum Reprod. 21, 2006, pp. 3103-3107.
- T. Piltonen et al .: Serum anti-Mullerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. In: Hum Reprod. 20, 2005, pp. 1820-1826.
Web links
- Anti-Müllerian hormone. In: Online Mendelian Inheritance in Man . (English)
Individual evidence
- ↑ M. Aghssa, M. Abbasi: Optimal cutoff value of basal anti-mullerian hormone in iranian infertile women for prediction of ovarian hyper-stimulation syndrome and poor response to stimulation. In: Reproductive Health 2015 Volume 12, Number 85, September 10, 2015, PMID 26357853 .
- ^ RL Ball et al .: Ovarian remnant syndrome in dogs and cats: 21 cases (2000-2007) . In: JAVMA Volume 236, 2010, pp. 548-553.
- ↑ A. Karkanaki, C. Vosnakis, D. Panidis: The clinical significance of anti-Müllerian hormone evaluation in gynecological endocrinology. In: Hormones (Athens). Volume 10, Number 2, April-June 2011, pp. 95-103. PMID 21724534 .
- ↑ BO Saleh, WF Ibraheem, NS Ameen: The role of anti-Mullerian hormone and inhibin B in the assessment of metformin therapy in women with polycystic ovarian syndrome. In: Saudi Med J. Volume 36, Number 5, May 2015, pp. 562-567. PMID 25935176 .
- ↑ BO Saleh, WF Ibraheem, NS Ameen: Anti-Műllerian hormone - a prognostic marker for metformin therapy efficiency in the treatment of women with infertility and polycystic ovary syndrome. In: J Med Life. Volume 5, Number 4, December 2012, pp. 462-464. PMID 23346251 .
- ↑ Judgment 26 U 91/17 of February 23, 2018 of the OLG Hamm on the website of the OLG Hamm, accessed on June 23, 2018 ( memento of the original of June 23, 2018 in the Internet Archive ) Info: The archive link was automatically inserted and still Not checked. Please check the original and archive link according to the instructions and then remove this notice.
